Software for E-Billing, Treatment Planning is Reviewed

The National Psychologist

May/June 1996

Larry D. Rosen, Ph.D.


Mental health technology changes continually. For this reviewer, this means staying abreast of trends, and separating technologies likely to endure from those inclined to fade. For the consumer, it means making trend fits your practice needs. Mine is the easier task.

In this issue, I will examine two of the newer trends in the market -- E-billing and treatment planners software.


Sounds futuristic and high tech? The reasons and decisions for buying e-billing software are rather straightforward. E-billing enables the therapist to send bills to an insurance company electronically rather than through the often painfully slow postal service. Payment through the mail may take weeks or months; through e-billing, you have a chance to be paid within days, the prevailing payment schedule being 7-14 working days.

So, if it's possible to be reimbursed quickly, why isn't everyone billing electronically?

One answer is there are costs involved. Although free computer programs are available from many insurance companies to bill them directly, it is nonetheless a cumbersome process because duplicate records must be maintained.

The most efficient decision is to purchase a somewhat costlier office management system that includes electronic billing. But in addition to the purchase, this also requires hiring a billing company -- which represents a "middleman" cost. The billing company will convert electronic bills to the format required by the insurance company and charge a yearly fee of about $125 as well as 50 cents or less for each bill being processed.

For busy, enterprising psychologists concerned with cash flow, this extra cost should be worth the price because it brings other rewards. It spares them from billing and other paper-shuffling irritations and enables them to concentrate on doing psychology.

Only 3% of all therapists have submitted an electronic bill. One reason is that some psychologists fear patients privacy would be jeopardized if financial information got tangled in phone wires and was floating in cyberspace. My experience is that no incidents of E-bills being intercepted have occurred. An apprehensive psychologist who fears an E-billing snafu should consider that postal mail gets mangled, lost or misdirected.

Further, only 10% of all psychologists have an office management program. E-billing options now makes these purchases more attractive. Although many office management programs are advertised, only a few are superior. Among them are Delphi Psychotherapy Billing System, Therapist Helper and ShrinkRapt reviewed by Michelle Weil, Ph.D. and myself (see end of article).

Treatment Planners

Electronically generated treatment plans are a recent addition to simplifying the practitioner's life. Imagine this scenario: A managed care client arrives for a first visit. You gather background information which you enter into your computer, to produce a treatment plan which includes the essentials -- presenting conditions, diagnosis, treatment goals, intervention strategies and behavioral objectives. Your managed care company will love you! Managed care organizations are highly supportive of such treatment plans.

Treatment planner software come in two models. On requires the therapist to type sentences in the large boxes on the computer screen; the other asks the therapist to select preprogrammed sentences by simply checking a series of boxes on the computer screen. The former can be found as "features" in many office management programs while the latter, called a "pick list," usually are stand-alone programs. Both have strengths and weaknesses.

Treatment planners embedded in office management programs are similar to templates in a word processing program -- a form set up in a word processing program and used repeatedly, changing names and words, but keeping the same format. The reports have a professional appearance but do not cost extra as they are part of the original office management package. There is no extra charge for them.

Currently gaining popularity is the stand-alone treatment planner. All stand-alone treatment planners provide brief patient data, treatment approach, treatment modalities, mental status, progress updates, diagnoses, prognoses, discharge criteria and your credentials. They will output a complete treatment plan that is professional and customizable. These programs are costlier ($150-$350) but seem worth the additional cost. Here are my reasons on a few:


TheraScribe (John Wiley & Sons, 800/879-4539) is a computerized version of Dr. Arthur Jongsma, Jr.'s well-respected 1995 book The Complete Psychotherapy Treatment Planner. TheraScribe will even recommend Axis I and II diagnoses based on a patient's presenting problem. It will track managed care clients and alert the therapist when reports are due. TheraScribe is easy to use, and allows room in its design for novice users.

Within 15 minutes of loading the program, I had generated a rudimentary treatment plan. After entering more patient information, I had completed a bona fide treatment plan. TheraScribe also provides a paper checklist form to use in conjunction with Jongsma's book to develop the treatment plan on paper. A clerk can enter the information and print the report.

Another sound treatment plan on the market with optional features is PsychAccess (Community Sector Systems at 800/988-6392) which provides a pick list approach and a Life Function Rating Scale to document patient status and change during the course of treatment. PsychAccess provides initial treatment plans and closing/discharge summaries complete with data from the Life Function Scale (six 5-point Likert scales rated by the therapist). While the program is somewhat bit slow in its present version, it will be faster once a revision, currently underway, is completed. PsychAccess is an excellent program and I found that it has solid company support.

QuicDoc (DocuTrac at 410/418-8510) handles the standard treatment plan functions mentioned previously. It also includes a Patient Satisfaction Questionnaire and a number of additional outcome measures. It contains a large body of information as I found by discussing the program with its creator, Dr. Arnold Schuster, a practicing psychologist. During my first practice session it took quite some time to work through all of the screens. But with practice, the user would learn to avoid those not needed. The program's outcome measures were interesting and could be usable data if required by an insurance or managed care company.

Civer-Psych (Civerex Systems 800/529-5355) includes four integrated modules (available as a package or separately) that perform intake/assessment, diagnosis, treatment planning and billing/claims processing. Civer-Psych differs from other stand-alone programs reviewed here. It does directly create a document ready for an insurance company although it generates a treatment plan through a pick-list approach. The program encourages the user to surround the treatment information with text and to personalize the document. It appears to be a powerful tool for the user who wants to customize treatment plans along with performing other tasks in the same computer program.

A prospective buyer should consider obtaining demonstration copies for, perhaps, two of these programs. But it's confusing, indeed overwhelming, to try too many at a time.

One word of caution

Ask your insurance/managed care companies whether they will accept treatment plans, updates and closing summaries presented in a different format than they heretofore required

Caveat emptor, let the buyer beware!


Copyright, 1995, The National Psychologist. Reprinted with permission. The National Psychologist is a privately-owned bimonthly newspaper which may be purchased for $30 a year. Write or call: TNP, 6100 Channingway Blvd., Suite 303, Columbus, OH 43232; telephone: 614.861.1999 or fax with Visa or MC to 614.861.1996.