There are MORE and MORE acupuncturists being asked for records and MORE and MORE acupuncturists are also being audited.
Understand that EVERY time you give your records you are giving the carrier evidence of your billing practices. Every. Single. Time.
I’ve spoken to providers who tell me – I ALWAYS get paid when I send in notes, and I am here to say – They are looking at your notes with far more scrutiny than ever before. I can pretty much confirm that ANY carrier that also sells Medicare Advantage Plans and you bill or have billed in the past, will probably at some point ask for records.
I used to say, they definitely go after outliers. What are those?
- Bill excessive units averaging 1 hr or more.
- Bill SAME thing for every patient.
- Bill the SAME diagnosis for months (or years)
- If you are OUT of network – and do 1,2, or 3 you will be audited at some point.
- If you are OUT of network and don’t do 1,2,3, but have a HIGH volume of patients from the same network or plan.
Now I’m saying – they are auditing IN network providers who show no signs of over-billing AND demanding money back.
They are still looking for 2 things, but NOW they are adding one more for IN network providers
- Did you document APPROPRIATELY what you billed for? Time for timed based procedures, rationale, time and goals for all procedures.
- Then they look at – IS the treatment medically necessary?
If you are IN network they will add – 3. Are you following our policies as required by your contract? These policies are sometimes DIFFERENT than standard billing practices and have additional requirements.
You NEVER want to be in an audit, make sure you are providing good quality records. Finally some people mistakenly think having an EHR with templates puts them “in the clear”. I have been a part of 6 figure audits, most had notes generated by EHR companies. There is NO magic in an electronically created record, especially if you don’t know exactly what is expected in your documentation.