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:

  • 1015_malo_top15_222

Hospital in Macon will pay $2.5 million to settle billing allegations

August 7th, 2017|Comments Off on Hospital in Macon will pay $2.5 million to settle billing allegations

The Navicent Health Medical Center has agreed to pay $2.5 million to settle federal allegations that it submitted bills for ambulance trips that were either medically unnecessary or inflated. The settlement follows a 27-month investigation, […]

  • carolinas-healthcare-system

Carolina Healthcare System Agrees To Pay $6.5 Million

July 6th, 2017|Comments Off on Carolina Healthcare System Agrees To Pay $6.5 Million

The Charlotte-Mecklenburg Hospital Authority, dba Carolinas Healthcare System (CHS), has agreed pay the Government $6.5 million according to U.S. Attorney Jill Westmoreland Rose. This was to resolve allegations that the company violated the False Claims […]

  • service-orthopedic

Norman Orthopedic Practice Pays $1,537,796

June 28th, 2017|Comments Off on Norman Orthopedic Practice Pays $1,537,796

Orthopedic and Sports Medicine Center-Norman (collectively “OSC”) have paid $1,537,796 to settle civil claims stemming from allegations that they submitted false claims to Medicare, Medicaid, the Department of Veterans Affairs, and TRICARE. In reaching this settlement, OSC […]

  • GenericFraudHFN_28

Richmond Hospitalist Group Settles Federal FCA Case

June 19th, 2017|Comments Off on Richmond Hospitalist Group Settles Federal FCA Case

Fredericksburg Hospitalist Group, located in Richmond, VA, and fourteen of its member shareholders have agreed to pay nearly $4.2 million to settle a federal FCA case brought under the “qui tam whistleblower” provisions. Dana J. Boente, […]