Sometimes we don’t want to do the things that are good for us. Dentist delay, thinking “I just don’t have the time,” or “it’s too expensive” or “I haven’t had a problem so far, why bother?” Why wait until a crisis occurs and you scramble to find the right attorney and resources to help you out of your jam? Outsourcing a chart audit is easy to put off, but it can be extremely useful to dentists and their staff. In a chart audit, qualified auditors review documentation, monitor for ¬compliance, identify risk management areas, and assist with continuing dentist and staff education.
What is an outside dental chart audit?
An outside or external audit is conducted by a third party with no ties to your practice. The auditor reviews documentation objectively, with no preconceived notions of your style of practice. Audits typically take one of two forms – prospective or retrospective. There are advantages and disadvantages to each.
A retrospective audit selects a sample of records from services already submitted and reimbursed. These records are readily available for review so you avoid claims processing delays, but auditing retrospectively can mean that you will have overpayments to correct or disclose.
Prospective (or pre-bill) auditing can help avoid problems with self-reporting. You will be able to ¬correct any documentation or coding discrepancies prior to submission, thus ensuring accurate claims and reimbursement. The ¬disadvantage of a prospective audit is that you will have to hold claims during the review, which may delay billing and payment.
We recommend dentists have internal prospective and retrospective chart audit processes in place. Prospective audits help ensure that only completed work gets billed and also to ensure that ALL work that is completed gets billed (nothing is missed). Retrospective audits typically yield additional work to correct mistakes. However, these audit present opportunities to ensure quality assurance (compliance with recordkeeping and billing requirements) and quality improvement (continuous efforts to ensure better outcomes).
Together these audit processes provide physical evidence to demonstrate a dental practice has a reasonably effective compliance program and deserve due consideration in the face of fraud and abuse allegations. Chart auditing often has an immediate (positive) impact on practice revenue. Given the increasingly aggressive efforts by government agencies to identify and recover overpayments to healthcare providers auditing is essential for establishing an organization’s defense.
What does the auditor do?
The auditor begins by selecting a random sample of clinical records for each provider in your practice. Items commonly reviewed in the audit include the following:
• Chief complaint and stated medical necessity
• Key components of medical and dental history, clinical examination, diagnosis and treatment planning
• Provider and patient identification
• Matching dates of service
• Availability of documentation
• Proper coding
• Benefit eligibility
The auditor prepares an audit findings report, giving detailed information concerning any problems or ¬inconsistencies found during the chart audit. The report includes recommendations to correct these findings.
The auditor schedules a teleconference with you (and your staff, if appropriate) to discuss the audit findings and report, and to provide related educational material.
Why should you have an audit?
A dental chart audit will do the following:
• Ensure that the CDT codes your practice reports are reflected in the services documented
• Verify that your practice is following CDT guidelines along with all applicable Medicaid (if applicable), state, and federal rules and regulations
• Ensure that your practice is receiving proper ¬reimbursement for services provided
• Determine that your dentists and staff are applying the ¬principles of documentation for compliance
• Identify any missed or absent documentation and possible unbilled charges
• Evaluate documentation for risk management exposure not specific to the documentation guidelines
When should you have an outside dental chart audit?
If your practice has never had a dental chart review ¬performed by outside auditors, now is the time. Once you have completed a baseline dental chart audit, you will be able to compare the auditor’s results with your code ¬selections and identify and correct any inconsistencies. From that point on, we recommend dental chart audits every one to two years to stay current with the ever-changing rules and regulations, and to keep your -practice in compliance.
Our goal at Dental Compliance Specialists is to complete your audit in a well-coordinated and timely manner to ensure continuity for your billing process.
We are available to conduct either a prospective or retrospective dental chart audit for your practice. Whether you are a solo practice or multi-office dental group, we have the resources and personnel on hand to make this a positive experience with beneficial results for you. For more information, call us at (817) 755-0035 or (888) 994-4744.