The Canadian Dental Care Plan (CDCP) has opened the doors for countless Canadians to seek the dental care that was previously out of reach. It is a blessing for those families, seniors and hard-working young Canadians who have had to suffer with their dental disease. An unexpected result of this plan has been the fear generated by the possibility of an insurance audit.
What is an insurance audit? Keep in mind that I am a ‘lay person’ in this regard and can only speak from my experience. Many years ago I worked in a dental practice that was audited by an insurance company. I remember it being a time consuming, paper filled odyssey that resulted in no consequences for the practice, but it was so stressful at the time. Like a CRA audit…if you’ve done nothing wrong, you have nothing to worry about.
Why is this happening now? The CDCP is a government funded program. Like all such programs the government has a responsibility to the taxpayers. Sunlife, as the insurance adjudicator of the program, also has a responsibility to the government. Their role is to ensure that billings are accurate. When in doubt they will have questions for the provider.
How does a practice prevent an insurance audit? The answer is simple. Bill accurately for the services you provide. There may be questions, but if you have the answers that’s as far as it goes.
Let’s go a little deeper into this…
- The importance of chart notes. The days of the ‘one line written in pencil’ chart note are behind us. Our regulatory bodies have a specific set of protocols for how these notes should be written and what needs to be included. If you haven’t educated yourself on these protocols, now is the time. Keep in mind the basics – grammar, abbreviation, tense and spelling all matter. The more accurate and precise your notes are, the fewer questions will be asked. As a fellow clinician I know that time is a barrier with chart notes. Templated notes and preparation are key. Just remember to personalize the template parameters for each patient. If a procedure was not completed, remove that line from the template for that patient. Blank spaces raise questions.
- Transparency is key. The number one complaint brought by patients to regulatory bodies is a lack of transparency with billing. Does that mean we are hiding our fees? No, it does not. Anyone with access to the internet can see the Alberta Dental Association fee guide. Most dentists follow the guide or are minimally above or below it. The issue is that our patients are often not told by their dental practice how much their treatment will cost. Major treatment is usually not the problem as that is more likely to be presented in a consult scenario with printed out estimates. It’s the hygiene and basic restorative appointments that can deplete a patient’s annual maximum. How do we change this? By training our team to give the full cost of the appointment, not just the amount they owe after their insurance reimbursement. I could write a book about this topic, so I’ll leave it here for now.
- Patients don’t want to pay for a service they don’t value. Dentistry is expensive. We all know that. So are groceries, gas, kid’s sports and vacations. It is not our job to take responsibility for our patient’s oral health, nor is it our responsibility to judge how they use their discretionary income. It is, however, our job to help them see the value in taking care of their oral health. This is a sneaky one. It may be argued that we are always creating this value through our education and treatment recommendations. That is true but consider the ways that we de-value it.
“Do you want to schedule your next appointment?”
“Don’t worry, if this appointment doesn’t work for you, just call us to cancel it.”
“Let’s send a pre-auth to see how much of that crown is covered?”
If these phrases are used in your practice, then the value is being chipped away slowly and consistently.
If this article resonates with you, and you’re not sure how to flip the script in your practice, we’re here to help. Reach out for a conversation to learn how you can help your patients see the long-lasting benefit of investing in their oral health, and avoid the questions from the insurance company!
Our team of Dental Consultants at Tayden Consulting Inc. specialize in providing on-site coaching to create the optimal experience
for your patients, and the most efficient systems for your team.
Contact us today for a complimentary consultation!
We look forward to meeting you.