Maintaining compliance is essential at every dental practice, as it means the difference between passing an audit with flying colors or facing serious financial penalties. Proper coding is important, and over-coding or under-coding are both common compliance errors. How can you ensure that your dental practice is ready in the event of an audit?


1.      Under-Coding

Some coding professionals are so nervous about over-coding that they end up under-coding. Whenever you perform a procedure or service, it should be accurately represented on the patient’s records and in the bill you send to the insurance provider. Whenever you are not properly representing what happened, you are committing fraud. This breaks the law, breaks the contracts that you made with dental providers and puts your dental practice in a state of non-compliance.

2.      Using the Wrong Codes

Utilizing the wrong CDT code is another one of the most common compliance errors. Every year, new codes are added, outdated codes are removed and other codes are modified or sub-divided. If your billing professionals are using an old version of the CDT manual or your charting codes are not updated, you should ensure that you make a habit of doing so every year when new codes go into effect. If you use the wrong code, you are not only being non-compliant; you are also at a higher risk for being denied when you submit them to insurance providers.

3.      Know Who to Bill

Another common compliance error occurs for more complex procedures and services that could be billed to either a dental insurance policy or a medical insurance policy. Some procedures can be billed to medical insurance instead. Some examples of this include:

  1. Oral infections, cysts or oral inflammation
  2. TMJ appliances
  3. Sleep apnea appliances
  4. Biopsies
  5. Clearance exams before surgery or chemotherapy
  6. Certain bone grafts and dental implants (check with the insurance provider first)
  7. Treatment for jaw pain or bruxism

APEX Reimbursement Specialists Can Help You with Common Compliance Errors

Whether you’re concerned about the potential for receiving an insurance provider audit in the new year or looking for a better way to ensure that all of your employees are maintaining compliance, APEX Reimbursement Specialists is here to help. Contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.