Most medical practitioners and dentists are wondering why healthcare audits are being frequently conducted. In 2010 the FBI estimated that nearly 10 per cent of total money spent on healthcare arises due to fraud. Since then; healthcare audits have been conducted more frequently to identify fraud, recoup overpayments and stop fraud. Therefore, it is likely that your dental practice will have to be audited.

WHY MY DENTAL PRACTICE?

You will probably be alarmed after receiving a notice of an imminent audit. So, why your practice? First, take the audit as a good thing, since it provides an opportunity to demonstrate to state regulators that your patients are getting high-quality services. Second, acknowledge that the audit aims at checking the dental plan, and they don’t focus on a specific dental practice.

TRIGGERS OF AN AUDIT

The most significant trigger for any dental claim audit will be data mining. The process of checking large databases to come up with new information. Another trigger is when an insurance or state insurance company files a patient’s complaint.

HOW TO PREPARE FOR AN AUDIT

Start by assuming your dental practice will have to undergo an audit at one point. Thus, improve your documentation. Also, conduct regular internal checks done by an independent hired party. A third-party auditor is less likely to be biased; hence will offer better feedback than an internal auditor would.

WHAT AUDIT RESULTS MEAN FOR YOUR PRACTICE

During an audit, about 75 patient files will be evaluated. If everything is in place, there is no further action. On the contrary, if auditors discover incorrect billing, your practice will be owing to insurance providers some money.

If the worst happens and the auditors reveal consistent errors in your billing practices; they might report your practice with fraud. A fraud report will warrant a criminal investigation which could ruin your business and reputation.

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