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32: Payment Audits in Speech Therapy Private Practice

How to start a speech therapy private practice

Going through an audit in speech therapy private practice can be frustrating, time consuming and scary (but it doesn’t have to be).  In this episode, I reveal a few items that a financial auditor will require from you as a provider plus give you important insight to required documentation that will prove the speech therapy visit actually occurred.  I first learned about this piece of documentation (called a signed visit log) from my good friend, Bob Herrmann who owns a very successful clinic in Surprise, AZ called Team4Kids.  Have you ever been audited?  Please comment below and share your thoughts on audits in speech therapy private practice.

In this episode:
01:40 – Listener Statistics
02:15 – Top states listening to the podcast
03:55 – Billing or credentialing services
04:08 – Financial audits
05:58 – Honesty and Integrity
08:04 – Visit documentation

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You want to make sure you’re doing things appropriately. So again honesty and integrity those are the two main factors when you have your own Speech therapy private practice and so when you do get audited and it will happen eventually you’re ready for it. So I want to give you some insight to a financial audit. Sometimes they’re caught a post payment auditor or a post payment review. And you’re going to see when the auditor does contact you. You want to be respectful, you want to be kind because again that person is doing their job. They have a boss and they’re just trying to get information to give to their higher ups so you can get through the process. So again you want to stay calm, do the right thing, be respectful, be concerned, be honest and be forthcoming.

[Commercial]

Well, Hello everyone! You’re listening to the Speech therapy Private practice Startup Podcast; this is episode number 32. My name is Kyle Meades and I’m a speech pathologist since 1993 and these podcasts are designed to help you improve your business and your life one podcast at a time.

Welcome back to the show everyone. Thanks again for all the emails and all the questions. And as of today, today is Saturday December 2nd 2017. We have well over twenty six thousand four listeners to the show. And I’m really happy you guys are out there getting valuable information. You’ve heard me say it time and time again value is what you get in the absence of money. These podcasts are free for you and if you are enjoying them would you please help others find the podcast easier and just go to iTunes or on the Android platform. The Google platform and leave 5 stars so others can find the podcast easier and get the same benefit.

Now we have many listeners from around the world. Currently the United States tops the list and we’ve got Japan then Australia, United Kingdom, Canada India, Germany, South Africa and then Singapore. Now when you look at the listener base just in the United States it looks like the West Coast California topping the charts. Then we’ve got Texas, New York, Florida, Arizona, Illinois, Pennsylvania, Maryland and then New Jersey. So those are the top states listening to the podcast and again I’m glad you are here and there’s something that you want to discuss with me just reach out and shoot me an email and you can find me at privateslp.com/contact.

Also too if you need help scaling or growing your own speech therapy private practice go to privateslp.com/coaching there you’ll find many different ways to get help. There’s an online platform called the All Access Community that’s where you have access to me online and we have live webinars and I will help you as much as humanly possibly can. The current members they hear from me and we have phone calls and webinars and we discuss current issues in their private practice. So don’t reinvent the wheel if you need help with your private practice privateslp.com/coaching. There is another option available for coaching and that’s where you’re flying to Tucson. That’s called The Perfect student. Again all this can be found on the privateslp.com/coaching website there so just go ahead and have a look.

Also too if you need assistance with your billing or collection. We also have another service available if you need help with your billing or credentialing services just reach out to me kyle@privateslp.com put billing in the subject line and I’ll get back to you. We can discuss that.

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So today I wanted to talk about financial audits. Now you want a bullet proof and audit proof your business because you never know when you get that phone call or that letter in the mail that says you’re under a financial audit. So again a lot of people out there they’re scared to start their own Speech therapy private practice for this reason alone.

People are scared of big government agencies like the IRS or Medicare or Medicaid. People are scared that they’re going to be audited and you have nothing to worry about if you follow the rules and audit proof your business. Again you have to be honest and you’ve heard me say it time and time again you have to be honest and you have to do things the right way because again the squeaky wheel will get the grease. You can’t steal from the government or from other people. I know in our Private practice sometimes we’ll get paid twice. We’ll get the pay from the patient then we find out that a week later when we get that EOB in the mail on that check in the mail that we got paid not only from the insurance company we got paid from the patient. So I’ll always write that check and give the patient’s money back to them because that’s their money. You want to always do the right thing.

