Handling Audit Findings as a Mental Health Practice Owner: Stand Empowered

Navigating the complexities of running a mental health practice often includes unforeseen hurdles. Among them, an audit from an insurance company can feel particularly daunting. But as someone who's been through the process, I've learned an empowering truth: auditors are not infallible. They can, and sometimes do, make mistakes.

Understand the Basics

Auditors are human, and like all of us, they may occasionally err or misinterpret a regulation. While the majority of them undertake their responsibilities with diligence, occasional missteps can lead to unwarranted stress and potential financial implications for mental health practices.

Take Control of Your Narrative: The Power of Due Diligence

Here's the reality: you don't have to simply nod in agreement with every finding. You have the power and the right to question, research, and challenge findings that seem out of place. As practice owners, you owe it not only to yourselves but also to your clients, ensuring the continuation and quality of care you provide.

Here's a step-by-step guide to empowering yourself through an audit:

1. Stay Calm and Organized: Responding emotionally can hinder the process. It's essential to stay calm, collected, and organized. Keep all documents ready and systematically stored for easy access.

2. Dive into the Details: Understand the exact concerns or issues the auditor is pointing out. The clearer you are on their perspective, the better equipped you'll be to address it.

3. Research Regulations: Before accepting any findings, always double-check the regulations cited by the auditor. Familiarize yourself with local, state, and federal guidelines that pertain to your practice. Websites of relevant licensing boards or professional associations often provide these resources.

4. Seek Expert Opinion: If in doubt, consider consulting with a healthcare attorney or a professional well-versed in insurance and mental health regulations. An outside perspective can offer valuable insights and pinpoint where an auditor might have gone astray.

5. Draft a Thoughtful Appeal: If you find discrepancies, draft a well-researched and clear appeal. Include evidence and citations of correct regulations to support your claims.

6. Stay Open to Feedback: While it's crucial to stand your ground, it's equally essential to be open to genuine feedback. Not every audit finding will be in error, and some may offer opportunities to improve your practice.

Continuous Education is Key

The world of healthcare regulations is ever-evolving. It's a good practice to routinely educate yourself and your staff about current standards and regulations, even if it's just a refresher course or workshop.

Wrapping Up: You Have the Power

Facing an audit is never a pleasant experience. But it doesn’t have to be a powerless one. As I discovered, the auditors were using the wrong regulations, a misstep they admitted had happened before. This experience taught me the importance of being proactive, well-informed, and assertive. It's your practice, your livelihood, and your reputation. Stand empowered, stand informed, and always remember: question everything.