Threats to audit from insurance companies

[StayOnTop]

Got a letter recently from the only insurance company I panel with that I'm billing too many 99214's and 90833's. Somewhere in the 80% range. Everyone at our practice got this letter. My follow ups are all 30 minutes, and the vast majority of my patients have at least two chronic conditions with med management (my understanding is this is enough for 99214 with MDM) and I document supportive, CBT and family work. It's usually 10 minutes for meds and 20 minutes for psychotherapy. Not everyone meets criteria, but then again, I don't bill for that when they don't.

Come to find out, several psychiatrists in my state received the same letter at the same time, so it seems like they're trying to intimidate us. Not sure how I should proceed.

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[Sushirolls]

Here is the thread you seek, drink from the fountain of prior posts:

Sent a threatening letter from a company for too many 99214

Recently got a letter from a third party company (don't recall the name), comparing my billing codes with others of the same specialty. While it was worded as nicely as possible it indicated that i was billing more 99214 and less 99213 than the average joe psychiatrist. It also suggested I...

forums.studentdoctor.net

 

[nexus73]

I shred those. If I was more antagonistic I would report it to the state insurance commissioner

 

[TexasPhysician]

Stop worrying about audits. If you are doing what you claim, there is no reason to fear an audit.

 

[StayOnTop]

Stop worrying about audits. If you are doing what you claim, there is no reason to fear an audit.

I'm sure that I'm in the right, but I worry about whether or not I'm documenting correctly or will I be paid during an audit or am I supposed to just sit there and wait?

 

[Celexa]

I'm sure that I'm in the right, but I worry about whether or not I'm documenting correctly or will I be paid during an audit or am I supposed to just sit there and wait?

As someone mentions in the other thread, there's a degree to which the insurance companies are looking for the weakest gazelles in the herd who will either start under billing out of fear or otherwise capitulate. You can run your documentation by a compliance officer or a trusted colleague who's on top of these things. At the end of the day if you have good documentation you will survive any audit and just knowing that means you're unlikely to end up having a problem even in the time suck administrative annoyance sense. At the severe end you could engage legal counsel to set your mind at rest but that really is several steps down the line if the insurance company actually decides to do more than send a statistical letter.

Think about it in another context. Sometimes they send letters saying you prescribe more opioids than 90% of your colleagues or whatever. That should actually concern or scare someone who practices normal primary care. But if a palliative care doctor receives that letter they're just going to laugh and throw it in the trash because of course they do. If your documentation is good you're in the same situation as that palliative care doctor. You're doing what you're supposed to you're doing your job and that's what matters.

 

[Candidate2017]

Got a letter recently from the only insurance company I panel with that I'm billing too many 99214's and 90833's. Somewhere in the 80% range. Everyone at our practice got this letter.

What do the other docs in your group say? It's important to discuss issues about insurance and reimbursement with colleagues.

Regarding your question, have you considered that insurance, admin, and other entities are nothing more than another difficult patient, for which you have been trained to handle?

I'm sure that I'm in the right, but I worry about whether or not I'm documenting correctly or will I be paid during an audit or am I supposed to just sit there and wait?

Sitting and waiting is literally and metaphorically what an outpatient psychiatrist does all day. Something, something, shades of gray, ambiguity and distress tolerance.

 

[annoyedpsychiatrist]

99214 criteria is easy to meet and i dunno how theyd prove you werent doing adjunctive therapy if you had f/us at 30 min appointments unless maybe the timing didnt make sense.