Navigating Through Audits and Records Requests

Bonus: This course includes a downloadable Health Plan Sample Audit Tool to ensure your charts meet documentation standards.

For most therapists, the idea of a health plan asking for session notes brings an acute wave of anxiety, and a strong desire to protect confidentiality. Yet every day, healthcare professionals nationwide are being asked to provide documentation for a variety of reasons. Even the notes of out-of-network therapists are being requested, as they are subject to review when a client seeks reimbursement from a plan.

While some audits are purely administrative, others can lead to costly claim denials or repayment requests (“clawbacks”). You may lose thousands of dollars in unreimbursed claims, or your out-of-network clients can have their reimbursements denied.

This course contains a recording of a webinar presentation, presented with video and audio versions, along with a transcript. In this course, Barbara examines why your notes might be requested by a health plan, how to respond if they are requested, and how to avoid these requests. She also gives tips on recordkeeping changes you can make now to avoid any loss of income.

Topics include:

• What is an audit, and how is it different than a treatment review?
• Why you might you be chosen for an audit
• The scary new trend: Pre-Payment and Post-Payment Audits
• What you should know about Risk-Adjustment Audits (Ciox, Inovalon, etc.)
• What are the plans looking for in an audit?
• If your notes are requested, what should you do?
• 6 reasons the plan might not pay for sessions
• What can happen if you fail an audit?
• What you can do now to get your notes in order