Question Answered: What is a Dental Office Audit

Are You Wondering: What Is A Dental Office Audit?

You’re in the right place.

Dental office audits have become more and more common in recent years. At one point, dental practice audits were practically unheard of but this has changed as insurance companies are now focusing more on the payments they make to healthcare providers.

Today, third-party payers and insurance companies routinely visit dental offices that are contracted to offer their dental plans to patients. The audits are meant to tame the rising cases of insurance fraud being reported in dental practices across the country. Below is a brief look at what is a dental office audit and what you can do to prepare for one.

Why Do Dental Clinics
Need To Be Audited?

Many dentists are caught by surprise when insurance providers send professional auditors and accountants to scrutinize their books and patient records. The question of why do dental clinics need to be routinely audited then arises. The answer to this question is pretty simple.

Recent reports from insurance companies state that up to 10% of claims paid out to healthcare institutions, which includes dental practices, are fraudulent. The companies estimate that this translates to losses of about $10 billion every year. This is not something that can be ignored.

As fraudulent claims become more common, insurance companies have no option but to impose stringent audit requirements on all hospitals, clinics and dental practices alike.

The Dental Office Audit Process

Many dentists are not sure of what to expect during an audit of their office or clinic. The audit process is pretty straightforward. It begins with the dentist being notified of an impending audit by the insurance company. The notification can either be via letter, email or phone call. A day and time for the audit is communicated through the notification and the dentist can then proceed to prepare for the auditors. It is important for the dentist to confirm which type of dental office audit will be conducted on the subject day in order to prepare accordingly.

Access To Patient Files and Records

On the material day, the insurance company will send its auditors and representatives to your dental office to scrutinize your patient files and records. They will first check to see whether your billing claims match the patient records you have in your files. The auditors will also check the amounts paid to the clinic for each patient who is covered by their insurance plans. They will seek to verify that the services billed to patients were actually rendered by looking at the treatment plans and procedures recorded in the files.

Quality Assessment

Apart from auditing the patient files, the insurance company may also want to assess the quality of the dental clinic. This process may involve checking the general state or condition of the office, maintenance of equipment, processing and storage of patient files, quality and quantity of staff, ease of scheduling appointments and compliance with federal and state laws and regulations. As you can tell, a simple dental office audit can entail a lot and it’s important to be thoroughly prepared.


So now you now have an idea of what is a dental office audit. It’s worth noting that audits are not meant to scare or put undue stress or pressure on dentists and dental office staff. Their aim is to simply prevent abuse of the system. If you’re concerned about your practice getting audited – you may benefit from taking a risk assessment survey that will help transform your practice into a thriving business. Visit UpgradeMyPractice to learn more.

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