How to Handle an Insurance Company Audit

You may never be audited by an insurance company, but if you are, here are a few tips and tricks for how to handle the insurance company’s request. Note that most dietitians find the insurance company requests a select number of chart notes for a particular client, with the aim of ensuring that you are billing for the services that you say you are billing for, billing via the correct diagnosis code, and billing for the amount of time that you said you spent with your client. In other words, an audit conducted by an insurance company is rarely what comes to mind when you think of an IRS audit where all of your records and documentation are examined.

The Process: What to Expected When Audited

An insurance company might approach you and request recent chart notes or notes from several months or even years prior. They may ask for a handful of records for a particular client, for example, just to make sure that you are accurately billing for services that appear in your chart notes.  

Follow the insurance company’s directions for information gathering and delivery – or better yet, have your Healthy Bytes billing ally manage this for you! Once you submit your records, you may or may not receive a response from the insurance company contact. Dietitians have noted varying degrees of follow up, and that also, after an audit, insurance companies have continued to cover their subsequent claims.

Be Prepared for an Insurance Company Audit

There are a few pieces of advice that your Healthy Bytes billing experts would like to impart to you and your practice so that you are prepared in the event of an audit:

  • Be prepared. Keep accurate and thorough chart notes and chart shortly after your client visit to capture the outcome and your client’s progress as accurately as possible.

  • Be organized. Track your client chart notes in a consistent format. Insurance companies don’t necessarily need notes to follow a set template, but this will help ensure that you’re maintaining standardization with tracking your clients and their progress.

  • Be diligent. Be diligent about your charting – it is better to be thorough in your charting than providing scant documentation. Refer back to your class notes on the steps in the Nutrition Care Process and use the preferred ADIME (Assessment, Diagnosis, Intervention, and Monitoring/Evaluation) outline for charting. Document medical necessity when possible.

  • Use the Healthy Bytes Platform. When you use the Healthy Bytes Platform, all of your claims are housed on our centralized dashboard for you to reference at any time. Talk about a great means for staying organized!

Remember that your Healthy Bytes team is here to support you in the event of an audit. We’ll help this process go smoothly for you so that you can spend time doing what you love – counseling your clients!

What questions do you have about insurance company audits?