NASW Shares Legal Issues in Health Insurance Audits
NASW National’s “Legal Issue of the Month” article discusses some of the issues involved in retrospective audits of mental health records. A retrospective audit occurs when a health insurer reviews past paid claims on a case by case or aggregate basis. Many provider agreements give health insurers the right to audit practitioners’ records. A retrospective audit is initiated by a letter from the health insurer or a third party acting on its behalf, usually requesting medical records from the practitioner in order to conduct an audit or review. When an audit notification is received, a social worker generally will have to determine whether it is necessary to comply with the record request based on the terms of the provider agreement.
Read the Complete Article
(You will need to log on to the National NASW Web site to view the article)