Our clients have seen a significant increase in carrier demands for SOAP notes (i.e. treatment notes) since 2020. Over the years, insurance coverage policies and payouts have changed dramatically. We believe that insurance companies made these changes to address certain billing practices that have previously been too difficult to police. These practices include:
- Overbilling. Billing too many units (more than 4) per date of service is an audit risk.
- Billing exams too frequently. It’s best to bill exams at least 30 days apart. Some eval is considered implicit in acupuncture; it’s inappropriate to bill an exam on every visit. It may be justifiable to bill an exam when the patient presents a new diagnosis, but billing exams too frequently is an audit risk. Is the juice worth the squeeze?
- Seeing patients too frequently. Insurance companies may only pay one claim per 7-day period.
Insurance companies are concerned about these practices because they can indicate fraud, waste, or abuse (FWA). Would it surprise you to learn that acupuncturists can accidentally commit FWA when they engage in these practices?
The issue at play is whether treatment is medically necessary. To prove medical necessity, the emerging trend is for insurance companies to request medical documentation for review.
Growing Carrier Demand for SOAP Notes
Have you noticed that acupuncture billing is more complicated than it used to be?
Medical documentation requests are increasingly common. Many newer policies require pre-authorization and heavily restrict the diagnosis codes they will cover. Insurance companies use SOAP notes to confirm that treatment conforms to their billing guidelines and policy specifications.
Poor-quality SOAP notes are likely to be rejected. Hand-written patient documentation has a high rate of denial. This is especially true for MVA (motor vehicle accident) and WC (workers’ comp) claims.
How to Get Paid the First Time
Type your SOAP notes
To be plain, mailing hand-written medical documentation to an insurance company is a waste of paper and postage. Carriers are far likelier to accept typed documents.
Indicate start and end times
Your SOAP notes should indicate the start and end times for each unit. For example:
- 97810. Start 1:00pm / End 1:15pm.
- 97811. Start 1:16pm / End 1:30pm.
Omit seconds
Your first unit might end at 1:15:33pm, with the second unit beginning at 1:15:47pm. Round to the minute; omit seconds. Otherwise, the carrier will deny the claim.
Start and end times should not overlap
If the end time of one unit overlaps with the start time of the next unit, the carrier will deny the claim.
- Good: 97810 from 1:00-1:15pm / 97811 from 1:16pm-1:30pm
- Bad: 97810 from 1:00-1:15pm / 97811 from 1:15pm-1:29pm
Need help with SOAP notes?
Contact us if you have questions regarding SOAP notes. We’re happy to provide our clients with a Google Docs template for electronic SOAP notes, and review them 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.