BCBS of NC audit - really bad
Hi everyone, this topic is shrouded in shame and I don’t feel comfortable sharing this with my local therapist community. My practice was audited by Blue Cross and 60 records were requested to be sent to them over the last three years. Since I felt I had nothing to hide, I immediately submitted all of the case notes for the dates and people they wanted information on. A week or so passed and the results came back that 0% of my notes were valid. Objectively, I thought that a 90837 was 50 minutes long but came to find out that all of those sessions should have been a 90847. I understand now that 90837s need to be at least 53 minutes long. I have been in the field for a very long time and can’t believe I’m just finding out this information now. Other findings in the report said that my note didn’t constitute medical necessity. It didn’t say why, it was incredibly vague. There were also other administrative issues regarding how my EHR submits claims for supervised associates. I hired a healthcare attorney and it has cost me thousands and thousands of dollars. They asked me to submit all case notes, treatment, plans, and diagnoses for all of the clients on the audit so they could request Blue Cross to re-review the previous notes I sent because I didn’t send any collateral information - I only sent the note for the date they requested. I’ve been waiting for over a month to hear what the new findings are from Blue Cross; however, if I had to guess, they will find 0% of my notes without error which will likely trigger them to extrapolate that all of my claims to them over the last 3 years are unsubstantiated. There are a couple other practices in the area that I’m aware of who have also experienced this. One lost their Blue Cross contract and the other was given a $700,000 recoupment demand. Based off of my research, I’m in the worst case scenario. It’s my understanding that it is an auditor‘s job to find something wrong with every case note/record that is submitted to them. I’m heartbroken and very fearful that I’m going to have to file for corporate bankruptcy. I understand that some people may think that I’m catastrophizing but this is actually very real. Does anyone have any experience with this? I’m trying to stay in the present moment; however, I want to create a Plan B should I have to claim bankruptcy. I own a group practice so this doesn’t just affect me, it affects the other people who work for the practice and hundreds of clients who will be without care should I be forced to close up. They will likely ask for hundreds of thousands of dollars which I do not have.