We get it: it can be confusing trying to keep up with all of the changes that go on in your world. But as an oral health provider, it’s up to you to make sure that you are operating in an appropriate way, and insurance payers have some rules. If you accept Medicaid or Tricare, then you need to be especially careful, as the government is keeping an eye on your approach, too. We’re here to help you understand your moves.
When you’re ready to take a look at your billing and coding approach, Dental Auditing Solutions in Arlington, TX has the answers. Our team knows that the dental industry is highly regulated, and we like to stay on top of them; they’re liable to change from time to time. So, whether you are a friendly, neighborhood family practice, a large DSO, an advanced oral surgeon, or you help people find a stronger smile in a different way, ask our office about ways to make sure you’re acting in good faith.
When compliance starts to slip, it can have real implications. Find out more about what we do at Dental Auditing Solutions.
Insurance Companies Want To See Proper Documentation
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 is up to you to make sure that they have all of the information, and for each date of service, you will 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. With the end of year upon us, it is time to plan 2026. We can help you with a risk assessment on your documentation and coding.
Also, check your state’s documentation requirements. They need to include as appropriate for the exam code, but comprehensive examinations include:
- Periodontal examination: Assessing the health of the gums and supporting bone structure.
- Dental examination: Evaluating the condition of each tooth for decay, cracks, or other problems.
- Occlusal examination: Checking how the teeth come together when biting.
- Head and neck cancer assessment: Examining the head, neck, and throat for any signs of oral cancer.
- TMJ assessment: Evaluating the temporomandibular joint (jaw joint) for any issues.
- Radiographic examination: Taking X-rays or other imaging to assess the health of teeth and bone below the gum line.
- Salivary function examination: Assessing the quantity and quality of saliva.
- Aesthetic examination: Evaluating the appearance of teeth and gums in relation to the face.
Are You Doing Enough For Your Office?
When you are 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 may have a different view on the subject.
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 is an easy mistake to make, it is 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.
Learn More With Dental Auditing Solutions
Your practice takes work and dedication. So, when your team needs help, we have 3 certified dental coders with revenue cycle experience to help you. Call Dental Auditing Solutions at (972) 459-1508 today.