What Happens When Your Behavioral Health Practice is Audited or Subpoenaed – and How To Prepare

Audits and subpoenas may strike fear into the heart of many mental healthcare practice owners—but if you’re well prepared, there’s really nothing to fear. Knowing what to expect if your practice does need to comply with either of these processes can help you feel ready for the real thing.

Benjamin Franklin’s quote, “failing to prepare is preparing to fail,” rings true here. Taking the time to find out what’s required during an audit or subpoena – and how to prepare – is essential for running a successful behavioral health practice. Read on to find out precisely what happens during an audit or subpoena and how you can best prepare your practice for both.

What are audits and subpoenas?

Audits are used to assess and evaluate the level of care offered by healthcare practices. They can be carried out internally as a way for you to review and improve your own processes. An external third party may also carry them out. For example, insurance companies may request to conduct an audit to evaluate compliance, billing practices, and more.

A subpoena is a legal document issued by the state or federal court, and they generally fall into two broad categories:

• Subpoena ad testificandum: orders a person to testify or provide a deposition under oath in court.
• Subpoena duces tecum: orders a person to appear at a specified time and place, bringing with them documents like healthcare records.

The majority of subpoenas received by behavioral health practices are related to:

• Child custody
• Child abuse
• Divorce
• Post-traumatic stress disorder
• Marital issues

Audits and subpoenas are different in that while an audit reviews a broad sample of your records, a subpoena relates to the records of a specific patient. Neither process is unusual within the mental health field, so it’s critical to know what happens during each and how you can best prepare your practice. The ability to respond in a timely and accurate fashion to either is crucial.

What happens during an audit?

If you decide to complete an internal audit, it will give you a significant advantage should your practice be called for a more formal, external audit. Knowing what information needs to be collected and by whom means your staff will be fully prepared and informed if an external audit happens. Sample methods for an internal audit will vary. Still, generally, each practitioner will collect a specific number of records over a particular time period, which another staff member should then review. Having each practitioner review their own records is rarely helpful, so it should be avoided if possible.

It’s a good idea to follow the guidelines you expect an external auditor to use, generally the 1995 or 1997 guidelines. Use your results as a learning opportunity, and identify any areas for improvement as you work as a team to correct any irregularities.

Health insurance audits may involve pre or post-payment reviews. In the case of external audits, these are usually initiated by insurance companies. They will signify their intent by sending your practice a letter with a records request. This authorizes them to view a sample of your records which will be collected similarly to an internal audit.

If you receive a letter notifying your practice of an external review, remember this isn’t unusual. Depending on the size of your practice, you may have a compliance officer who can help arrange the collection of documentation. Treat the process seriously, but don’t panic.

What happens during a subpoena?

Subpoenas can be served personally or posted through the mail. Never ignore a subpoena, and remember that failure to respond could result in penalties, fines, or waiving your rights. Keep in mind that responding to a subpoena doesn’t necessarily mean you’ll have to disclose the information requested, but you will have to provide reasons for not doing so. Not all subpoenas will carry a legal obligation to comply. For example, a subpoena issued in one state may not have any legal bearing over a provider who practices in another state.

If anyone at your practice receives a subpoena, the first step is to consult with an attorney specializing in health law. They will be able to determine how you should respond. You’ll also need to contact your professional liability insurance provider and inform them. And finally, it’s important  to get in touch with the client in question to let them know you’ve received a subpoena. They may or may not be willing to have you release the information, and this is when your attorney’s advice will again be required.

If you do have to release information, this will usually be in the form of:

• Patient notes
• Patient admission forms
• Billing records

Most behavioral healthcare practitioners will have to comply with HIPAA regulations, so you’ll need an authorization form to allow the release of confidential information.

If a client does not consent to the release of their confidential information, you may need to ask your attorney to file a ‘motion to quash.’ This is a request to block or modify the subpoena and will be reviewed by a judge. If a client does not consent to their records being released via a subpoena, the next stage is a court order signed by a judge.

During the subpoena process, make sure you document all relevant actions you take. You may want to note phone calls and file any emails, letters, or meeting records together for easy reference. 

How do you best prepare your practice for audits and subpoenas?

Audits and subpoenas are a fact of life for behavioral health practices, but that doesn’t mean they’re not stressful. Accepting that at some point your practice could be subjected to either can help you decide on the best ways to prepare.

Both of these procedures rely on accurate records, so using a comprehensive EHR built for behavioral health is your best form of preparation. Whereas the right software gives you an advantage, if you’re still keeping paper charts it could mean days of extra work. When comparing EHR software, make sure you evaluate the ability to provide complete and consistent clinical documentation, as that can also impact the ease of completing the audit or subpoena requirement.

Book a demo to learn more about how Valant can minimize this burden on your practice, while also helping you improve your clinical and administrative efficiency.