Happy 2024, Whalen dentists. January is a great time to re-evaluate your practice’s insurance plan participation. To assist dentists with this task, the ADA has developed several documents designed to streamline the process. These include the following:

• Contract Negotiation Guide,
• Terminating a Network Agreement, and
• What Every Dentist Should Know Before Signing a Dental Provider Contract.

These documents are provided here to help you get started quickly. Performing an insurance audit can help you determine which plans you should keep and which ones to eliminate. Paul Bornstein, writing in Dental Economics, gives these additional tips:

 

1. Read your state’s dental practice act to make sure that you understand all of the regulations on dental practice. Ohio’s Dental Practice Act is found here. Current Ohio Dental Practice Act
2. Read your contracts and provider manuals before you sign and re-evaluate yearly. Less than 10% of dentists read these items before signing their contracts!
3. Medicaid regulations are state-dependent, so be sure to carefully read the contracts and manuals because what is legal in one state may constitute fraud in another state.
4. Acquaint yourself with all required documentation under PPO contracts and federal Medicaid laws.
5. Make sure you sample audit your patient records to ensure that the patient record is complete to the state’s practice act requirements and notes are signed. Medicaid excludes unsigned claims from consideration, as do some private dental payers.

Whalen CPAs is dedicated to helping you improve your practice’s operational efficiency. We are here to help with questions you may have regarding this information. For assistance, reach out to us here.

 

Bornstein, P. (2022, June 13). Preventing fraud and insurance audits: 6 mistakes you might be making. Dental Economics. https://www.dentaleconomics.com/practice/article/14275864/simple-corrections-to-prevent-fraud-and-insurance-audits

• Category: Client Alerts, Dental & Health Care