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How Your Practice Can Avoid Non-Intentional Dental Fraud

July 28, 2016 By Kim Elmore

Accidental fraud happens. Learn what you can do to avoid an accident:

Accidental errors happen. Learn what you can do to avoid an accident:

• Continue education.

Initial training is important, but repeating protocol can make the message stick. Ensure your staff knows appropriate patterns of practice. For example, your office may submit multi-stage procedures on the preparation date, when in fact, the insurance carrier requires the completion date.

• 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.

 • Consult insurance benefits manuals.

As a dentist, you already know every insurance carrier differs in billing procedures. For example, certain procedures require diagnostics (x-rays, periodontal charting, etc.) to be submitted with the claim. Go the extra mile—consult the insurance carriers dental benefits manual before you complete a claim.

• Control coding errors.

Be sure your dental practice is utilizing the most current CDT codes when submitting claims as the codes are updated yearly. Some codes are added, some are deleted, and other codes are modified. If you’re unsure as to the proper code(s) for procedures, be sure to contact the dental insurance carrier or the American Dental Association (ADA).

Whether you’re a dentist and/or a dental professional – anyone can report fraud. You can reach the Delta Dental of New Jersey Fraud Hotline at 888-696-3262 or at reportfraud@deltadentalnj.com. *

 *Do not include protected health information (PHI) in an unsecured email.

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