Your Best Defense in a Dental Insurance Audit

What would an insurance audit uncover in your dental practice?  Even if you have nothing to hide, you may still have potential liability.  What typically sinks the ship for dentists is the lack of documentation, and if insurance auditors cannot clearly connect the dots between chart notes and billed procedures, you may be in trouble.

The current issue of Insurance Solutions Newsletter covers insurance audits in great detail.  As the newsletter points out, in the eyes of the law if you did not document it in the patient’s chart, the need for treatment didn’t exist, the treatment was not rendered, and/or you never informed the patient.  This is not a good formula for success in surviving an insurance audit.

Keep in mind that auditors are looking closely at the need for treatment, especially with crown build-ups, treatment for gum disease, surgical extractions, and x-rays.  If your chart notes do not clearly support the reasons for those procedures, you may fail the audit.

Therefore, it’s a good idea to conduct your own in-house audit.  How complete are your chart notes and what would make the notes even better?  How can you modify your approach to ensure chart notes are always complete?

If you have an intra-oral camera, are you using the photos to substantiate treatment—in addition to educating patients?  Consider how you store the images.  Those images could really help during an audit.  Finally, consider how your protocols for x-rays and perio care compare to established guidelines.  If your recommendations fall outside of the guidelines, can you support why?

The only thing worse than an insurance audit is failing an insurance audit.  Look closely at your documentation.  Some fine-tuning could save you an enormous headache and expense.

Learn more about how our dental practice consulting can help your dental practice. Call us at 503-245-0766.

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