INSURANCE AUDITS are no longer a "rare occurrence" where you hope that 'they' will get "the other guy" and not you.
INSURANCE AUDITS are a part of your contract with your carrier. You AGREED to provide specific information to them. It is no longer an option to ignore this.
INSURANCE AUDITS are a way for insurance carriers to confirm that what YOU, as a practitioner, or your facility, are putting in your documentation is what meets the CARRIER'S guidelines for "Medical Necessity."
There are LOTS of GREAT workshops, seminars, presentations, and expert advisors out there. My personal surveys and conversations have demonstrated that MOST providers HAVE been to at least one (often more than one) documentation workshop within the past three years.
Over 1/3 (37.3%)* of Chiropractors' notes won't pass an AUDIT due to insufficient documentation which includes determination of Medical Necessity
34.9%* of Inpatient Rehabilitation Facilities will not pass an AUDIT due to insufficient documentation which includes determination of Medical Necessity.
ONCE I started sharing publicly on our Virginia Chiropractic Association Listserve IN DETAIL about my audit experiences, I started hearing from DOZENS of docs asking me for help and guidance. I came to realize:
Most Docs HAD the information that they needed,
and the intention to do the right thing.
But "making it happen" wasn't happening! Why??
"WHAT do I need to do, and WHERE do I need START?"
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a FREE 30-minute Compliance Snapshot Strategy Session to:
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In 2017, my office of 17 years was subjected to a post-payment documentation audit and prepayment review audit. Anthem asked for my EHR documentation from 18 months previous, 10 patients for six-months' worth of care, which was over 800 pages. I heard back 6 months later: they contested some billing codes, asked for some money back (a LOT), made some vague comments about notes that "appeared templated", AND...my office was subjected to "PRE-PAYMENT REVIEW."
Here's where the fun REALLY began!
If you are NOT familiar with what "Pre-payment Review" is:
SOUND SCARY? If it doesn't, it SHOULD.
...this will throw YOUR office staff, YOUR office flow, and YOUR mindset into an absolute turmoil, believe me.
...you can be asked for large reimbursements of previously-paid services.
In December 2019 I SUCCESSFULLY had my own UNJUST audit OVERTURNED. I now spend my time helping offices and providers be PROACTIVE in all-things-documentation compliance, from fixing notes, to confident responsive billing, to challenging AUDIT findings.
Here's what Dr. Ellen had to say recently at a Virginia Chiropractic Association convention, passionately sharing about WHY it is CRUCIAL that we FIX THIS CRISIS in our PROFESSION immediately.