Dental Coding Audits

Dental practices should periodically audit their coding to minimize compliance risk and optimize revenue. Many private payers, Medicaid’s Special Investigative Units (SIU’s), and the Department  of Justice have had recently increased their focus on compliance, especially since children’s dentistry is now covered by the Affordable Care Act, a/k/a “Obamacare”. They are auditing dental practices with greater frequency to detect fraud, waste, and abuse. These compliance audits can lead to large recoupment payments from practices. In our experience, many practices that are caught for fraud aren’t purposefully committing criminal acts, they are simply victims of deficient coding or documentation knowledge. Periodic coding audits will help you catch these deficiencies in your practice’s coding or documentation skills before a payer audit, giving you proper time to fix any issues.

 

Most dental providers never receive proper training in documentation and coding or delegate this task to untrained receptionists. Our audits commonly uncover documentation deficiencies, which can inadvertently lead to lower payments and missed revenue as well as legal exposure. We often identify cases in which providers properly document their services but aren’t coding for every procedure they perform, which can also lead to lower payments.

 

Our years of experience in performing coding and auditing projects as part of dentists’ legal settlements with the Office of the Inspector General and The Department of Justice have given us a deep understanding of both the risks that practices face and the importance of prudent and early action. Accurate coding requires walking a fine line. Your practice wants to optimize revenue by accurately coding for each service rendered, while simultaneously ensuring that your coding and documentation aren’t opening the practice up to any compliance issues. The Coding Network’s dental audits will help you determine just how accurate your coding is and what effect it is having on your compliance risk and revenue cycle.

Latest Blog Posts:

  • Orthopaedic-Surgery

CPT 2018 Changes for Orthopaedic Surgery

January 15th, 2018|Comments Off on CPT 2018 Changes for Orthopaedic Surgery

CPT 2018 Changes for Orthopaedic Surgery: It’s all about that Spine……almost

By Heidi Stout, CPC, COSC, CCS-P

 

Not much will change for orthopaedic surgery coding in 2018.  Most of the changes in CPT 2018 to the Musculoskeletal […]

  • 41728339 - close up of patient and doctor taking notes

Repeal of MIPS – Recommendation to Congress, MedPAC 12 to 4 Vote

January 13th, 2018|Comments Off on Repeal of MIPS – Recommendation to Congress, MedPAC 12 to 4 Vote

A top Congressional advisory body has voted to recommend that Congress repeal the Merit-based Incentive Payment System (MIPS) and replace it with a simpler quality reporting system that would not be mandatory in […]

  • SKAFF+DENTIST

Charleston dentist sentenced to five years in federal prison for health care fraud

December 18th, 2017|Comments Off on Charleston dentist sentenced to five years in federal prison for health care fraud

A Charleston dentist who falsely billed West Virginia Medicaid for more than $700,000 was sentenced today to 5 years in federal prison. Skaff, a dentist, admitted that he falsely inflated his billings (a practice commonly known as […]

  • mitchell-and-residents-730x564

Utah Pain Doctor and Medical Practice Settle Medicare Fraud Claims

November 5th, 2017|Comments Off on Utah Pain Doctor and Medical Practice Settle Medicare Fraud Claims

On July 21st, 2017, Jahan Imani, M.D., and Intermountain Medical Management, P.C., (IMM), a Utah based pain management specialist and his practice, entered into a $399,895.92 settlement agreement with OIG. This resolves allegations that IMM, […]