Audits and Record Requests: What EVERY Therapist Should Know

This webinar satisfies requirements for live interactive CE credits for all professions.

How would you feel if a health plan asked to see your notes? For most therapists, this would bring a wave of anxiety. Yet every day, healthcare professionals nationwide — including out-of-network therapists— are facing these requests, and being asked to provide documentation to back up billing. Yes, even the notes of out-of-network therapists are subject to review whenever a statement/superbill is submitted to a plan, and it is happening more frequently.

While some audits are purely administrative, others can lead to costly claim denials or repayment requests – also known as “clawbacks.” You (or your clients) can lose thousands of dollars in unreimbursed claims.

In this webinar, we take a closer look at the reasons your notes might be requested by a health plan, how to respond if they are requested, and what you can do 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 be chosen for an audit: Key Audit Triggers
• The scary new trend: Pre-Payment and Post-Payment Audits and “clawbacks”
• What you should know about Risk-Adjustment Audits (Datavant, Inovalon, Datafied etc.)
• What are the plans looking for in your notes?
• If your notes are requested, what should you do?
• The most common reasons the plan might not pay for sessions
• What can you do now to get your notes in order?

PLUS! FREE DOWNLOADS: You’ll get 2 downloadable Treatment Record Checklists used by OPTUM/United Health Plan and Aetna when auditing your documentation.

Note: We will only be discussing record requests from insurance plans, not from courts.

Target audience: This course is appropriate for all mental health professionals

Content level: Introductory/Intermediate