Every year, your dental practice faces the threat of an audit from an insurance provider. Do you think that you would pass? Many dental practices fail to adequately self-audit their businesses, which can lead to serious consequences if a formal audit occurs. Whether you think you have nothing to worry about or have concerns about the accuracy of your coding, here are some of the signs that your dental practice could benefit from a third-party audit.


What Is a Third-Party Audit?

During a third-party audit, a professional company can complete a review of your office’s practices and procedures, from your charting methods to your insurance claims. When you work with an insurance carrier, your dental practice is always at risk for an audit. These audits are designed to ensure that providers are properly documenting treatment and that the treatment paid for was appropriate for the situation. During an audit, the insurance carrier will request copies of patient records from your dental practice to confirm the necessity of the treatment. A third-party audit can ensure you are maintaining compliance and, in the process, you may even find out that there is revenue opportunity! 

Could Your Dental Practice Benefit from a Third-Party Audit?

  1. Medicaid Compliance: Any dental practice that participates in Medicaid should schedule an annual third-party audit to ensure compliance. Medicaid standards are very strict, complex and change from year to year. Dentists can face civil or criminal charges in the aftermath of a Medicaid audit under the False Claims Act, so what seems like a small error could turn into a big deal.
  2. Chart Irregularities: Are all of your dentists and coders doing a consistent job writing down what procedures were completed and supplying documentation? A third-party audit can complete a random charting review to check for everything that an insurance company would when completing an audit and identify any necessary areas for improvement.
  3. Changes to Your Processes: If you recently made significant changes to how your practice workflow operates, switched coding software or had other alterations to your practice that could affect the accuracy of your claims, a third-party audit can ensure everything is going according to plan.

Benefit from a Third-Party Audit from APEX Reimbursement Specialists

Whether you’re concerned about the potential for receiving an insurance provider audit in the new year or looking for assistance in raising your overall revenue with skilled PPO fee negotiation, 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.