It’s a turbulent time in the insurance business, to say the least!
As you have undoubtedly noted, the insurance companies have become more persnickety lately. This makes insurance billing a bit more complicated — especially follow-up.
Carriers Increase Requests for SOAP Notes
Many of our clients regularly submit claims to United Healthcare. Recently, they began to report a significant increase in the number of carrier requests for SOAP notes (i.e. treatment notes).
This appears to be a growing trend: many newer policies require pre-authorization and heavily restrict the diagnosis codes they will cover. SOAP notes are being used to confirm that treatment conforms to policy specifications.
Along with the increase in requests for SOAP notes, we’re seeing greater pushback and more claim denials based on the quality and content of the notes.
This is especially true for MVA (motor vehicle accident) and WC (worker’s comp) claims.
How to Get Paid the First Time
The emerging standard for SOAP notes is to indicate precise beginning and ending times with no overlap.
Realistically speaking, billing 1 unit (15 minutes) of acupuncture might not be exactly 15 minutes. But if your SOAP notes indicate the first unit (97810) for 1:00:00-1:15:33pm and the second (97811) from 1:15:34-1:30:17pm, the carrier would deny the claim.
Carriers don’t want to see overlap in your times — they want you to round up or down. In this case, the start and end times for the first unit should be 1:00-1:15pm, and 1:16-1:31pm for the second unit.
It’s pedantic and imprecise, to be sure — but this is the current norm. Over time, and as carrier systems stretch to accommodate the realities of acupuncture treatment, we anticipate that carriers will be likelier to accept greater accuracy in start/stop times.
Contact us if you have questions regarding SOAP notes. We’re happy to provide our clients with a template for electronic SOAP notes (greatly preferred over handwritten SOAP notes), and review SOAP notes before submission to confirm that they meet the carrier’s basic requirements.
Don’t be shy! Reviewing SOAP notes prior to submission is easier — and less frustrating! — than fixing documentation problems during the followup (FUP) process.