No Prior Auth

by Lindsay Hill, DNP, PMHNP-BC

Business Education

Season 2

Are You Coding Your Psych Visits Wrong? (A Medical Auditor Answers) No Prior Auth with Crystal Stone - S2.E2

Crystal Stone has sat on every side of your insurance claim: the psych NP who delivers the visit, the certified coder who submits it, the biller who chases it, and the medical auditor who reviews it. She's an Air Force veteran and the founder of three businesses in Southern Illinois, including a billing and auditing firm with the motto "Professional on Paper. Savage in Appeals." We cover the 99214 and 90833 myths she keeps seeing on social media, in-network vs. out-of-network billing from zero, her warnings about Headway and Alma (PHI access, credentialing roadblocks, clawbacks), why your NPI makes you the responsible party no matter who bills, the audit-proof note formula (target, intervention, response, progress, plan, time), and where audit risk really comes from. Plus the story behind it all: the Air Force, an adult ADHD diagnosis in nursing school, and the day she fired her biller and learned to do it herself. This episode is education, not billing or legal advice. Payer rules vary, so verify everything for your own practice. Timestamps: 00:00 Cold open: "I see a lot of fraud" 02:04 Her story: the Air Force, ADHD, firing her biller 13:11 In-network vs. out-of-network, from zero 18:34 The Facebook billing myths that scare her 19:44 Headway, Alma, and the VC platform problem 27:21 Clawbacks and your NPI 39:45 The audit-proof note formula 44:47 The right code, not the highest code 46:30 What "No Prior Auth" means to Crystal Connect with Crystal: https://www.newleaf618.com/ (she also teaches a monthly billing and coding series with Psychiatry Circle) Watch on YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez More episodes: https://psychnpfellowship.com/podcast/ Community: https://www.skool.com/psych

Dr. Chris Aiken: "The Depression Add-Ons You Use Every Day Don't Work" S2.E1

Dr. Chris Aiken opens this episode with a sentence that could change your prescribing. The add-ons most of us reach for in treatment-resistant depression — bupropion, mirtazapine, buspirone, even stimulants — have failed their large randomized trials. Unanimously. "California rocket fuel" went down in three of them. Meanwhile the treatments with real evidence behind them, like TMS, lithium, and pramipexole, almost never show up in the chart before a patient reaches him. If that name sounds familiar, it should. Chris Aiken is the editor-in-chief of the Carlat Psychiatry Report and co-host of the Carlat Psychiatry Podcast with psych NP Kellie Newsome: 700 episodes, more than 13 million downloads, and not a dollar of industry money, ever. He started at the NIMH at eighteen, trained at Yale, Cornell, and Duke, and wrote Bipolar, Not So Much and Difficult to Treat Depression. One more thing. A month ago, he and Kellie got married at the Chelsea Hotel. The podcast couple is now an actual couple. From there we cover a staggering amount of ground: lithium orotate without the hype, deprescribing when a patient walks in with five diagnoses and ten medications, and the Lindsay Clancy case, where he explains why postpartum psychosis belongs at the top of the diagnostic hierarchy and points out that a psychiatric NP was the one who finally raised the bipolar flag. He gives his honest read on keto and GLP-1s versus their actual trial results, names his three desert-island books, shares the daily ritual that keeps him current (scanning up to 100 new abstracts every morning), and tells the private-equity story he calls a regret, plus the pivot that became Psych Partners, which hires psych NPs. We finish on AI in practice, including Danny Carlat's eyebrow-raising "that might be malpractice" line, and on writing as the way out of rumination. I also share something I haven't said on this show before: I went through TMS myself last summer, and what it did for my own rumination surprised me. If you prescribe for depression, this is the hour. Go listen. Then tell me which part landed. — Lindsay CONNECT WITH DR. AIKEN 🌐 chrisaikenmd.com — he posts one new study a day (@chrisaikenmd on every platform) 📰 The Carlat Psychiatry Report: thecarlatreport.com 🎙️ The Carlat Psychiatry Podcast (with Kellie Newsome, PMHNP) 📚 Bipolar, Not So Much · The Depression and Bipolar Workbook · Difficult to Treat Depression (audiobook on Audible) · supplement guide with Dr. Carlat coming soon 🏥 Psych Partners (NC/SC/VA — and they hire psych NPs): psych-partners.com 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych #PsychNP #PMHNP #Psychiatry #TreatmentResistantDepression #Bipolar #Lithium #MentalHealth #NoPriorAuth

Season 1

He Hates Networking. It Built His Entire Career.

