The only Risky Business we like is that movie with Tom Cruise ... and to be fair, we don’t like it that much anymore -- it hasn’t aged well.
But there is one thing in our space that never gets old: a provider billing an insurance company runs the risk of an audit.
No one likes an audit, but comprehensive reviews are a reality in the addiction treatment and recovery industry. With heightened attention toward billing practices, providers need to be proactive in preventing and eliminating accusations of fraud or abuse.
There are best practices to handle an audit that will benefit your recovery program or addiction treatment center. There are also best practices to avoid being audited.
There are red flags for fraud detection as the payers employ investigators to look for anything that resembles fraudulent practices. One red flag can trigger an investigation or audit, which results in a full review of a provider’s insurance methods, billing practices, referrals, marketing practices, medical and billing records, spreadsheets, claim information, and supporting documentation. Enforcement actions may result from an investigation by the SIU. That can include freezing all payments until the investigation is complete, accusations of fraud, or a court case.
Audits can have severe consequences for both finances and workflow. As the behavioral health field expands to better meet the needs of a national addiction crisis, payers are putting more attention on the industry, and subjecting providers to significantly more scrutiny.
This seminar, co-sponsored by Infinity Behavioral Health Services, Nelson Hardiman, Lin and Patel, and BHAP, will provide lessons learned for surviving an audit, offer some tips for how to avoid being flagged in the first place, and give an overview of the commercial payer SIU process,.
Industry experts will discuss the issues most frequently addressed by payers, how to address them in an audit, and how to make the changes to your practice today to lower the chance of being audited.