When you submit a claim, there are multiple edits and people on the other end making sure that you are doing things the right way. That means that if your team has started to become a little sloppy, you could wind up seeing an increasing number of denials, claim review, and requests for repayment. That’s not a good spot to be in as a practice, and it’s a good indicator that you’re ready to make a compliance push.
Here at Dental Auditing Solutions, we help people to understand where they fall short. In the healthcare world, diagnostic evaluation is an incredibly valuable tool, and our office understands that it’s helpful for your practice, too. Regulations are constantly on the move, so if you’re not sure about your steps, reach out to our team. We can help your office to understand what they need to do to stay compliant, and also, why they need to do it.
Staying on top of regulations is tough when you’re focused on your patients. Let Dental Auditing Solutions keep you up to speed.
Are You Providing All The Records?
As a general rule, pay attention to the timeframe and records that have been specifically requested by the payer. If they want to know something, it’s up to you to make sure that they have all of the information. For each date of service, you’ll want to note a few things. If the date in question is a treatment from an exam outside the audit period, include the original exam for the determination of this treatment plan.
Also, check your state’s documentation requirements. They need to include as appropriate for the exam code but comprehensive includes:
1. Periodontal examination: Assessing the health of the gums and supporting bone structure.
2. Dental examination: Evaluating the condition of each tooth for decay, cracks, or other problems.
3. Occlusal examination: Checking how the teeth come together when biting.
4. Head and neck cancer assessment: Examining the head, neck, and throat for any signs of oral cancer.
5. TMJ assessment: Evaluating the temporomandibular joint (jaw joint) for any issues.
6. Radiographic examination: Taking X-rays or other imaging to assess the health of teeth and bone below the gum line.
7. Salivary function examination: Assessing the quantity and quality of saliva.
8. Esthetic examination: Evaluating the appearance of teeth and gums in relation to the face.
How Some Practices Fall Short
When you’re taking some time to improve your office, it can be helpful to look at where your competitors slip up. They experience some of the same issues as you do, and they can be a cautionary tale. While these might seem like little things, payers have a different view.
If you skip some important records, steps, or documentation, insurance payers can use that as a reason for denial. This is one of the most common issues that providers run into, and while it’s an easy mistake to make, it’s still a mistake. Records must also be printed with the provider’s signature, or else they become invalid notes. The patient’s medical history must be included with the provider’s review and documented, as well.
Treatment consents and cost for each service/procedure must be signed by the patient or guardian. Post treatment instructions documented that they were reviewed with patients verbally and provided in writing. If the patient is under 18, most states will not accept that as informed consent, so it needs to be the guardian.
Schedule A Compliance Documentation Review With Dental Auditing Solutions
Would you like to support your compliance program with third party coding reviews? We can be that support team. If you’re ready to renew your billing compliance efforts, we’re here to help you do it well. To find out more about us, or to schedule a time to talk about what insurance payers want, call Dental Auditing Solutions at (972) 459-1508.