Insurance Billing and Audits
Wednesday, January 16, 2019
Posted by: Bridghid McMonagle | OANP Board Member
We have had members reach out to the board about insurance billing audits in the last few months. One audit had to do with recommending a non-FDA approved treatment and subsequently denying payment for the visit. I had a personal experience where my insurance biller was notified at a Moda training that some plans may require a primary care (as according to Moda) to refer a patient to an ND in order to have coverage. She was not able to attain a list of what particular plans this will affect. If you have patients that are credentialed with Moda, you may want to have them call their insurance company to ask if they now need a referral or have your biller look into this.
If you are offering treatments that are not part of a billable office visit, you may want to consider having separate visits for those with separate cash only chart notes. That is what we are currently doing at our office in order to keep things separate.
Please let us know if any of you have had audits that do not seem to have a reasonable outcome or questions about insurance billing. We may be able to offer some continuing education on this topic if we have enough demand for it.
Either way, we would like to know what is happening with our members and any concerns they are having with in-network or out-of-network insurance plans.
Please review your contracts with your insurance biller so you are clear regarding the contract you have signed. We have not been able to review the chart notes in question but hope to for more information.
Please send any information regarding these types of insurance billing issues to firstname.lastname@example.org.
If you are interested in CE on this topic, please email email@example.com.