For an ABA practice, an audit from a health insurance company can seem intimidating, especially for smaller practices without the manpower or technology to handle bigger claims. Being audited by a health insurance company isn’t just a possibility — it’s a certainty. Health insurance companies use audits as a common strategy to ensure operations and claims are being managed properly.
Still, audits can sometimes cause panic and anxiety. The worry about the potential consequences — prepayment review, contract termination, or reimbursement requirements to pay back paid claims that are deemed non-compliant — can put a practice at risk. There’s even the possibility of fraud investigation. If widespread problems exist, that could mean not only financial loss, but loss of business and reputation for the company.
While this may seem like a terrifying situation, a health insurance audit doesn’t have to be a challenge — if you have the proper strategies in place. Here’s what you need to know:
What Triggers an Audit?
ABA audits can happen for many reasons. Practices should prepare for these audits, as most will see them one or more times over the life of the business. Some of the common reasons an audit may occur include:
- Higher use of specific codes: If you use a particular code more often than expected — often in relation to peers — this could trigger an audit.
- Performing a higher frequency of service: In situations where you provide care more frequently than what your peers experience, that could also trigger an audit.
- Previous problems or errors: If you have experienced claims denials in the past or a fraud claim, that could mean more frequent audits.
Best Practices to Prepare for an ABA Audit
Preparing for an audit long before one is requested is the best strategy. That means taking steps to proactively maximize the amount of information or data available to support your claims. Some key strategies to help minimize audit risks include:
- Standardization: Consistency is critical for health insurance companies. Ensure you are using standard protocols and templates in all evaluation processes. That way, there will accurate, consistent documents to prove care needs. Showing medical necessity is a critical concept that auditors nearly always need to verify.
- Minimize Irregularities in Billing: One key to getting through an audit is providing accurate, organized information that clearly supports claims. Billing consistency is critical to ensure proper payment calculations.
- Expertise in Billing: ABA billing expertise is important, as this is one of the most common concerns in audits. Having a process in place to minimize errors and using a service capable of ensuring clear documentation and practice management could help minimize audit risks.
- Practice: Staging mock audits is an excellent way to find problems and fix them before they occur. Mock audits can be eye-opening, especially when conducted by an experienced provider, pinpointing common areas of concern and hidden problems you may not know exist.
- Accuracy Across the Board: From improper use of billing codes to questionable diagnoses, you must provide accuracy and consistency across all areas of the practice. This includes avoiding HIPAA violations, ensuring no claims errors occur and maintaining clear, standard fee schedules.
- Document Storage: Proper record storage can save you a lot of headaches down the road. While HIPAA rules must be in place, you should make sure that your records are comprehensive, locked and hidden from anyone not on a patient’s care team.
Managing audits is key to long-term success. Without a plan in place, ABA practices may find it nearly impossible to get through these trying audits.
Missing Piece Specializes in the Services You Need
Fortunately, Missing Piece offers the support you need to manage an audit with ease. By providing full ABA billing services, we can ensure all your documentation is consistent and within compliance requirements. Our range of services also includes audit compliance support. If you experience an audit, you don’t have to go through it alone.
Contact Missing Piece today to learn more and get the level of support you need for your next audit.