Every dental practice and dental school is trusted by patients, insurance companies and the government to properly code and bill procedures. When that trust is broken and the dental practice breaks the rules, there are serious consequences. Another recent case at a Las Vegas dental school is bringing more attention to the problem of overcoding.
What Is Overcoding?
Overcoding is when a practice utilizes a billing code that gives you a higher reimbursement rate than the one that would be most appropriate for the services actually performed. For example, seeing a patient for a simple matter (popcorn stuck in the teeth and gums) and billing them for an hour-long visit and examination would be improper. The same thing could occur if a pharmacist gave a patient the generic version of a drug but billed the insurance provider for the brand name, higher-cost drug. Obviously, overcoding is a form of dental fraud and non-compliance.
Trouble at a Las Vegas Dental School
As a recent article in Becker’s Hospital Review detailed, The University of Nevada, Las Vegas School of Dental Medicine might have overbilled insurance companies and patients by thousands of dollars. One of the former leaders at the faculty practice, Dr. Devore, billed patients who received simple extractions for expensive surgical extractions three times more often, which was flagged as irregular.
Numerous staff members were found to have contributed to the billing abnormalities, but Dr. Devore was found to be the most egregious offender. Analysis found that over $400,000 of his $600,000 income came from patient billings. While Dr. Devore claims that he did not overcode anything, the school is now paying the price for these striking irregularities.
What Can Your Practice Do?
This case shines more light on the importance of regular third-party audits to confirm that all billing practices are being followed properly. All of your coding should be accurate and follow best practices. Not sure if your practice is up to snuff? APEX Reimbursement Specialists is here to help.
APEX Reimbursement Specialists Can Help You Maintain Compliance
Whether you’re concerned about the potential for receiving an insurance provider audit in the new year or looking for a better way to increase your revenue, 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.