Neuropsychology Salary

[WisNeuro]

All I want are progress notes.

Then the ROI should work. Step 1, send the request to office staff with a reasonable time frame for turnaround. If you don;t get anything, Step 2 is to call and ask to speak with the therapist about the issue. If they refuse, just calmly say that you will need to refer the case to their board as well as the state dept of health due to violations of state and federal law. I've only ever had to resort to step 2 maybe twice in my entire career, and in those instances I have gotten the records that I have requested.

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[AcronymAllergy]

I'll admit that I worked in VA for a while, so getting notes from therapists was never an issue. But whenever I had to request outside records (e.g., from neuropsych exams done outside VA), I never ran into a problem. It's so odd that there are multiple therapists, and a neuropsychologist, who refuse to provide notes when provided an ROI (and, technically, I believe they could send notes even without an ROI if it relates to continuity of care; but always a good idea to have one, just in case). That just seems unethical and legally problematic.

But to be fair, I've also never really requested therapy notes from non-VA providers. I wonder if it's more rampant in my area than I realize.

 

[WisNeuro]

I'll admit that I worked in VA for a while, so getting notes from therapists was never an issue. But whenever I had to request outside records (e.g., from neuropsych exams done outside VA), I never ran into a problem. It's so odd that there are multiple therapists, and a neuropsychologist, who refuse to provide notes when provided an ROI (and, technically, I believe they could send notes even without an ROI if it relates to continuity of care; but always a good idea to have one, just in case). That just seems unethical and legally problematic.

But to be fair, I've also never really requested therapy notes from non-VA providers. I wonder if it's more rampant in my area than I realize.

We'd get records from outside evals not all that infrequently while I was still in the VA, never a problem in multiple states. I have to get records frequently now, and have also never had a problem getting them. I get notes with and without ROIs with little to no problem.

 

[AcronymAllergy]

We'd get records from outside evals not all that infrequently while I was still in the VA, never a problem in multiple states. I have to get records frequently now, and have also never had a problem getting them. I get notes with and without ROIs with little to no problem.

Good point. There were definitely external therapy records that I had access to, although much of the time, those were for folks who'd been referred out via the Choice program (or whatever it was called at the time). But I also never heard of problems from other providers related to getting any therapy notes when requested.

 

[PikminOC]

Then the ROI should work. Step 1, send the request to office staff with a reasonable time frame for turnaround. If you don;t get anything, Step 2 is to call and ask to speak with the therapist about the issue. If they refuse, just calmly say that you will need to refer the case to their board as well as the state dept of health due to violations of state and federal law. I've only ever had to resort to step 2 maybe twice in my entire career, and in those instances I have gotten the records that I have requested.

I've spoken to therapists, etc told them what you said and reported them to the board. They don't care as they know board won't do anything. I actually work in two states and both boards won't act.

 

[PikminOC]

Good point. There were definitely external therapy records that I had access to, although much of the time, those were for folks who'd been referred out via the Choice program (or whatever it was called at the time). But I also never heard of problems from other providers related to getting any therapy notes when requested.

Lots of psychiatrists don't even ask for notes. I am one who does and gives the state recommended 30 days to get them

 

[WisNeuro]

I've spoken to therapists, etc told them what you said and reported them to the board. They don't care as they know board won't do anything. I actually work in two states and both boards won't act.

Have you considered that there may be something about what you're doing, as no one else really has this problem?

 

[Ollie123]

Agree this seems really, really weird. Admittedly my volume was always super-low, but I've literally never heard of anyone flatly refusing to provide notes even with a release. Slow-moving yes. Sometimes incredibly so. It took me nearly 3 months to get an ER record from a local hospital, but there was never any question whether it was going to happen...just the timeline.

Things getting lost in the shuffle and needing multiple requests/contact attempts, also yes. Hospitals with dedicated offices for records requests usually fall somewhere between borderline incompetent and extremely incompetent when it comes to this. Joe blow private practitioner who gets a fax and writes it down a sticky notes he puts on his monitor....yeah. Actually refusing to provide them? That's just...strange.

Is there something about your practice setting that is particularly unique/contentious?

