Coding Q&A: When an insurance carrier requests patient records...

Published: 2009-10-20 14:29:34
Author: Marty Kotlar | Chiropractic Economics | October 2009

Q: I just received a letter from an insurance company requesting copies of exams, SOAP notes, and financial records on 14 patients. What do you recommend I do?

A: The following is a checklist on how to handle a similar situation if it occurs.  

Check the names of the patients listed in the letter you received from the carrier. Are they your patients? Often times, providers receive correspondence from insurance carriers that were not intended for them to receive.

Pull the patient charts and being reviewing them. Check to see if the dates of service in your chart notes coincide with the dates of service the carrier is requesting. If the answer is yes, you can continue with the remainder of the checklist. Letís assume the answer is yes.

After your initial chart review, ask yourself if youíll be able to gather all of the requested information by the request deadline. Typically, carriers request patient charts to be submitted within 30 days of the date on the letter you received.

This may or may not be reasonable. If itís not, call the carrier and ask for an additional 30 days to submit the requested information.

Making this call may also give you the opportunity to speak to the lead investigator. Do not, however, provide any information to the investigator that can hurt you. Some attorneys may recommend you not speak to the investigator at all; however, it doesnít hurt to speak with the investigator about an extension.

It also doesnít hurt to ask the investigator why you were chosen for this chart review. But remember, do not volunteer information that can link you to any wrongdoing.

After copying the requested information, itís typically recommended you provide the carrier with a cover letter or treatment summary for every patient.

A summary of the care you provided helps the carrier understand your clinical approach. However, treatment summaries are not required. If you think your SOAP notes and treatment plans are sufficient, itís not necessary to create treatment summaries as they can be time consuming. (For an example of a treatment plan, visit www.ChiroEco.com/treatment.)

Full story