I just finished another audit and the issues remain the same. I see the phrase “The documentation does not support the treatment provided,” which means the dentists faces significant financial loss because he is being asked for repayment for the “unjustified” services.
Audits can be very, very costly for dentists. If a “random” audit of 20 patient charts suggests that a dentist mistakenly billed 10 percent extra, the auditor will use an extrapolation formula to determine how much the dentist owes over the period of time covered by the audit. Then he or she will multiple the amount by the 10 percent established by the audit and demand 10 percent back based on the entire amount paid to a dentist over the specified period of time.
Does that get your attention? It should. Legally speaking, if a procedure is not in your dental record, then it never existed. Dentists MUST document the services administered to EACH patient in such a way that there’s no questions left unanswered or treatments left to the imagination. If you think there’s not enough time in the day to embark upon these thorough reports, well, ask the dentist who will likely have to cut a six-figure check as penance for his inability to maintain these detailed reports. Doing whatever necessary to defend yourself and your practice is priceless.