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Internal Prospective and Retrospective Audits
Given the increasingly aggressive efforts by government agencies to identify and recover overpayments to healthcare providers auditing is essential for establishing an organization’s defense.
A retrospective audit selects a sample of records from services already submitted and reimbursed. These records are readily available for review so you avoid claims processing delays, but auditing retrospectively can mean that you will have over-payments to correct or disclose. We recommend dentists have internal prospective and retrospective chart audit processes in place.
Prospective audits help ensure that only completed work gets billed and also to ensure that ALL work that is completed gets billed correctly (nothing is missed).
Retrospective audits typically yield additional work to correct mistakes. However, these audit present opportunities to ensure quality assurance (compliance with record keeping and billing requirements) and quality improvement (continuous efforts to ensure better outcomes).
Together these audit processes provide physical evidence to demonstrate a dental practice has a responsibility effective compliance program program and deserve due consideration in the face of fraud and abuse allegations.
Chart auditing often has an immediate positive impact on practice revenue.
What does the auditor do?
The auditor begins by selecting a random sample of clinical records for each provider in your practice. Items commonly reviewed in the audit include the following:
- Chief complaint and stated medical necessity
- Key components of medical and dental history, clinical examination, diagnosis and treatment planning
- Matching dates of service
- Availability of documentation
- Proper coding
- Benefit eligibility
HIPAA helps ensure that all medical records, medical billing, and patient accounts meet certain consistent standards with regard to documentation, handling and privacy. Since fines can be up to $1.5 million for violations or imprisonment up to 10 years for knowing abuse or misuse of individual health information, compliance is imperative. In addition, there are remediation fees, the stress of being audited, and the disruptive and exhaustive efforts to catch up on all requirements.
Full Comprehensive OSHA Audit
Dental Teams who work in a safe and compliant practice are more productive and confident.
A Full Compliance OSHA Audit identifies if the practice is in compliance or at risk of accidents, injuries, or OSHA citations. We’ll help you recognize violations and provide you with clear action steps on how to correct. The Comprehensive Compliance Audit starts with a full inspection of the entire clinical area. We’ll determine if all OSHA, Infection Control (for patient protection), and Dental Board requirements have been met. Next, the documentation is evaluated including all required training and record keeping forms, OSHA manuals, and Safety Data Sheet pages. Finally, the entire dental facility itself will be evaluated for proper signage and physical safety hazards.
You will receive a written report of the findings and recommendations. If desired, we’ll assist you in correcting the problem areas as we go through the practice. Signs, labels, and documentation will be provided as needed. If there are extensive corrections, you’ll have a checklist of what steps to take to meet compliance. By the end of the audit, you’ll have clear, concise information on how to protect the patients, practice and team.
Meet Christine Taxin and Leslie Canham
Dental Consultant Connection’s Compliance Specialists
Based on several thousand dental practices studied, coding errors are among the most common problems identified. Coding and fee positioning errors are predictable in today’s dental practice. Learn the top errors – and how not to make them! Increase practice cash flow immediately by learning how to do it right!
With over 30 years of experience in the dental and medical fields, Christine Toxin’s workshop and lecture attendees benefit from her expertise in medical to dental cross-code billing, administrative systems, internal and external marketing and financial planning.
Prior to starting her own management consulting company, Christine worked for a large New York City hospital as administrator of a critical department, managed an extensive practice and worked with Coaching Solutions and Dynamic Administrators consulting companies. She has trained in management at LVI.
Christine is currently a guest speaker for Henry Schein, Patterson Dental, Carestream Dental I -Cat Congress Dental.
She presents for the American Association of Dental Office Managers, Pennell’s Professional Dental Assisting and the New York Academy of General Dentistry. She is also an adjunct instructor at NYU College of Dentistry and teaches in the residency programs at Maimonides Medical Center, Jamaica Hospital and St. Barnabas Hospital.
Academy of Dental Management Consultants, Member
National Association of Dental Plans:
- Code Revision Committee, Member
- Medical Changes Committee, Member
- ADA Code Revision Committee, Participant
American Academy of Oral Systemic Health, Founding Member
ADIA Auxiliary Education
American Association of Dental Consultants
ADAA American Dental Assistants Association
National Dental EDI Council Foundation, Board
Directory of Dental Speakers, Member
Store-A-Tooth, Foundation Board
Speaking Consulting Network, Member
Expert Consultant for ADA
Leslie Canham, is a speaker and consultant specializing in Infection Control, OSHA Compliance, Dental Practice Act, HIPAA regulations, and a variety of subjects surrounding accommodating and treating special needs patients. In dentistry since 1972, Leslie lectures nationally and internationally and has earned the reputation as an outstanding speaker in dentistry. Her fast paced, entertaining programs deliver up to date accurate information that dental teams can relate to. For the 4th year in a row, she has been listed as a “Leader in Consulting” by Dentistry Today.
Leslie is a Certified Speaking Professional, which is a designation conferred by the National Speakers Association. Fewer than 10 percent of speakers worldwide hold this professional designation. It is earned by a proven track record of speaking experience, expertise, a commitment to ongoing education, outstanding client service, and ethical behavior.
Leslie has been published many times in peer reviewed dental journals and she maintains a high profile in the online dental community.
She is the moderator of the Infection Control forum on Dentaltown.com and has authored multiple continuing education courses for Dentaltown, Dr. BiCuspid, and the American Dental Assistants Association.
In addition to her busy speaking schedule, Leslie provides in-o.ce training, mock-inspections, dental office audits, consulting, online home study courses and webinars. Leslie is recognized as a continuing education provider by the Academy of General Dentistry and the California Dental Board. She is also authorized by the Department of Labor as an OSHA Outreach Trainer.
The Organization for Safety
Asepsis and Prevention
The Speaking, Consulting Network
The Academy of Dental Management Consultants
Directory of Dental Speakers, Member
The California Dental Assistants Association
The California Association of Dental Assistant Teachers
The California Dental Association
National Speakers Association
Consultant to ADA
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