Mike Asbach is the first physician associate on this show, and he set the bar high. He's the Associate Director of Interventional Psychiatry at DENT Neurologic Institute in Buffalo, where he leads a team of 17 prescribers delivering TMS, ketamine, and Spravato. He's also the AAPA's liaison to the American Psychiatric Association, a professor, a medical writer, a podcast host, and a captain in the Army Reserve. Here's what surprised me: he hates networking. A perfect night for Mike is a good book and a quiet porch. Nearly everything on that resume exists because he overrode that preference, introduced himself to conference speakers, sat through the mixers, and kept showing up. It's how we met, at a schizophrenia ad board in Arizona. A two-minute conversation with him on his way to the airport put biotech consulting on my radar, and I've since done it. He never planned on psychiatry. Male PA students went into surgery or ortho, so that was his plan too, right up until he pictured himself at 35 getting called in for a hip fracture on Christmas Eve. He applied to one psychiatry job on a whim. Mid-interview, the medical director walked him down the hall, put a TMS magnet over his palm, and made his hand jump. That was it. Fifteen years later he's still there, four doors down from the same boss. We get into career design: how to move toward 0.7 FTE clinical without taking a pay cut, and why teaching scales in a way one-on-one patient care never will. We talk about money, a subject providers are trained to avoid, and where the line sits between a social media presence that builds trust and one that costs it. He's honest about the weight of this work too. Our patients come to us on the worst day of their lives, and for us it's a Tuesday. Then he tells the story behind his industry work. His sister-in-law has cystic fibrosis, and when she married his brother they hoped she might reach 35. A drug approved in 2019 changed her expected lifespan to nearly normal, and Mike now has two nephews who wouldn't exist without it. He's clear-eyed about profit motives, and just as clear about what that innovation gave his family. If you're a psych NP or PA wondering whether this career comes in a version with more range and less grind, Mike is proof that it does. CONNECT WITH MIKE: https://www.linkedin.com/in/michael-asbach/ Associate Director of Interventional Psychiatry, DENT Neurologic Institute (Buffalo, NY) 🎙️ Co-host, White Coats of the Round Table - https://www.masterclinicians.net/podcast-whitecoats LISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych #PsychPA #PhysicianAssociate #PMHNP #InterventionalPsychiatry #TMS #Ketamine #MentalHealth #NoPriorAuth

How to Find a Preceptor (and Not Waste Your Clinical Hours)

Andrea Kemp is back for Part 2, and this one is for the students. If Part 1 took you inside the inpatient unit, this is the practical playbook: how to find a preceptor when your program won't, how to walk into day one of clinical ready, and how to actually learn once you're there instead of watching someone else work. Andrea has precepted students for years and now teaches in a PMHNP program, so she sees both sides. She's blunt about what separates the students who get hired from the ones who get forgotten, and almost none of it is knowing every diagnosis. Show up with a notebook, not an iPad. Make yourself an asset, not a liability. Ask three good questions at the end of the day and look up the rest yourself. Curiosity over confidence, every single time. The part that stuck with me: your didactic classes teach you how to be a provider, but your clinicals teach you how to be in a room with a human, and those are two different skills. Andrea walks through how she actually talks to patients — the five questions she never skips, why silence is a tool, why she'd rather ask a hard question than let someone off the hook, and how she narrows two hundred medications down to five without ever tricking anyone into a prescription. We also get into the stuff nobody warns you about. Paying for clinicals. Preceptors who don't know how to use you. What to do when a patient doesn't want to be there. And how to protect your license when the board holds NPs to a harder line than physicians, including the state-board resource most students don't know exists. If you're in a program right now, or about to start clinicals, take notes on this one. Go listen. Then tell me what you wish you'd known sooner. — Lindsay LISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych #PsychNP #PMHNP #PMHNPstudent #NPschool #NursePractitionerStudent #ClinicalRotations #MentalHealth #NoPriorAuth