I have some people that ask me what are the magic codes for Speech therapy and how do you build this and what’s the best way to jug all these CPT code so you can maximize your reimbursement. That’s really the wrong way of looking at your speech therapy Private Practice. You want to do the right thing. Of course you don’t want to leave money on the table you want to make sure you’re billing in capturing your time appropriately. But you can’t just sit there and bill and expect to get paid.

You want to make sure you’re doing things appropriately. So again honesty and integrity those are the two main factors when you have your own Speech therapy private practice and so when you do get audited and it will happen eventually you’re ready for it. So I want to give you some insight to a financial audit. Sometimes they’re caught a post payment auditor or a post payment review. And you’re going to see when the auditor does contact you. You want to be respectful, you want to be kind because again that person is doing their job. They have a boss and they’re just trying to get information to give to their higher ups so you can get through the process. So again you want to stay calm, do the right thing, be respectful, be concerned, be honest and be forthcoming.

You’re going to find that the audit will be inclusive of a period of time like a range of time for let’s say the last 90 days of service for these patients and the auditor will provide you a list of consumers names for instance there will be 25 names on a spreadsheet and they want the last 90 days. They want proof that the visit occurred. They want proof that the visit duration was appropriate. They want proof that the person seeing the patient was licensed at the time of treatment. They want proof to substantiate that payment because if you can’t prove that the visit occurred then the auditor will submit that to the insurance company and take that money back.

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So again you want to do the right thing, be upfront, be honest and do some of these things that I’m going to share with you so you can keep your money and pass that audit. So again you’re going to look:
1. For a period of time in a range of time.
2. You’re going to be contacted by the payer, so the payer can be a private insurance company that can be a Medicaid company it can be Medicare or can be maybe a state that you have a contract with so they’re going to contact you via email or by phone.

Now again the main thing they’re looking for is proof of the visit and that’s got to be substantiated by visit documentation. Now what is visit documentation? How can you prove that you or someone who works for your company was at that visit? How do you know that the visit actually took place? So the way to do that is you want to have what’s called a visit log. So when you have a visit log that shows the time the visit started and the time the visit ended. Now also to it will show if the therapist had the visit or the patient cancelled the visit or if the therapist cancelled the visit or if the therapist went out and let’s just say the family wasn’t there and there was a no show. So that is something that you want to have. We have these forms in the private SLP all access community so this is already done for you. But the visit documentation should include some sort of log to justify those aspects of the visit. Also the auditor would like to see how long was the visit again. You’ve heard me say it time and time again Speech therapy when you bill insurance companies or most of the insurance plans its CPT Code 92507. Don’t forget that’s a non-timed code.

But some contracts state that that code would be timed. It’s rare that you’ll see that. But for the state of Arizona some of those plans do want you to provide an hour’s worth of service. So if you see the person for an hour you bill one unit. If you see them four and a half an hour you them a half a unit. So again you can have words and semantics in your documentation that say one unit equals 60 minutes of patient therapy clinical documentation collaboration with other therapists and family members and ongoing training. Or it can say the visit took place from 1 to 2 O’clock. Also the auditors going to want proof that the person providing the treatment had a valid license to practice Speech pathology in that state during that treatment session and then also to cover all of that you can also have what’s called a timesheet. So when the therapist turns their timesheet to you the owner at the end of the week it’s got the consumer’s name, the data service and how many units were built you’re how long that session was, whatever your contract states. So again all those things I’ve mentioned right there will help you pass an audit. So again do the right thing, be honest, be open and always be mindful of doing the right thing. Again the last thing you need is a private practice owner is to give that money back and then you’re in a loss because the therapist that works for you has already been paid but then you’ve got to give that money back so you be in the negative.

I hope this has been helpful for you regarding audit proofing your business if you have any questions whatsoever reach out to me at kyle@privateslp.com or privateslp.com/contact. And as always thank you for listening.

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