How would you feel if a health plan asked to see your notes? For most therapists, this request would bring an acute wave of anxiety, and a strong desire to protect confidentiality. Yet every day, healthcare professionals nationwide — whether in or out of network — are facing these requests, as they are being asked to provide documentation to back up their billing. Yes, even the notes of out-of-network therapists are being requested, as notes are subject to review whenever a statement/superbill is submitted to a plan.
Let’s face it — audits are stressful. While some are purely administrative, others can lead to costly claim denials or repayment requests (aka“clawbacks”). You — or your out-of-network clients — can lose thousands of dollars in unreimbursed claims.
In this pre-recorded 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 how to avoid these requests in the first place. We’ll also give tips on record-keeping changes you can make now, to avoid any loss of money.
- What is an audit, and how is it different than a treatment review?
- Why you might you be chosen for an audit: Key Audit Triggers
- What are the major audit triggers?
- The scary new trend: Pre-Payment and Post-Payment Audits
- What you should know about Risk-Adjustment Audits (Ciox, Inovalon, Datafied etc.)
- What are the plans looking for in each type of audit?
- If your notes are requested, what should you do?
- Can you refuse a records request? Can you ignore it?
- The most common reasons the plan might not pay for sessions or refuse to reimburse your clients
- What happens if you fail a records audit? How to appeal
- If your notes are not great, what can you do now to get your notes in order?
FREE DOWNLOADS: All participants will be given access to 2 downloadable Treatment Record Checklists used by major health plans to check your documentation
EASY TO VIEW: The webinar takes no technological know-how to watch — after purchase you will immediately be sent a link. With one easy click you can watch it on your computer or smartphone at your convenience. You can stop and restart, as needed. The link will be available for one year.
CE CREDITS: 2 CE credits are available for California BBS Licensees — counts toward Legal and Ethical CEs! Other professionals should check with their licensing boards about possible credit. More about CEs below.
IMPORTANT: AFTER PURCHASE, DON’T LEAVE THE SCREEN! YOU WILL BE IMMEDIATELY REDIRECTED TO A THANK YOU PAGE — scroll down this page to find the blue links to the webinar and handouts (and CE Evaluation link, if purchased). We will follow up with a separate email with these links within 1 business day, in case you didn’t get them. If you do not receive this follow-up email, please CHECK YOUR SPAM FOLDER.
CE CREDITS: To receive your CE certificate, just choose the CE ticket option, and along with the webinar link, you will be sent a link to complete a brief evaluation and post-test after viewing the webinar. If you get 70% correct, YOUR CERTIFICATE WILL BE SENT VIA E-MAIL within 15 minutes of submitting the evaluation. Please check your spam folder if you do not see it. If you do not receive it, please contact us at firstname.lastname@example.org. Barbara Griswold LMFT (CAMFT CE provider #023504) is approved by the California Association of Marriage and Family Therapists to sponsor education for California LMFTs, LCSWs, LPCCs, and/or LEPs. Barbara Griswold maintains responsibility for this course and its content. For complete CE policies, click here
Disclaimer: The webinar focuses mostly on insurance plan records requests, and not records requests from attorneys, courts, disability, or other requesters.
Who should attend? This recording is designed for all types of mental health professionals nationwide, including pre-licensed therapists, whether they work with insurance or not.
PRESENTER:Barbara Griswold, LMFT is author of Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance – And Whether You Should, now in its 9th edition. In addition to her private practice in San Jose, CA, she provides consultations and trainings about insurance, progress notes, and practice building to therapists nationwide. She invites you to contact her here.
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