Inside Inpatient Psych: The Locked Door Isn't What You Think

I went to school with Andrea Kemp at Arizona State, so I've watched her become one of the sharpest inpatient psych NPs I know. She almost went to law school. Psych won. Eleven years later she runs a step-down unit, teaches in a PMHNP program, and says the thing most people get wrong about inpatient psychiatry starts at the front door. That locked door? It isn't there to protect the world from the patients. It's there because someone is not safe, and the unit is where they finally get to be. Most of what you picture from TV is wrong, and Andrea spends this episode setting it straight. This is Part 1 of two, and we stay on the unit: what inpatient psych actually is, the medication puzzle she loves solving, and the hardest part of the job — involuntary treatment, and what it means to take someone's autonomy while still treating them like a person. Her rule has stuck with me. A patient may not remember the meds you gave them, but they will always remember whether you talked to them like a human being. We also get honest about safety. Andrea has been assaulted on the job, and she doesn't sugarcoat it. It's also, oddly enough, where she met her husband — he stepped in the day a patient's family member threatened her. She talks about all of it without flinching, and about why she still loves this work. And because she got hired five months before graduation and negotiated $130,000 as a brand-new grad, she walks through exactly how she pulled it off. If your first job is for learning and not earning, she'll show you how to still get paid while you learn. Come back for Part 2, where we get into prepping for clinical and everything she wishes psych NP students knew. Go listen. Then tell me what surprised you. — Lindsay CONNECT WITH ANDREA Inpatient-focused community for psych NPs & PAs — launching soon Speaking on NP decision fatigue at the Southwest NP Symposium (Mesa, AZ · late July) [add Andrea's TikTok / community link] LISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych #PsychNP #PMHNP #InpatientPsych #PsychiatricNursing #MentalHealth #NursePractitioner #PMHNPstudent #NoPriorAuth

He Runs Ketamine and TMS — but Wants You on Less Medication

Most of the guests on this show built private practices and never looked back. Ben Egbers is the outlier. He built one in rural Montana, and then he walked away from it. Ben came to psychiatry the long way. A psychology and German degree in 2000. Years as a case manager, then teaching English in Europe. An avalanche in the backcountry that he barely survived, and that he dug his best friend out of. A career in pharma he hated, a $60,000 pay cut to go back to bedside psych nursing, and his own recovery from alcohol use disorder — this month he's ten years sober. He didn't finish his nursing doctorate until 2021. Today he runs some of the most intensive treatments in the field, deep TMS and ketamine, while holding a belief that sounds almost backwards: the goal is the least medication a person needs, not the most. We get into all of it. Why he opened a private practice and then let it go (the billing alone will make you wince). How he partners with therapists in a way that has them telling him "you're the first psychiatric provider who ever called me." What ten years of sobriety taught him about who's actually ready for help. And why he's now stepping back from the interventional work to train in psychodynamic therapy and do something that feels more like him. If you've ever felt like an outlier in this field, or like the "right" path just wasn't fitting, this one's for you. Go listen. Then tell me which part landed. — Lindsay CHAPTERS 00:00 The cold open 01:09 Meet Ben Egbers 02:40 From a psychology & German degree to psych NP 03:30 The book that hooked him: "An Unquiet Mind" 05:10 Community mental health, then a pivot to Europe 08:30 The avalanche that changed his path 09:55 Hating med-surg and pharma — the 2am misery 12:50 A $60K pay cut back to bedside psych nursing 14:20 Why he's the "outlier": walking away from private practice 21:00 Networking with therapists (and picking up the phone) 24:50 What he hated most: the billing 25:40 Ten years sober: his recovery story 30:40 Being a provider in recovery, and who's ready for help 34:00 Psychodynamics 101: the unconscious and transference 39:40 The fellowship, and training toward therapy 47:10 What "No Prior Auth" means to him CONNECT WITH BEN Axis Integrated Mental Health — Colorado (deep TMS, ketamine) | https://axismh.com/ LISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych #PsychNP #PMHNP #InterventionalPsychiatry #Ketamine #TMS #Recovery #Sobriety #Psychodynamic #MentalHealth

