It can happen to anyone, even you. If you are not keeping your eyes open and maintaining accurate data, you could be subject to an insurance audit, an inquiry by the state or curious question from your patients about inaccurate coding. Not that you are doing it intentionally or being malicious about it. However, we sometimes just get comfortable and lose track of monitoring our systems and watching for red flags.
Now that I am working for hundreds of offices and not just one, I see things, sometimes very odd things, which make me ask questions. What kind of checks and balances does the office have in place? Who is responsible for monitoring the documentation? I always make it very clear to my doctors that I am not only helping them optimize their Dentrix software, but I am also trying to help them protect their license. The following are coding errors which could be linked to many problems for the practice and the patient.
Double check your daysheet against your scheduled patients
One of the most common errors I see in the dental practice is either posting a procedure that didn’t happen or forgetting to post a procedure. One time a doctor called me because a patient had walked in with an insurance EOB for a root canal he never had done. Yep, the root canal was accidentally set complete in the patient chart instead of charted as existing and it was sent to the insurance company and paid. The doctor was very upset with her clinical team, when in fact this should have been caught on the daysheet well before it was sent out to the insurance company.
The same can be said for missing procedures: every office should have a system in place where they are matching what is posted on the daysheet with each patient who came in for treatment that day.
You must code what you do
Whenever I put together an in-office Dentrix Optimization training schedule for an office, I look at the practice numbers and reports to see where I can make improvements to the practice productivity and profitability. One of the numbers I always look at is the perio percentage in the practice. With more than 47% of all Americans today having some level of periodontal disease, every dental practice should be billing out a significant amount in perio services. When I see the number is low, there is usually one of three things happening in the practice: They are either not diagnosing it, not selling it, or they are coding it incorrectly. If your hygienists are performing perio maintenance, then you must code it properly.
This can happen with other codes as well. Many dental insurance companies are downgrading codes for crowns, removable prosthetics, and X-rays, this way the office starts to use this as their coding system as well. So, if the insurance company is coding it this way then it should be right, right? No, it’s not.
Download and Install the CDT update
Finally, the ADA is adding, deleting and editing codes all of the time and every January you receive a CDT update pushed out to your software automatically. All you must do is click on the button to launch the update. I am surprised at how many offices do not perform this update and are still using old, outdated codes. This could result in a loss of benefits for your patients because of unnecessary denials or delay in claim processing which will impact your cash flow.
Going in with eyes wide open and having a check and balance system can help ensure your patient accounts are accurate as well as protecting the practice from unnecessary inquiries. There are many systems you can put in place to help your team code and document properly. For example, button sets on the patient chart, checking the daysheet and updating the CDT codes regularly. Protect your license and keep your system clean and mistake free.
Seeing a need in the dental industry for more resources, Dayna Johnson founded Novonee® – The Premier Dentrix Online community in 2016 and helps cultivate Dentrix superusers all over the world. Dayna knows that your entire day revolves around your practice management software and the more you learn the more productive and stress-free your office will be.