Audits are becoming more common in addiction treatment and professionals need to be prepared when a Special Investigations Unit (SIU) walks in the door.
Los Angeles, CA (PRWEB) March 02, 2017
The American Addiction Treatment Association (AATA) is hosting a lunch and learn for professionals in the addiction treatment industry entitled: Special Investigations Unit (SIU) – What to Know in a Commercial Payer Audit.
The word “audit” can raise an alarm in any business, but in addiction treatment, insurance companies and state and federal governments are increasingly scrutinizing the industry for fraudulent and abusive practices.
“Audits are becoming more common in addiction treatment and professionals need to be prepared when a Special Investigations Unit (SIU) walks in the door. The consequences of noncompliance are significant, from insurance companies refusing to reimburse for services to civil litigation leading to money damages and penalties, to criminal investigations and potential jail time. Even if you have done nothing wrong, an audit or investigation can be costly and time consuming,” said Zachary Rothenberg, Partner at Nelson Hardiman and featured seminar speaker. “Many of these investigations fall under the terms of state and federal ‘false claims’ statutes, which generally prohibit the preparation and/or submission of false claims for payment to private insurers or to state and federal programs such as Medicaid and Medicare. These statutes impose serious penalties, including triple damages, on violators, and give ‘whistleblowers’ a financial incentive to report fraud because they are entitled to a portion of any recovery.”
Addiction treatment facilities need to be extremely careful about their billing practices.
“The most important thing for anyone in a role like this is to always ensure that everything about the services you are billing is a 100% accurate representation of the services that are being provided, and that you stay up-to-date with all payer changes and requirements,” said Frank Brady, Director of West Coast Operations for Infinity Behavioral Health Services and featured seminar speaker. “It should be assumed that every single patient's chart will be reviewed at some point. It is important that each patient's chart tells the story of their treatment without any questions left unanswered. This means more than matching CPT codes with a treatment plan. This means that providers understand what procedure codes represent and that they understand what payers expect at different levels of care. Unfortunately, behavioral healthcare is a very young industry and simply asking colleagues for advice is not sufficient. I would encourage anyone in such a role to educate themselves, or involve a knowledgeable industry professional who can do so. If you are billing appropriately for the services you are providing, you are more likely to endure long-term success than a provider looking for the right combination of procedure codes to get paid as much as possible.”
Compliance with current regulations is critical. “There are different layers of compliance that providers should be concerned with when it comes to financial arrangements. To ensure compliance with the law and also to meet the expectations of commercial health insurers, it is important to implement sound policies and procedures which govern the financial arrangements made between providers and patients,” Brady added. “Failure to formalize these processes with diligence may result in conflict with payers if patients are not required to pay their portion; or even worse, conflict with the law if a provider is engaged in illegal forms of patient inducement.”
The Special Investigations Unit (SIU) – What to Know in a Commercial Payer Audit Seminar, which features speakers Zachary Rothenberg, Frank Brady, and Max Sirianni, will be held in Los Angeles at the Nelson Hardiman Conference Facilities on April 13th, 2017 from 11:00 AM – 1:30 PM. Lunch is included as well as time for Q&A with the presenters. Seats are limited.
This seminar is part of an ongoing educational series offered by AATA, which offers regulatory compliance resources for eight states: California, Arizona, Texas, Florida, New York, Illinois, Tennessee, and Georgia. AATA plans to make content available to its addiction treatment industry membership for all 50 states over the next 12 – 18 months.
AATA Membership provides a variety of benefits and is available to recovery industry professionals, owners, and operators to navigate the evolving clinical and regulatory landscapes. For more information, visit http://www.addiction-tx.com, email, or call (888) 958-2282.