'The Criticism of NP School Is Sexist' — A Psych NP Fires Back

Nick Goodwin built one of the more interesting psychiatric practices in the country, and he did it on a shoestring. Eight years ago he opened Goodwin Health Cafe in Spokane with $800 for his DEA license, a free fax tool, and a friend's spare office. Today it's a four-provider practice across two locations, built around treatment-resistant depression — Spravato, TMS, and a space designed to feel nothing like a clinic. He's also the psych NP who writes the psychiatry courses for The Elite Nurse Practitioner, so he's taught thousands of new NPs both the clinical and the business side of this work. And he came on the show to give it all away. We get into the real stuff. How he bootstrapped a practice for almost nothing, and which expenses he'd actually pay for up front. The hiring mistakes that cost him friendships, and the business rule he got from his dad (whose old company inspired the movie Office Space) that he'll never break. His honest read on new grads jumping into private practice, what to do if you're shaky on pharmacology, and the EHR headaches nobody warns you about. Then he says the thing a lot of nurse practitioners have been waiting to hear out loud: the constant dunking on NP education is, in his words, "horrifically sexist." He explains why, and it's worth the listen. If you're building a practice, thinking about it, or just tired of the gatekeeping, this one's a gift. Go listen. Then tell me which part landed. — Lindsay CHAPTERS 00:00 The cold open 01:11 Meet Nick Goodwin & Goodwin Health Cafe 06:24 How he got into psych (his mom and the state hospital) 08:51 Clinical hours vs. running the business 10:49 "The criticism of NP school is sexist" — Nick's take 12:27 What to actually do in your psych NP clinicals 14:43 Opening a practice in 2018 for $800 16:33 The expenses worth paying for on day one 17:08 EHR lessons (and the billing trap to avoid) 18:25 Hiring NPs — and the friendships it cost him 22:00 His dad, "Office Space," and why he'll never take a partner 23:45 Honest advice for new grads going solo 29:33 Becoming the Elite NP psych course creator 31:50 "Get out of here" with the scope-of-practice gatekeeping 39:50 What "No Prior Auth" means to him CONNECT WITH NICK Goodwin Health Cafe — Spokane, WA: https://www.goodwinhealthcafe.com/ Nick's psychiatry & practice courses at The Elite NP: [add the course links Nick is sending] LISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych #PsychNP #PMHNP #PrivatePractice #NursePractitioner #Spravato #TMS #MentalHealth #PMHNPlife

He Caught Criminals for the Air Force. Now He's a Psych NP.

Denis Grigorov has reinvented himself more times than most people change jobs. Born in Ukraine, raised in Seattle, he enlisted in the Air Force out of high school, got picked for the Air Force Academy, and became a captain and special agent investigating crimes inside the military. Ten years of service. An MBA. A management job at Amazon. Then he did the thing nobody saw coming — he walked into healthcare. He became an ER nurse at one of the busiest trauma centers in the country, did a full year of psychiatric residency at the VA in Los Angeles, and in January 2026 opened his own practice, D&Y Integrated Psychiatry, named after himself and his wife Yesenia. Four months later, he had 60 clients. This is the private-practice startup conversation I wish every new psych NP could hear. Denis holds nothing back: the VA residency and the $89,000 pay cut he took on purpose, the $4,000 he spent on a "Google expert" who got him zero patients, the EHR he regrets, the legal retainer that was worth it, the collaborating physician he found for $500 a month, and the DEA rule that makes him rent an office one day a month even though he's fully virtual. He also says the quiet part out loud — private practice is not the patients-rain-from-the-sky story some influencers are selling. His Psychology Today bio reads, "You're not broken. You are exhausted from surviving." He's a disabled veteran who now spends his days caring for other veterans, and you can hear why this work found him. If you've ever wondered what it looks like to reinvent yourself five times and land exactly where you belong, this one's for you. CONNECT WITH DENIS D&Y Integrated Psychiatry — Monrovia, CA (TRICARE & VA Community Care) 🌐 https://dyintegratedpsychiatry.com/ 🌐 https://www.linkedin.com/in/denisgrigorov/ 🌐 https://www.psychologytoday.com/us/psychiatrists/denis-grigorov-encino-ca/1681386 LISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple Podcasts: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 Website: https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych #PsychNP #PMHNP #PrivatePractice #NursePractitioner #VeteranOwned #MentalHealth #PMHNPlife

Traci Spent 30 Years Saving Babies. Then She Had to Save Herself.

