Tuesday, July 26, 2016

Protect yourself from an insurance audit with proper documentation

Have any of you been noticing your X-rays being denied more frequently than usual or have you been subject to an insurance audit on excessive X-rays? It is
happening and if you have not seen it yet, you will soon. I want you to be as prepared as possible when the insurance companies come knocking on your door.

When I work with dental teams, I often see the practice using the Continuing Care system in Dentrix as a way of tracking when a patient is due for his or her next series of X-rays. Your recare system is the most powerful system in your practice and it is the lifeblood of your practice. If you let patients fall through the cracks, you are letting thousands of dollars walk out the back door and your patients may suffer from unscheduled treatment. I do not doubt that your team has the best patient care at heart when you use the Continuing Care system in Dentrix as a way of staying focused on staying current on your diagnostics for your patients. However, taking X-rays is not based on the insurance frequency nor your “office policy” on BWX frequency.

Diagnostics is the reason for taking X-rays, not frequency. With this being said, your clinical documentation needs to reflect this in order to defend yourself in the case of an insurance denial or insurance company audit. I recently attended a study club meeting presented by my good friend and colleague, Teresa Duncan.  She stressed two main points in your clinical documentation.

Since I help dental practices all the time with their custom clinical note templates, there are two things you need to include in your template.  This can easily added to your clinical note template with a checkbox prompt so you can choose the variable answer for each patient.
  • X-rays were reviewed by . . .
  • X-rays are needed because of . . .

One office I know has made a new office policy that the doctor comes into the exam before the hygienist or dental assistant starts to take the X-rays so they can be properly diagnosed. I have another office that has changed up its recare appointments so that the X-rays are diagnosed at the current appointment and then scheduled with the next recare visit so they cover all their bases.

Now, I am not suggesting that you stop using the Dentrix Continuing Care system for tracking X-rays. However, I am suggesting that you add the risk assessment and diagnosis in your clinical note to substantiate the taking of the X-rays.

If you would like the full report developed by the ADA and the FDA on this topic, please email me directly and I will send it to you.

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