When I started out in practice, the biggest risk I faced was a potential malpractice suit. Now 32 years later, the biggest threat to my practice is an audit. Often, audits are triggered by patients who are not unhappy with your clinical care, but your billing or collection practices. Recoupment is BIG business.
Are you trying to determine your best course of action when receiving records requests after receiving payment for services? We give you a launching point and a breakdown based on the number of files requested.
Some time ago I worked with a client who needed help with an appeal. The provider had seen a patient over the course of four weeks for severe low back pain with radiculopathy to the left calf and foot. The provider put together a care plan and outlined goals based upon functional deficiencies. At each encounter, the following codes, among others, were billed:97110 Therapeutic exercises, 97140 Manual therapy. The therapy services were denied for most of the visits. The claims reviewer provided the following partial explanation for the denial:
Chiropractors across the country have been opening up their mailboxes to find audit letter(s) from Medicare. Although consultants have preached an increase in audits within the profession for years, many chiropractors were shocked to be the recipient of such a letter. You may be wondering why so many are being audited and what to do if you receive an audit letter at your office.