Traci Powell spent almost 30 years as a nurse, most of it in the NICU, holding together the most fragile babies you can imagine. She was the strong one. Straight A's, more degrees, more proof she had it all together. Then at 46 it came apart — a first panic attack, and a depression she'd hidden her whole life that she suddenly couldn't hide anymore. CONNECT WITH TRACI For private clients: https://TheRebuiltWoman.com/ Beyond the Script Society Membership: https://community.beyondthescriptsociety.com/ Beyond the Script LIVE: https://beyondthescriptlive.com/ Free PMHNPs Beyond Meds Facebook group: https://www.facebook.com/share/g/1Dtq92bd4F/ Are you interested in Traci's Radical Restoration Fellowship? https://therebuiltwoman.com/intensive-therapy-for-accelerated-healing/ So she did everything you're told to do. Weekly therapy. EMDR. An SSRI, then another, then another. She got labeled bipolar and treatment-resistant, kept getting worse, and reached the lowest point of her life. The mental health system she would later join as a clinician had failed her as a patient. What finally worked was something almost no one had told her about: the difference between trauma wounds, the bad things that happen to you, and attachment wounds, the good things that should have happened and didn't. Two wounds. Two completely different treatments. Once she understood that, her life changed fast Now Traci practices psychiatry in a way most people have never seen. Three-day trauma intensives instead of years of fifteen-minute med checks. She's trained whole cohorts of psych NPs to do the same, grown a 3,300-member community called PMHNPs Beyond Meds, and is hosting what may be the first national psych NP conference built around therapy and trauma work instead of medication. We get into all of it — the breakdown, the Frozen moment that finally named what she'd been doing her whole life ("conceal, don't feel"), why she calls medication the Tylenol of mental health, her suicide attempt and the hope on the other side of it, and what she'd say to any psych NP who's been told to "stay in your lane.” One line of hers stuck with me: "One person's spoken story is another person's permission to speak."

The Most Recognized Psych NP on the Internet | Dr. Kojo Sarfo

Links from Dr. Kojo: 1. More to ADHD - ADHD updates straight to your inbox Sign up to receive emails with tips on how to help treat and manage your ADHD. You'll also get access to helpful questions for your doctor and a free resource. - https://www.moretoadhd.com/adult/adhd-information?utm_campaign=MoretoADHD_ADHD_DTC_Adult_Organic-Social-Media_UB_PSY_2025_instagram_influencer_kojo_sarfo&utm_medium=socialinfluencer&utm_source=instagram&utm_content=PSY.2025-0050_UB_MoretoADHD_kojo-sarfo-ig-link-in-bio Dr. Kojo’s Comedy 2026 Tour Dates ⬇️: Boston, MA — July 24th Springfield, MA — July 25th Phoenix, AZ — September 17th San Diego, CA — December 3rd For ticket information 🎟️: https://www.kojosarfo.com/ Dr. Kojo Sarfo has 4.5 million followers, around 150 million views a month, and a confession: the internet pays him more than psychiatry does. He wasn't diagnosed with ADHD until he was 25. He couldn't read until third grade, graduated high school with a 2.7 GPA, and only tried nursing because his dad said his grades wouldn't get him in anywhere else. His parents cleaned buildings in Nashville while putting themselves through school. Two months into a forensic inpatient psych job, he posted his first TikTok — it got three likes, and he didn't post again for two months. Now he might be the most recognized psychiatric nurse practitioner on the planet: a telehealth practice, a clothing line that gives back to Mental Health America, a comedy tour, two podcasts, brand deals with CBS and Hulu, a book with Simon & Schuster, and two trips to the White House. In this one he's honest about the parts most people leave out — which platform actually pays (and where psychiatry lands on the list), what it's like to be a Ghanaian-American man in a field of mostly white women, and the thing nobody films: how lonely it gets when millions know your name and almost no one knows you. Whether you're a psych NP, a student, or you just want to meet the person behind the videos — go watch. Then tell me which part landed. His advice for new psych NPs WHERE TO FIND DR. KOJO [add Kojo's TikTok / Instagram / Facebook / practice / book links] LISTEN TO NO PRIOR AUTH 🎥 YouTube: https://www.youtube.com/playlist?list=PL2xQMQAfCsq3OrVz3RTndA80gfFEFOsez 🍎 Apple: https://podcasts.apple.com/podcast/id1893233469 🎧 Spotify: https://open.spotify.com/show/5tNbJqeMERnglfTHedOhym 🌐 https://psychnpfellowship.com/podcast/ 👥 Community: https://www.skool.com/psych #DrKojo #ADHD #PsychNP #PMHNP #MentalHealth #ADHDinAdults

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