Engr. Estela L. Go is a Chemical Engineer in the Philippines. After taking all the major accounting courses in UCLA, she worked as a General Accounting Manager in Mortgage Corporations for 15 years. Dr. Robert Y. Go and Engr. Estela L. Go founded Go Family Dental after decades of experience in dentistry, accounting and operational excellence in Anaheim, home of Disneyland, in 2007.
For more content by and for dental office managers, visit AADOM at https://www.dentalmanagers.com.
Running a successful dental practice is about more than just providing excellent clinical care. It's also about ensuring your operations are efficient, compliant, and focused on delivering the best possible patient experience. That's where dental audits come in. While the word "audit" might conjure images of stress and scrutiny, it's a powerful tool for growth and improvement.
Why are Dental Audits Essential?
Dental audits are more than just a regulatory necessity; they're an opportunity to take a deep dive into your practice's inner workings and identify improvement areas. They can identify inefficiencies in a practice's operations. Health care costs can be high, and an audit helps ensure the accuracy and transparency of billing, both for the patients and the insurance company. It prevents overbilling and underbilling, which can cause problems down the line. Addressing these issues earlier can create a smoother operation and save the staff valuable time.
Compliance is an essential key in dental audits. Being proactive about the dental audit from the insurance company is a good way to create trust between the dental office and the insurance carrier. It also helps practices identify areas for improvement. Auditors can suggest how to manage patient records and all the treatment plans that need to be signed by patients. Being open to suggestions from the auditors is a guiding principle for a dental office, and it is important to approach it positively. It is about a continuous quality improvement that ultimately benefits the dental office.
Dental Audit Advantage
Collaborating with auditors is not just passing an inspection. It is about gaining valuable insights and expertise that can transform your practice. The dental auditors who are also dentists bring a wealth of knowledge and experience in running a dental office. Having a regular audit encourages a proactive approach to identifying and addressing potential issues before they escalate. It builds confidence among your staff, patients, and your practice. On the patients' side, they feel more confident that they receive ethical and high-quality care. It is about demonstrating transparency and accountability, mainly when it deals with people’s health. It is an essential tool for patients’ protection, financial fairness, and building trust in the dental field.
The Vital Role of Dental Insurance Audit Grading in Efficient Practice Operations
While audits can sometimes feel like a hurdle, the grading results they yield are not merely a judgment; they are a powerful diagnostic tool that can significantly impact your dental office’s efficiency and financial health. Understanding the importance of this grading and proactively utilizing its insights can transform your practice from simply surviving to thriving.
A common practice in dental insurance audits is where auditors provide an overall percentage score reflecting the office’s performance based on two key components: the structural and process reviews. This percentage serves as a quick indicator of the office's compliance and efficiency in handling insurance-related matters.
TOTAL % = Structural Review + Process Review
Understanding the Components:
- Structural Review: This is the section that auditors check if all the patient’s information is there, if it is correct, and if it is kept in a way that insurance companies expect. He wants to see everything about that patient’s visit – what was done, why, and what was charged. He wants to see that the patient signed the treatment plan corresponding with the progress notes of the dentist. Under this review, the auditor will review all the manuals, such as the Policy and Procedure. He also checks if the dental office complies with the Dosimetry and Occupational Radiation Exposure reports.
Under this review, the auditor also ensured that the office had a working emergency kit and oxygen tank and that nothing had expired. Safety is very important to him. So, in case of emergency, the dental team has all the right tools ready to go, and they are safe to use.
- Process Review: When dental auditors do a “process review,” they watch how the dental office does things. They will look at the patient’s X-rays on the software if the office does it. They check the details of the appointment scheduled to ensure they are correct. He also checks if the patient is documenting and signing the consent form. The auditor also double-checks the treatment steps to ensure they are recorded accurately. Auditors are trained to spot “red flags” like billing for procedures that do not seem necessary and a lack of specific details in patient notes. So this is where auditors have to make sure that everything is being done right for both the patient and for proper billing.
The Significance of the Overall Percentage
This number tells you how well your office is doing in setting up its systems and handling insurance claims every day. It's like a quick snapshot of your performance.
You can learn a ton by looking at how they got that percentage and digging into their detailed report. It shows you exactly where you need to improve things. This means your office can run smoothly, you'll have fewer insurance claims denied, and your practice will be much healthier financially.
Embrace the Audit: A Path to Growth
Dental audits are not just about checking boxes; they're an opportunity to learn, grow, and enhance the overall functioning of your dental practice. By embracing the process and collaborating with auditors, you can unlock your practice's full potential.
Don't view audits as a burden. Instead, see them as a valuable tool for continuous improvement and long-term success. By working with auditors, you can build a stronger, more efficient, and more compliant dental practice that delivers exceptional patient care.
