Dental coding is important for many reasons, including accurately describing the procedures that your office performs and being prepared in the event that an insurance company asks to see more information to ensure you are being compliant. The best time to audit your coding is not when it is formally requested by an insurance company. Instead, it’s before they ever send you a letter!
Understanding Insurance Coding Audits
Receiving a letter from an insurance company can be scary. After all, even if you know that you have standards in place to maintain compliance, there is no way for you to be absolutely certain that every person in your practice has maintained a level of 100% accuracy. Mistakes happen, and a lack of training, an employee who was let go or a failure to update new CDT codes in time could all lead to insurance paperwork that is inaccurate. Compliance coding audits can lead to consequences ranging from reimbursing insurance payments to, in more serious cases of fraud, cases being given to the authorities.
Preparation Is Key
If you are prepared and proactive, you will always be ready to collect records, bring up evidence and hand over patient records to the insurance company. Having a third party like APEX Reimbursement Specialists audit your coding can ensure that your coding practices are appropriate and compliant. Because insurance carriers have such broad databases filled with thousands of dentists, their algorithms can identify when a dentist or practice’s breakdown of procedures appears outside of the norm. While in some cases this indicates fraud, it others there are perfectly valid reasons why certain procedures are being performed more often.
Our team can examine your coding practices and see if you are following best practices. Are your systems updated with the newest CDT codes? Are your records always comprehensive and up to date? Remember that, if things are not recorded on a patient’s chart, in the eyes of the insurer, you didn’t notice the problem, you didn’t do anything to fix it and it effectively never happened.
APEX Reimbursement Specialists Can Help Audit Your Coding
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.