OLERE OLERE - Oklahoma Legal and Ethical Responsibilities Fee Arrangements and Business Practices 2 — Questions and Answers
Question 1: When submitting insurance claims for counseling services in Oklahoma, the LPC is ethically and legally required to:
- Always bill the maximum allowable code regardless of the service actually rendered
- Accurately represent the services provided and avoid fraudulent billing practices (Correct answer)
- Use the diagnosis code most likely to maximize reimbursement rather than the clinical diagnosis
- Submit all claims under the supervising physician's NPI number to ensure payment
Correct answer: Accurately represent the services provided and avoid fraudulent billing practices
Accurate billing is both a legal requirement and an ethical obligation — misrepresenting services or diagnoses to maximize reimbursement constitutes insurance fraud.
Question 2: When an Oklahoma LPC provides pro bono services to a client who cannot afford to pay, the counselor must:
- Offer a reduced standard of care appropriate to the reduced level of compensation
- Maintain exactly the same professional, ethical, and clinical standards as for fee-paying clients (Correct answer)
- Document pro bono cases using a different clinical record format than standard cases
- Limit pro bono sessions to no more than 20 minutes to manage professional time equitably
Correct answer: Maintain exactly the same professional, ethical, and clinical standards as for fee-paying clients
Ethical and professional standards apply uniformly to all clients regardless of whether they are paying full fee, sliding scale, or receiving pro bono services.
Question 3: An Oklahoma LPC's sliding scale fee policy is most ethically implemented when it is:
- Applied informally and individually based on the counselor's personal judgment about each client
- Based on objective financial criteria, applied consistently across clients, and documented in writing (Correct answer)
- Kept confidential from insurance providers to avoid complications with reimbursement agreements
- Applied only to clients referred by specific partner agencies with written referral agreements
Correct answer: Based on objective financial criteria, applied consistently across clients, and documented in writing
Sliding scale policies must be based on transparent, objective criteria applied consistently to avoid favoritism or discrimination, and documented in the financial agreement.
Question 4: When an Oklahoma LPC must terminate a client due to non-payment of fees, the counselor's ethical obligations include:
- Ceasing all contact immediately once a balance remains unpaid
- Providing adequate advance notice, clinical referrals, and confirming the client is not in crisis (Correct answer)
- Immediately reporting the outstanding balance to a credit reporting bureau
- Notifying the Oklahoma State Board before proceeding with any fee-related termination
Correct answer: Providing adequate advance notice, clinical referrals, and confirming the client is not in crisis
Termination for non-payment must be handled ethically by giving clients adequate notice, appropriate referrals, and ensuring no client is abandoned during a mental health crisis.
Question 5: Billing both the client and the client's insurance company for the same counseling session in Oklahoma is:
- Acceptable practice if the client's copayment is waived by the counselor as a courtesy
- Insurance fraud and an ethical violation that can result in criminal charges and license loss (Correct answer)
- Standard practice for high-cost specialized counseling services
- Permitted when the client provides explicit written consent acknowledging the dual billing
Correct answer: Insurance fraud and an ethical violation that can result in criminal charges and license loss
Billing both the client and insurance for the same service is double billing, which constitutes insurance fraud regardless of whether a copay waiver is offered.
Question 6: When an Oklahoma LPC closes a private practice, ethical obligations regarding clients with outstanding balances include:
- Writing off all outstanding balances immediately without any client notification
- Notifying clients in advance, allowing reasonable time to arrange payment, and providing appropriate referrals (Correct answer)
- Selling all outstanding balance accounts to collection agencies without prior client notice
- Reporting all clients with unpaid balances to the Oklahoma State Board as a required closing step
Correct answer: Notifying clients in advance, allowing reasonable time to arrange payment, and providing appropriate referrals
Practice closure requires ethically winding down financial obligations, including notifying clients, offering a reasonable resolution period, and ensuring continuity of care.
OLERE OLERE - Oklahoma Legal and Ethical Responsibilities Fee Arrangements and Business Practices 2
When submitting insurance claims for counseling services in Oklahoma, the LPC is ethically and legally required to: