Clinical Due Diligence


Whether you’re drilling in a patient’s mouth or making notations in their chart, accuracy matters a great deal. When editing patient records, it is vital that dentists always accurately record what was done, even if the results were not notable. Clinical due diligence is essential to maintain a dental practice that is protected from any insurance provider or third-party audit, or when evaluating a new practice for purchase.

In Your Personal Practice

A patient records review is an effective way to determine whether or not your practice is meeting clinical due diligence benchmarks. When insurance companies deny claims, and it’s time to resubmit, do you have all of the necessary paperwork to prove that the work you did was appropriate? A third-party audit, like those offered by APEX Reimbursement Specialists, can look through both front-office paperwork and patient records.

A patient record review is a thorough look at the files of several patients, chosen at random. We will look at all components of the chart, including:

  • Patient health history
  • Baseline charting of examination findings
  • Diagnosis
  • Treatment plan (caries examination, periodontal evaluation, etc.)
  • Radiographs and X-rays
  • Progress notes
  • Patient financial ledgers

The charts will then be examined to see if they include all critical legal and healthcare insurance paperwork documents, including:

  • A signed informed consent form
  • Office privacy notice
  • Financial agreement
  • Signed HIPAA paperwork, including who can be granted access to PHI

The absence of one of these documents could lead to difficulty being recredentialed, trouble during an audit or even legal trouble if a patient brings a complaint and you lack proper supplementary evidence.

When Evaluating a New Practice

Clinical due diligence is also essential when evaluating a new practice for purchase. Just like a third-party audit can assist in making sure that your practice is operating with all proper procedures in place, a third-party audit can do the same for a practice you are looking at purchasing or partnering with. Patient chart examinations are an illuminating glimpse at how the practice operates. Does the seller’s treatment philosophy mesh with yours? Were the procedures billed for actually performed? When looking at radiographs, do they coincide with what is noted on the chart? A discrepancy here and there doesn’t always point to a bigger problem, but consistent lack of attention to detail is a big red flag.

APEX Reimbursement Specialists Can Assist with Your Clinical Due Diligence

If you want to learn more about how APEX can help your practice improve your numbers and gain more insight into how you’re doing, contact our team today by calling (410) 710-6005. We look forward to working with you to make your practice a more profitable place.