 

[PikminOC]

Have you considered that there may be something about what you're doing, as no one else really has this problem?

Wow. You are blaming me for this? You even say you don't believe me. I send the roi, and I follow up. What else do you really think I should have to do?

 

[PikminOC]

Agree this seems really, really weird. Admittedly my volume was always super-low, but I've literally never heard of anyone flatly refusing to provide notes even with a release. Slow-moving yes. Sometimes incredibly so. It took me nearly 3 months to get an ER record from a local hospital, but there was never any question whether it was going to happen...just the timeline.

Things getting lost in the shuffle and needing multiple requests/contact attempts, also yes. Hospitals with dedicated offices for records requests usually fall somewhere between borderline incompetent and extremely incompetent when it comes to this. Joe blow private practitioner who gets a fax and writes it down a sticky notes he puts on his monitor....yeah. Actually refusing to provide them? That's just...strange.

Is there something about your practice setting that is particularly unique/contentious?

It's contentious apparently because I ask for notes, follow up on the requests, and ask again for the notes. Private practice therapists are who I deal with and they really don't want to send the notes. I have the patient sign the therapists consents as well. One said she would send a summary and I should 150 for the time it takes her to write a summary.

The forced notes that I am able to get sometimes are completely cut pasted or very minimally documented.

The therapists who send me notes correctly that are good I refer my patients to.

 

[WisNeuro]

Wow. You are blaming me for this? You even say you don't believe me. I send the roi, and I follow up. What else do you really think I should have to do?

I'm saying that things are very weird in what you are telling us. Multiple people here, who have lived and worked in many different states, who routinely have to get records from other providers, are telling you that they have NEVER encountered the problem that you are telling us that you are having. Can you see why we think there may be something else going on here?

 

[Sanman]

It's contentious apparently because I ask for notes, follow up on the requests, and ask again for the notes. Private practice therapists are who I deal with and they really don't want to send the notes. I have the patient sign the therapists consents as well. One said she would send a summary and I should 150 for the time it takes her to write a summary.

The forced notes that I am able to get sometimes are completely cut pasted or very minimally documented.

The therapists who send me notes correctly that are good I refer my patients to.

Can you explain about the bolded further? Are these therapists that are currently seeing your patient or records requests for patients that are no longer being seen? If they are no longer being seen, I can see this being something blown off if they have paying clients to deal with instead. Certainly, there are plenty of solo practitioners with no/minimal office staff out there. Also, are there any medical records fees that patients are not willing to pay?

 

[AcronymAllergy]

Are these primarily older therapists? I know a lot of people freaked out when regulations started being passed that for EMRs, patients had to have ready access to their notes in those systems.

I wonder if it's just an "old guard" of therapists who are used to doing things how they want, views therapy as uniquely protected, may not see notes as especially helpful or necessary, and/or is defensive about what's actually in their notes. Or maybe they just don't like psychiatrists? Would be interesting to know if they send notes to other therapists when needed.

It's just so odd. I'm racking my brain to try to figure out what the rationale might be.

 

[Sanman]

Are these primarily older therapists? I know a lot of people freaked out when regulations started being passed that for EMRs, patients had to have ready access to their notes in those systems.

I wonder if it's just an "old guard" of therapists who are used to doing things how they want, views therapy as uniquely protected, may not see notes as especially helpful or necessary, and/or is defensive about what's actually in their notes. Or maybe they just don't like psychiatrists? Would be interesting to know if they send notes to other therapists when needed.

It's just so odd. I'm racking my brain to try to figure out what the rationale might be.

Also, are these fee for service/cash pay therapists or insurance-based?

 

[PikminOC]

Also, are these fee for service/cash pay therapists or insurance-based?

Insurance based

 

[PikminOC]

Can you explain about the bolded further? Are these therapists that are currently seeing your patient or records requests for patients that are no longer being seen? If they are no longer being seen, I can see this being something blown off if they have paying clients to deal with instead. Certainly, there are plenty of solo practitioners with no/minimal office staff out there. Also, are there any medical records fees that patients are not willing to pay?

