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Dental Practice Audits – What To Expect

Dental audit in progressDental audits, which used to be quite rare, are now much more common. Because insurance companies and other third-party payers are auditing much more frequently, the odds increase that you’ll someday face at least one audit.

The reason for the increase in dental audits is due to some depressing statistics. The FBI has estimated that more than 10% of the money spent on healthcare is due to fraudulent activity. In addition, insurance companies estimate that fraudulent health care billing accounts for up to $10 billion each year! Medicare fraud is also becoming much more rampant, racking up costs for our nation’s health-care system.


Audits are used to check the status of a dental plan, and not to check on any specific dental practice. The way they choose you may vary; sometimes, it’s based on random selection, other times it may be because of atypical claims submitted online. A computer will sort each claim submitted and flag any abnormal charges.

Third-party payers use audits to attempt to prevent any abuse of payment systems. By performing random audits, these third-party payers are ensuring that dentists understand how important accurate records are and are only submitting truthful claims.


The first thing to happen during an audit is a letter sent to you in the mail. Occasionally you’ll be contacted by telephone. If this is the case, the phone call will tell you what day and time the audit will be conducted and you can ask why the audit is happening at your practice.

Next, the insurance company will probably send a representative to your office to make sure billing claims match any notations in the patient files. Auditors are there to check whether amounts paid to your practice were for a real member of their insurance plan, whether the services you provided were in accordance with the treatment plan and if services provided were in accordance with federal law.

Any problems you may run into during the auditing process will most likely be because of improper documentation and record keeping. To prevent this problem, you need to be sure to be keeping thorough and accurate records. In addition, make sure you’re aware of the terms of any third party contracts and make sure each procedure you perform matches the one being billed.

For more information on what to do if your practice is being audited, or for any of your dental marketing needs, please contact Pro Dental Designs today! And don’t forget to check our website frequently for more information about running a successful dental practice!

Posted on Jul 11, 2016
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