How to Survive a Health Insurance Audit Professional Resource Article
The Insurance Vultures are Circling
What is a Clinical Insurance Audit?
Insurance companies have recently been conducting audits, like vultures looking for dinner. Especially Medicare.
A clinical insurance audit is a review of treatment that is meant to root out fraud, abuse, and waste in the health care system. Unfortunately, it seems that when the new mental health parity laws kicked into effect February 10, 2021, it had an unexpected consequence. Insurance audits jumped. So the new parity law is experienced as (and not without merit) a way to limit services to clients and deny payment to providers to keep healthcare costs down.
Fight, flight, freeze, or fawn! An audit letter from a health insurance company is enough to send shock waves through your body and make your mind go blank. Have you received this letter? The first thing to do when you get one of these letters is take some deep breaths. Then read it. Many therapists have and they have a lot of questions when they do. Lately, I’ve been getting requests from therapists to review paperwork for audits almost daily. Andy, a 46-year-old therapist from Colorado who works with elders, contacted me when she received an audit letter. Within the first 3 minutes of our conversation, it was obvious her racing thoughts kept her from absorbing the information even though she reread the letter many times. All she could remember was the deadline – “send immediately.” After listening to and validating her fears, my next task was to read the letter and explain the finer points in a way that her muddled brain could hear. She calmed down immediately. Together, we planned her strategy for submitting her notes.
Though most therapists will not be audited, many will. So be prepared. What Health Insurance Companies are looking for in an Audit The first question is always — what do I send? If you read the letter closely, it tells you exactly what to send. But because of the anxiety audits generate, it’s easy to just stare blankly at the paper or dissociate and eat a bunch of chocolate instead of absorbing the content of the letter. To start with, it’s easy to confuse psychotherapy notes with progress notes. I call psychotherapy notes, “Memory Notes”
