Worried About Audits?
Hi Medicare Therapists! There has been a lot of talk recently about a word we all dread: AUDITS.
Unfortunately, audits are a part of working with every insurer, not just Medicare. I’ve been through them (and passed, including one with Medicaid) and it’s much easier to prepare in advance. They aren’t as scary as you think and it’s important to me that you feel EMPOWERED in your clinical work and aren’t working from a place of scarcity- remember, you’re the expert!
If you want to learn more about how I passed an audit and what you need to include to pass one too, you can still purchase my webinar I did with Kym Tolson on surviving an insurance audit:
Here are a few tips to help you make sure your documentation is in line with the insurer’s standards:
Document start and end times. Seems simple but this is one of the most common errors auditors see in Medicare audits. Your start and stop times need to match the CPT code billed- if you bill 90837 your timing should show that you spent 53 minutes or more with the client
Bill for what you did! Oftentimes I hear people are afraid to bill 90837 for fear of getting audited so they bill 90834 instead. This is also incorrect billing! Bill for the service you provided and document as such.
Clearly document progress in each note. Discuss in your progress note how the client presented, the interventions used, how this relates back to treatment goals, and how the client responded and progressed towards goals.
Document medical necessity. Clearly document why the client needs services and how their mental health is impacting their functioning.
Bill appropriately. Remember, you’re in an outpatient setting. If a client is needing additional monitoring or multiple sessions per week, they may need a higher level of care.
You can purchase my note template HERE which helped me pass an audit.
Reach out if you need more assistance- happy to help you get your documentation on track!