Medicaid Audit Readiness for Therapy Practices: Plan of Care vs Prior Auth | MyTherapyWizard

Medicaid Audit Readiness: Your Prior Auth Is Not Your Plan of Care

Medicaid Audit Readiness - Your Prior Auth Is Not Your Plan of Care - MyTherapyWizard help article card

A practice owner shared that a Medicaid auditor ruled their prior authorization submission "is NOT a plan of care." A prior authorization is a request to the payer. The plan of care is the clinical document it should be drawn from. With audits increasing, owners need each piece in place and connected.

✨ Available on: Teams; Provider Orders and Authorizations require Billing

👥 From the clinician community

Shared in a pediatric therapy practice owners' advocacy group. Names are blurred.

🧩 What auditors commonly ask for

  • The evaluation the plan of care is based on
  • A signed plan of care with goals, frequency and duration, and the prescriber's signature where required
  • The provider order or referral
  • The authorization approval
  • Session notes that support each billed code and unit, signed by the treating therapist and co-signed where required

🪄 In MyTherapyWizard

  1. Create the Plan of Care from the evaluation report. It keeps its signatures and review history.
  2. Track the order in Provider Orders and the approval in Authorizations.
  3. Use Evaluation Tracker to see, for each evaluation, whether the report, signatures, POC, provider order and authorization are complete.
  4. Admin and Office can use Needs Action for missing auth documents, unsigned notes, notes missing a code and any other lifecycle needs.
  5. Set co-sign and modifier rules for assistants in Insurance rules.
Evaluation Tracker showing report, signatures, POC, provider order and authorization status
Plans of Care list with status and review dates

💡 Why it matters: each document links back to the evaluation, so you can produce a complete chart for an auditor without searching.

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📚 See other articles in Practice Owners: Revenue & Compliance here.