News — Compliance
I work with Private Equity firms as a partner in their due diligence processes. For my parts, office review and records audits, it is about identifying proficiencies and deficiencies (or what I call ‘opportunities’).
Is the office compliant with OSHA, infection control, DEA regulations, radiation regulations, sedation safety/medical emergency preparedness, HIPAA, advertising/marketing, dental board rules/Dental Practice Act? What safety mechanisms are in place to ensure patient and employee safety? Does the practice code/bill properly? Using correct codes? Have adequate supporting clinical notes to support what is billed? Any overbilling or fraud issues? If so, are they isolated or systemic?
- Tags: administer, Compliance, Controlled Substances, DEA, Dental Compliance, monitoring, prescribing
Daily perspective (pre-bill) audits help identify and minimizes billing errors by ensuring the accuracy of claims before they are submitted. This step alone can help compliance programs pay for themselves. Periodic retrospective audits involve the detailed review of clinical and billing records for compliance with state and federal recordkeeping and billing requirements. Some items to check include verifying the quality and quantity of radiographs, consent for treatment, proper coding, clinical notes to support each claim that was billed, and medical necessity.
My mantra is: “If It Is Not Written, It Did Not Happen!” Record audits must be documented. In the face of a fraud allegation this documentation can help your defense attorney make their case.
- Tags: Code of Conduct, Compliance, Compliance Training, dental compliance, Recordkeeping, Risk management
If the government and third-party payors know you maintain an effective compliance program and have your ducks in a row, you are less likely to get picked on in the first place! We have seen it happen.
If you are an administrator or compliance officer for a dental practice and you are looking for solutions to concerns that keep you up at night or you’re looking for an ally for support or an existing compliance program or you are looking to develop a compliance program, but don’t know what to do or how to go about it, we will love to have a chat with you.