Some are current, some are old patients of theirs. Shouldn't matter the rules are the same regarding record requests

 

[PikminOC]

I'm saying that things are very weird in what you are telling us. Multiple people here, who have lived and worked in many different states, who routinely have to get records from other providers, are telling you that they have NEVER encountered the problem that you are telling us that you are having. Can you see why we think there may be something else going on here?

This is unique to me with therapists only. I request records from physicians, ot, pt, speech pathology, etc and have no issues. I am a psychiatrist and run into this issue every week.

 

[PikminOC]

They have also confused or purposely confused process notes with progress notes and said I need a court order for the progress notes as well.

 

[PikminOC]

One of them I sent the consent to said the patient has to send them the consent themselves. It's all very annoying. Many therapists require witness signatures so that slows it down too.

 

[WisNeuro]

This is unique to me with therapists only. I request records from physicians, ot, pt, speech pathology, etc and have no issues. I am a psychiatrist and run into this issue every week.

You are reporting two things that are highly unusual for those of who do this often. One being that it is common for you to not get records after an ROI when this is an issue that mo one else seems to ever have encountered, especially after follow up contact. On top of that, you are stating that the state psych board has never acted on a complaint for this. This is one of the easiest and most actionable things that a state psych board can act on as it's a violation of state (in most places) and federal law. State boards act on this commonly. In fact, after multiple relationship stuff, the most common board actions are documentation and statute violations regarding records. Both of these things are so rare, that it's difficult to believe that one is true given what has been stated here, let alone both things in the same instance. Theoretically possible, sure, but extremely unlikely.

 

[PikminOC]

You are reporting two things that are highly unusual for those of who do this often. One being that it is common for you to not get records after an ROI when this is an issue that mo one else seems to ever have encountered, especially after follow up contact. On top of that, you are stating that the state psych board has never acted on a complaint for this. This is one of the easiest and most actionable things that a state psych board can act on as it's a violation of state (in most places) and federal law. State boards act on this commonly. In fact, after multiple relationship stuff, the most common board actions are documentation and statute violations regarding records. Both of these things are so rare, that it's difficult to believe that one is true given what has been stated here, let alone both things in the same instance. Theoretically possible, sure, but extremely unlikely.

Most therapists prefer to talk to me rather than send notes. That's not what my consent is for. I would be spending all day talking to therapists rather than seeing patients.

I have had therapists argue with the state board regarding these requirements. The board also has only a few people who know the law as there are many new workers since it's understaffed who just believe the therapist. I have contacted the directors and they don't follow up on it. I don't want to annoy the board so now I just don't report it.

 

[WisNeuro]

Most therapists prefer to talk to me rather than send notes. That's not what my consent is for. I would be spending all day talking to therapists rather than seeing patients.

I have had therapists argue with the state board regarding these requirements. The board also has only a few people who know the law as there are many new workers since it's understaffed who just believe the therapist. I have contacted the directors and they don't follow up on it. I don't want to annoy the board so now I just don't report it.

The state psych board has office staff, but they are not the ones who adjudicate the complaints. Licensed providers, along with the adjunct members of the board, do this, and they know the state and federal laws. They literally have to read and respond to complaints as per their own legal obligations and oversight by the state HHS/equivalent agency. The more you say, the more skeptical I get with this story.

 

[PikminOC]

The state psych board has office staff, but they are not the ones who adjudicate the complaints. Licensed providers, along with the adjunct members of the board, do this, and they know the state and federal laws. They literally have to read and respond to complaints as per their own legal obligations and oversight by the state HHS/equivalent agency. The more you say, the more skeptical I get with this story.

Makes sense that I would like right? The board hasn't gotten back to me on complaints from years ago.

 

[Sanman]

Makes sense that I would like right? The board hasn't gotten back to me on complaints from years ago.

This is not my area of expertise. However, is the board required to get back you? If you filed a complaint and it was adjudicated, it would simply be on the board's website in most states discussing the issue and the judgment. Not sure if they are required to call the complainant and discuss if nothing was found. I also imagine that the board would have a hard time if the complainant is not the patient. You say you sent a request, they say they never got it. Unless the patient showed up and requested the records in person and was refused, I don't see how this rises to the level of a board complaint.

