Question: I have had several colleagues describe their experience with dental plan audits. All of them have had to pay something back. Sometimes they say this is due to a service being deemed a “noncovered service.” Other...more
1/31/2025
/ Audits ,
Dental Practice ,
Dentists ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Insurance Claims ,
Insurance Industry ,
Insurance Litigation ,
Reimbursements ,
Risk Management
Question: I am under audit by a dental plan I participate with. The audit has identified a few issues in connection with how my billing employees have been submitting claims for payment. For example, the name of the treating...more
7/27/2023
/ Audits ,
Billing ,
Burden of Proof ,
Dental Practice ,
False Billing ,
Fraud ,
Health Care Providers ,
Insurance Claims ,
Misrepresentation ,
Participation Agreements ,
Reasonable Doubt
Question: A health plan that I participate with has sent me a notice stating that it has audited some of the claims I have submitted over the past three years. The health plan believes that some of these claims were improper...more