Insurance companies have the right to request documentation to verify the medical necessity and appropriateness of services billed by a mental health provider. However, it is generally not appropriate for an insurance company to require a provider to submit all of their patient’s records in an audit.
In most cases, insurance companies will request specific information related to the services provided, such as progress notes, treatment plans, and diagnostic assessments. The insurance company may also request additional documentation, such as authorization for treatment, to verify that services were provided in accordance with the terms of the insurance policy.
It’s important for mental health providers to be aware of the requirements and limitations of insurance audits and to protect the privacy and confidentiality of their patients. Providers should only submit documentation that is necessary to support the services provided and should not disclose information that is not relevant to the audit or that may compromise patient privacy.
If a mental health provider is unsure about the requirements or scope of an insurance audit, they may wish to consult with their professional association, legal counsel, or an insurance billing specialist to ensure that they are complying with all applicable laws and regulations.
Some insurance companies are willing to accept a written summary of treatment in lieu of progress notes – if you are uncomfortable providing the full medical record, then it is strongly recommended to reach out to the insurance company to see if they would be willing to accept a summary instead.
Please note that the content provided in this blog post is intended solely for informational purposes. While we strive to provide accurate, up-to-date and helpful information, the content should not be used as a replacement for professional advice.