From Intake to Audit, Part 3: Medicare, Medicaid, TRICARE, and Audits
When you run a solo practice, you are the counselor, the biller, and the compliance officer, and every records request comes to you. This course shows you how Medicare, Medicaid, and TRICARE differ on the rules that decide whether you are paid and what you may collect: enrollment and opt-out, mandatory Medicare assignment, the ABN, Medicare Advantage authorizations and appeals, Medicaid managed care, EPSDT and payment in full, TRICARE certification paths, referrals, the Noncovered Services Waiver, video-only virtual health, East and West regional rules, and rural health clinic and FQHC billing. It then helps you build an audit-ready routine a one-person practice can sustain, with note deadlines, record retention, and a quarterly self-audit, and gives you a step-by-step plan for the day an Additional Documentation Request or payer records request arrives, including appeals for each payer and overpayments you find yourself. Templates, a scored self-audit spreadsheet, and two practice games turn the rules into habits.
5
CE Hours
4
Modules
22
Quiz Questions
4
Est. Minutes
What you'll learn
- Compare how a counselor becomes eligible to bill Medicare, Medicare Advantage, Medicaid, and TRICARE, including the rules for pre-licensed associates.
- Select the correct pre-service coverage notice (ABN, Medicare Advantage organization determination, or TRICARE Noncovered Services Waiver) for a service that may not be paid.
- Apply payer-specific telehealth, timely filing, balance-billing, and coordination-of-benefits rules to sample claims.
- Design a compliance routine for a solo practice that includes note-completion deadlines, a written retention policy, and a quarterly chart self-audit.
- Construct a deadline-driven response to a records request or audit letter that protects separately kept psychotherapy notes.
- Identify the correct appeal track and filing window for Medicare, Medicaid managed care, and TRICARE determinations.
- Explain the federal duties that apply when a counselor discovers a Medicare or Medicaid overpayment.
Who it's for
Licensed professional counselors and clinical mental health counselors in solo or small-group practice who bill, or plan to bill, Medicare, Medicaid, or TRICARE; pre-licensed associates; and clinical supervisors who oversee associates' billing and documentation. Content level: intermediate.
Approval & credit
CounselorReady is an NBCC-Approved Continuing Education Provider (ACEP #7760). This course awards 5 NBCC-approved CE hours; a certificate is issued on completion. Programs that do not qualify for NBCC credit are clearly identified. CounselorReady is solely responsible for all aspects of the program.