James Anderson

Staying Vigilant About Fraud in the Dental Practice

It is something every dentist dreads hearing – the word fraud linked with their practice or staff. While you can never absolutely be 100% sure that you will avoid making any mistakes in your billing practices being extra vigilant in certain areas can certainly reduce your risks.
1.)    Discuss coverage and fees with patients BEFORE treatment. Signed treatment estimates are even better. Document as much as possible but always make sure patients are aware – both verbally and in writing via a disclaimer on your treatment plans – that you are just estimating their coverage based on information you have been provided.
2.)    Make every effort to collect insurance and patient payments. Do not casually write-off balances for patients without documenting an attempt to collect. If you are waiving a balance due to patient’s inability to pay have them fill out a hardship waiver form.
3.)    Write out a fraud policy and have everyone in the office sign it. Have a meeting about it so your team can ask questions and make sure they understand what you consider fraud, what is not allowed in the practice and what your protocols are.
4.)    Implement quality checks. While you may have a billing coordinator who posts all your payments it is advisable to have another team member go through and double-check those for accuracy. Two sets of eyes are better than one.
5.)    Don’t neglect your reports! Reconcile your postings in your software to your bank deposit and your bank deposits to your 1099s from the insurance companies at the end of the year. Making sure everything matches across the board is vital to preventing accidental fraud.
6.)    Bill for what you do and do what you bill for. If you do a core build-up but insurance does not cover it than it becomes the patient’s responsibility. Do not discount these services just because they are not covered. By the same token if you are only doing a crown don’t have your team trained to automatically walk out a crown and build-up.
7.)    Avoid the cookie cutter. Everyone is short on time in a dental practice no matter how well-oiled the machine. Avoid the temptation to use template notes, explosion codes and other “easy buttons” in your PMS just out of habit. It’s fine to have these things if they truly fit the situation but make sure you are adding detail to those template notes, that you actually performed all those service codes and that all your documentation matches up.
For a real-life perspective from an expert on avoiding fraud in your dental practice check out Dr. Roy Shelburne’s podcast on Episode 41!


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Dental Billing