What To Expect From An Audit

Perhaps you’ve recently received a letter along these lines:

“Dear Dr. Smith,
We periodically analyze claims to determine the accuracy of the submitted codes. We have noticed unusual patterns in the claim submissions of your practice, and request copies of the patient records we’ve listed below.

Sincerely,

Utilization Review Department”

You’ve been audited! This doesn’t automatically mean you’ve done anything wrong, but you’ve somehow attracted the attention of an insurance company or Medicaid program.

Why Am I Being Audited?

The most common reason for a dental audit is that the frequency of a certain CDT code has been higher for you than the norm. The computer at the insurance company will recognize an unusual pattern.

Another reason for a review would be a complaint from a patient. If a patient complains to their insurance company about a billing or quality of care issue, the company may request a copy of the patient’s record.

What To Do If You’re Audited

Before you send copies of patient records to the insurance company, enlist some immediate help. It’s important that you have help with this process from start to finish instead of after the review or request for payment. Don’t send any more or any less information than what is specifically asked for.

We know that an audit can be a stressful and scary time. But the most important thing you can do is to get the ball rolling as soon as you receive the letter. Call CTC National right away and we can help you through the auditing process as painlessly as possible!