Accidental fraud happens. Learn what you can do to avoid an accident:
1. Continue education.
Initial training is important, but repeating protocol can make the message stick. Ensure your staff knows appropriate patterns of practice. For example, a well-meaning hygienist may take radiographs during every check-up simply because he/she wasn’t aware. Make compliance a priority in your practice. Read the Department of Health and Human Services’ recommended compliance programs for small healthcare practices.
2. Review your daily activities report.
Make it known to your employees: You check the report at the end of each business day. You’re not only double-checking for errors, you’re keeping your staff accountable.
3. Consult insurance benefits manuals.
As a dentist, you already know every insurance carrier’s billing procedures differ. For example, Delta Dental dentists are required to submit a claim on every service performed on a Delta Dental–covered patient (even if the procedure isn’t covered). Go the extra mile — consult your patients’ benefit manual before you complete a claim.
4. Control coding errors.
Upcoding occurs when a patient is charged for a more expensive procedure than the one performed. Undercoding happens when a patient is charged for a less expensive procedure. Both mistakes have one thing in common: incorrect coding. Even if you’re not at fault, dentists — and sometimes hygienists — can be held legally liable for fraudulent coding activity. Don’t solely depend on computer-assisted coding (CAC). Many of the codes that offices are required to use can be interpreted in different ways. Double-check codes for yourself.
Whether you’re a dentist or dental professional, anyone can report fraud by emailing [email protected].
Do not include personally identifiable information or protected health information in an unsecured email.