Dental providers need to know how to navigate payer systems, because without accurate information, you’re bound to make mistakes. Now that private insurance companies and government agencies are using artificial intelligence tools, too, there are more ways than ever to slip up. But remember that you do have the chance to understand common red flags in dental billing, and that has real power. Talk to a talented team of compliance professionals to find areas where your office could make mistakes.
When you work with Dental Auditing Solutions, you’ve got information on your side. We stay up to date with the latest in billing and coding compliance so you and your team can focus on delivering real results through quality dentistry. There are certain things that payers look for when inspecting claims, so take the time to learn how they can affect you. Because when you become a statistical outlier, insurance companies and the office of the OIG may have some more questions for you.
Knowing payer direction helps your team make precise moves. Schedule a time to talk with Dental Auditing Solutions about common red flags in dental billing.
Statistical Outliers Are Easily Spotted
One of the most important tools that payers have to identify fraud, waste, and abuse is information. By taking a look at the services you perform, they can cross-check that data with that of other providers in your area. Should they see that your office is billing for a higher number of services or those with a higher cost than your peers, they are bound to ask why that is the case.
Sudden shifts in the kind of patients you see can also trigger some alarm bells. When a dental office suddenly starts seeing patients with government-funded payment sources, it can seem like their team is trying to hide fraudulent claims behind upcoding or unbundling. If you are thinking about changing your patient base, let’s talk about how to do it well.
Bulletproof Documentation Is Your Friend
When you’re working with a payer, it’s more important than ever to be accurate. In the world of dental compliance, if something is not documented, it essentially never happened. And now with more advanced tools to throw up red flags, documentation is a key part of your own protection.
Auditors are not only looking for the what, but also the why. That means that when you’re billing for a procedure, they want to see clear notes that demonstrate medical necessity. We can help your team to shore up your documentation so you have stellar clinical notes to rely upon.
Avoid Dental Billing Red Flags With DAS
Payers look at your claims with more scrutiny than before. So, when it’s time to talk about common red flags in dental billing, call Dental Auditing Solutions at (972) 459-1508 today.