David Klein, CPC, CHC
Chiropractors are well aware of the large increase in post-payment reviews and audits, as well as the heightened emphasis on correct coding and proper documentation. This growing scrutiny has led many providers to feel that insurance companies are out to get them. This feeling often translates into fear and an adversarial approach when dealing with insurance carriers. Be advised: this approach is counter-productive!
I used to be the billing and compliance manager for a group of 35 chiropractors. We were faced with an audit, and I took it personally. “Don’t these insurance companies know we are trying to do our best for our patients”, I wondered? I was angry and concerned. In my first conversation with the investigator, I told him the only reason he was reviewing these claims was to make money and justify his existence. My approach did not have the desired effect. He became defensive and quoted certain stipulations in our provider agreement that empowered him to subpoena our records if we wanted to go that route. Immediately, my anger turned to regret. Why was I trying to provoke the investigator?
I recently had a conversation with a senior investigator at one of the nation’s largest private health insurance companies. He was very forthcoming, shared his perspective, and dispelled the myth that all carriers are out to get the doctor. Here is what he said:
It’s true that audits and post payment reviews can be scary, time consuming and costly. And, it’s natural to feel overwhelmed. However, if you take a proactive approach, you will be much more likely to handle these situations gracefully, successfully and confidently. So remember:
Of course, there may come a time when you need to fight for your rights. In the meantime, becoming better educated and developing positive relationships with your insurance carriers can protect you and your practice and reduce the likelihood of negative and costly reviews.