Telehealth audits may be triggered by billing patterns, documentation inconsistencies, patient complaints, random compliance reviews, or payer oversight — they do not always occur because the provider did something wrong. While healthcare professionals can’t eliminate the possibility of an audit, good business practices can protect your professional standing if one occurs.
As telehealth has become a more common method of healthcare delivery, oversight has increased. Insurance companies, government payers, employers, and regulatory agencies all have an interest in ensuring that virtual care meets the same professional standards as in-person treatment.
Becoming the subject of an audit does not necessarily mean you’ve violated legal or professional standards, but incomplete, inconsistent, or missing records can make even appropriate clinical care difficult to defend. Approach each virtual encounter with the possibility of an audit in mind, and you’ll stay prepared to stand up to scrutiny.
For telehealth providers, the word “audit” can describe several different types of reviews. Depending on the circumstances, your records may be evaluated by:
Some audits focus primarily on billing and reimbursement. Others determine whether services met the applicable standard of care or complied with telehealth regulations or documentation requirements.
Regardless of who initiates the review, your records often become the primary evidence of what occurred during the time period in question. Detailed documentation can put an audit to rest, but missing or improper documentation can trigger a deeper investigation.
Most clinicians are already accustomed to documenting assessments, diagnoses, treatment plans, and follow-up care. Telehealth requires additional details that may not pertain to in-person office visits.
Depending on your organization’s policies, thorough documentation of a telehealth appointment may include:
Including these details creates a more complete record of the appointment and prevents you from relying on memory if questions arise months (or even years) in the future.
Auditors are usually more attuned to patterns than isolated oversights. A series of identical notes may cause the investigator to question whether your documentation accurately reflects the care provided, or if it was merely copied over. On the other hand, dramatic variations in your level of detail across similar appointments could also draw scrutiny.
Consistently recording the events of each visit as well as the rationale for your clinical judgments will make it much easier to satisfy an auditor’s concerns if you ever need to revisit a moment or defend a decision. Utilizing templates can help ensure you don’t omit critical information, but remember to keep your notes thoughtful and individualized.
Employers often establish internal procedures that go beyond the minimum legal requirements.
If your organization has specific telehealth policies that address recordkeeping, confidentiality, or informed consent, it’s important to stick to these standards — audits can examine whether employees are compliant with both internal and external regulations.
Because telehealth is technology-driven, best practices are subject to change over time. Make a habit of periodically reviewing employer and licensing board policies to make sure you’re up to date.
Many telehealth audits begin with billing issues rather than patient care. Documentation should reflect the accurate level of services billed and the precise duration of the appointment rather than estimates.
Even if you are not the person who ultimately submits the claim, clinicians are still responsible for ensuring that their records reflect the care delivered.
One of the best ways to stay ready for an external audit is to periodically conduct an internal one.
Set aside time to review a sample of your own telehealth documentation with fresh eyes, and ask yourself:
Self-audits can reveal problematic habits and give you a chance to correct them before they become compliance concerns.
Receiving notice that your records are being reviewed can be quite stressful, but a thorough, timely response greatly improves your likelihood of a positive outcome.
If you have received an audit notice, read the request carefully and note all the response deadlines. The process is time-sensitive, and failing to comply will likely result in an unfavorable default finding.
An attorney can help you navigate the process and collect the information you need to respond appropriately. Preserve any documentation you think may be relevant to the request, and avoid altering existing records. Attempting to “clean up” documentation once an audit is underway can create far more serious problems than the original issue.
Allegations that center on regulatory compliance, competence, or professional judgment may extend beyond an employer investigation or payer audit to include your licensing board.
When boards become involved, the stakes exceed your role at your current organization — your ability to continue practicing may be on the line.
It’s wise to seek the guidance of a professional license defense attorney, but waiting until your audit escalates to a board investigation can limit your options. Statements made during an internal audit can follow you into the licensing proceeding, so make sure you fully understand the implications before giving your initial response.
If you’re concerned about the potential scope of a telehealth audit, Landon White Law can help. Involving an experienced attorney sooner, rather than later, will position you for a more effective defense should your licensing board become involved.