 

[WisNeuro]

This is not my area of expertise. However, is the board required to get back you? If you filed a complaint and it was adjudicated, it would simply be on the board's website in most states discussing the issue and the judgment. Not sure if they are required to call the complainant and discuss if nothing was found. I also imagine that the board would have a hard time if the complainant is not the patient. You say you sent a request, they say they never got it. Unless the patient showed up and requested the records in person and was refused, I don't see how this rises to the level of a board complaint.

State psych boards and relevant state statutes spell out records keeping, documentation, and sharing of records. A complaint can be made for any rule violation, whether it be by a patient or another provider. Our state law explicitly states that another provider can report any Practice Act violation to the board, and actually lists out situations in which another provider is a mandated reporter for issues that need to be brought to the board.

 

[Sanman]

State psych boards and relevant state statutes spell out records keeping, documentation, and sharing of records. A complaint can be made for any rule violation, whether it be by a patient or another provider. Our state law explicitly states that another provider can report any Practice Act violation to the board, and actually lists out situations in which another provider is a mandated reporter for issues that need to be brought to the board.

Oh, I am aware that there are statutes and regs spelled out, but does the board get in touch with the complainant about the resolution of the complaint or simply post it publicly? Also, is there ever a time they deem something a nuisance complaint?

 

[PikminOC]

Oh, I am aware that there are statutes and regs spelled out, but does the board get in touch with the complainant about the resolution of the complaint or simply post it publicly? Also, is there ever a time they deem something a nuisance complaint?

They don't seem it a nuisance. A few times in the past they reached out to the therapist and got me the notes. They ascertained I got the notes asn then closed the complaint. They did have to threaten that therapist with further consequences of they didn't comply. After those, when I complained they ignored.

 

[PikminOC]

This is not my area of expertise. However, is the board required to get back you? If you filed a complaint and it was adjudicated, it would simply be on the board's website in most states discussing the issue and the judgment. Not sure if they are required to call the complainant and discuss if nothing was found. I also imagine that the board would have a hard time if the complainant is not the patient. You say you sent a request, they say they never got it. Unless the patient showed up and requested the records in person and was refused, I don't see how this rises to the level of a board complaint.

I show the board the copy of the consent that the patient signed with proof of when I sent it to the therapist with the therapist communication.

 

[WisNeuro]

Oh, I am aware that there are statutes and regs spelled out, but does the board get in touch with the complainant about the resolution of the complaint or simply post it publicly? Also, is there ever a time they deem something a nuisance complaint?

Our board does have to respond with the outcome of the complaint and their findings.

 

[AcronymAllergy]

If it's not already been done, I wonder if the best course of action going forward may just be to put it back on the therapists via pressure from the patients. Let the patients know you've requested the records and provided the ROI, and have called to follow-up, but the therapists have refused to send any notes/are not responding. Let the patients know they can request the records themselves and bring them to you if they so choose. I don't think I would have a problem throwing a problematic provider under the bus in that situation.

And I agree, even though it technically shouldn't, complaints from patients in this regard may carry more weight than from providers.

 

[Sanman]

They don't seem it a nuisance. A few times in the past they reached out to the therapist and got me the notes. They ascertained I got the notes asn then closed the complaint. They did have to threaten that therapist with further consequences of they didn't comply. After those, when I complained they ignored.

I show the board the copy of the consent that the patient signed with proof of when I sent it to the therapist with the therapist communication.

Our board does have to respond with the outcome of the complaint and their findings.

This is good to know for future reference. Thanks.

 

[PsyDWannabe]

She is on the insurance panels. If people don't use their insurance then she does the three hour feedback. If they use their insurance then she does one hour feedback.

what kind of feedback takes 3 hours?

 

[PsyDWannabe]

The patients tell me. She has reviews too where people complain they have to pay for the feedback to get their results.

Last I checked my state's rule governing our practice, a provider cannot withhold results due to non-payment...

 

[PikminOC]

Last I checked my state's rule governing our practice, a provider cannot withhold results due to non-payment...

I don't see she has gotten dinged by the state board

 

[PikminOC]

Also, are these fee for service/cash pay therapists or insurance-based?

Also shouldnt matter as both are required to keep notes.