Hi folks, this Ben Tuinei and it’s my pleasure to introduce today’s topic. Today, I audited a client office and found over $150,000 money they should be collecting from insurance payments! I’m amazed at how many dental offices are leaving on the table when it comes to money they rightfully deserve, but insurance doesn’t pay them. This is not negotiated revenue, or negotiating PPO fees, this is money lost resulting from under-coding to not being persistent in your appeals and simply not knowing where the problems are with insurance A/R. Today we interview Hilary Tien and she explains the insurance auditing process. When performing an insurance audit here is her checklist:
Correct provider assigned
Clinical notes match the ledger
Ledger matches EOB that was processed
Insurance was billed
Date insurance payment was received
EOB was scanned
EOB entered into ledger correctly
Correct adjustments were made
Denial noted, correct action taken
Other pending claims reviewed
Family ledger reviewed
Hillary goes through her process of how to perform an insurance audit and how often you should be auditing your numbers. Major corporations audit their numbers regularly. Some as often as each month and in an effort to make sure they are collecting every penny they’ve earned from their clients. We highly recommend performing an insurance audit of your own, or having Hilary perform an audit, to help you find and capture insurance money that is not reaching you.
To ask Hilary a question email her at email@example.com.
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