When Your Chiropractic Office Receives an Insurance AuditPosted by Cannon Marcussen on May 30th, 2021 When Your Chiropractic Office Receives an Insurance Audit Unfortunately, for many chiropractors, it's no longer IF you receive an audit letter from a third party insurance payer (such as Medicare, Blue Cross, Aetna, etc) but WHEN you receive one! Despite the fear and anxiety that receiving an audit notice can bring, going into a complete panic will not help. Instead, here are a few tips for handling your chiropractic audit effectively, efficiently and successfully: 1. Extreme Behavior is Not Necessary! Although receiving an audit letter can certainly bring out extreme emotions, responding in the extreme will not help. In other words, do not panic and do not ignore the letter. Just because you received notice of an intended audit -- whether it is from Medicare or any other third party payer -- does not mean that you are guilty of some offense. Some audits are completely random and conducted routinely with no suspicion cast toward your billing activities, documentation ability or treatment parameters. So do not panic in the presence of an audit letter. Don't assume that your documentation is substandard. Don't automatically determine they will find your records insufficient and make plans to be subversive. On the other hand, do not ignore the audit letter. Instead, plan to take action. 2. Know Your State Laws! You do have legal rights depending on the state in which you practice in regards to how audits can be conducted in your state. For example, if you are an out of network provider, there is a possibility that the carrier cannot audit unless they suspect fraud. On the other hand a governmental entity like Medicare definitely can audit you, so move on to the next step. Perform your due diligence immediately and research this issue. 3. Choose Your Battles. Once you have determined the audit is legitimate, you need to figure out exactly what is being audited. Are they requesting a chart audit where they want to look at your medical records? Do they want to perform a site visit? Once you've determined which type of audit they're intending to conduct on your practice, you need to formulate response to that audit in a timely manner. In some types of audits, no answer is the worst possible answer you could give. So you want to respond in a timely manner to the request for the audit. Also, provide what is requested: nothing more, nothing less. The auditors do not want to review a 42 page explanation of your chart notes; they should stand for themselves. Furthermore, any additional material you provide beyond what is requested can be used against you as well. One tip: do not respond to phone or fax audit requests. Get it in writing! 4. Bad is Better Than Bogus. Once a chiropractor receives an audit notice, the most common question I am asked is: "What do I need to do to prepare for this audit?" To be blunt: the time to prepare for your audit is not when an audit request letter is in your hands! Never take matters into your own hands and alter medical records to improve what appears to be incomplete or insufficient documentation. Poorly done records are still better than the best records that have been fraudulently contrived. Better to have bad notes, than bogus ones. 5. Be on Time! If you have to respond in 30 days, then respond in 30 days! If the time frame that the carrier is requesting is not reasonable due to some sort of extenuating circumstances, contact the auditor for an extension. If it's going to take you more time to produce the information, ask for an extension. 6. Should You Appeal? Quite frankly, not all insurance reviews are accurate. Therefore, to protect your interests, appeals are sometimes necessary. Particularly if you have high dollar value claims in question, you want to consider appealing. If your "audit" letter is actually a demand for repayment, your best option may be to start the appeals process. Do not automatically presume that the payer's review is final or even correct. If appropriate, an appeal can save you thousands of dollars in unnecessary repayments and headaches. 7. Is help needed? You may need to obtain the assistance of a certified professional coder or a certified professional medical auditor whose expertise is in chiropractic to help defend you. A healthcare attorney may also be wise, especially if there are several zeros in your demand or repayment letter. Again, before you hit the panic button or get out your checkbook, it may be critical to the success of your defense or appeal to get professional help. The reality is that your license, your lifestyle and your livelihood may all depend on it! My first hope is that you don't receive an audit letter. But if and when you do, keep this list in mind so that you can successfully defend your claims! maroc emploiLike it? Share it! |