Proactive Steps for Insurance Audits

No one welcomes an insurance audit.  But the time to prepare for one is now, long before you receive notification from an insurance company.  Remember that an audit is an attempt to find enough evidence in your chart notes and x-rays to support the treatment you recommended.  Therefore, effective chart notes and films are essential.

Risk Mitigation

This can range from x-rays and chart notes supporting the reason for a crown to comprehensive periodontal charting and films for the treatment of gum disease.  Clinical evidence must clearly denote why a procedure was performed just as films must be diagnostic; otherwise claims will get rejected.

Auditors also want to see that you bill the service you performed.  This can get practices in trouble when they attempt to pacify patients, for example, by billing a regular cleaning when the actual service performed was a periodontal maintenance.  Or if extra surfaces are incorrectly billed on fillings.  Therefore, it’s very important to review the production that is posted for the day to make sure it matches the services provided to patients.

Review Records

Finally, insurance companies look very closely at discounts offered to patients.  If you offer a cash discount, for example, it must be applied to the total amount charged, including the part you bill to insurance.  The same goes for other types discounts.

The best way to survive an insurance audit is to start preparing for it right now.  Make sure your chart notes and x-rays are complete, your insurance billings are accurate, and your discounts are applied correctly.  Make sure your entire team is knowledgeable about how to proactively plan for an insurance audit.

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