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How to Conduct a Team Chart Audit

October 29, 2021 638

While it is great to have a well-functioning team that you can trust to accomplish their tasks, it is important that the owner dentist consistently be involved in the financial auditing process to support a system of checks and balances. Doing so will help identify areas of needed training, increase collections and identify areas of strength and opportunity for your team. It will also help deter the opportunity for embezzlement. Embezzlement is a felony that is most commonly committed when the opportunity is presented. Being involved in a daily and monthly audit will help you remove that perceived opportunity within your office.

A 2018 survey from the American Dental Association demonstrates the importance of implementing a team chart audit to protect your practice, your team, and your patients:

  • 48% of dentists surveyed said the employee who embezzled from the practice had access to end-of-day procedures, including creating bank deposits.
  • 41% could write-off balances without approval.
  • 54% entered insurance payments.
  • 64% were front-office positions and 23.32% of those were office managers.
  • 39% worked with that dentist for four or more years.
  • 49% of dentists surveyed reported experiencing employee theft from the practice and less than 25% of that was found from auditing, meaning the losses could be more significant than reported.

Below are recommended steps and the responsible party for conducting dental practice audits:

Daily Audit

  • Office manager: Print your practice management software’s day sheet at the close of each business day. The day sheet should include all posted production, adjustments to production, collections, patient payments, dental benefit payments, and write-offs.
  •  Have all managers/dentists review the day sheet and initial it.
  •  Office manager or dentist: File the initialed day sheet in a secure file cabinet for a minimum of 60 days as a point of reference when conducting a monthly audit.
    • Note: If the day sheet is reviewed electronically, place the file in a secure folder on the same computer where other financial records are securely stored.

Monthly Audit

  • Once a month, pick a few days from the previous six to eight weeks when the office was open from your “day sheet” folder.
    • Insurance payments are likely to have been paid by the time of the audit to ensure a complete chart audit.
  • Review all procedures charged that day.
    • Do they match your clinical notes?
    • Were all radiographs and other images were taken that day charged out?
  • Check the submitted claim form.
    • Does everything on the submitted claim form match the completed procedures from that day?
  • Review the EOB.
    • What did the dental plan pay?
    • The plan reimbursement is unlikely to match the claim form, as the practice submits its UCR but is paid on the contracted rate.
      • Payments should match what was expected in your operating software.
    • Does the posted payment match your EOB statement?
    • Are there any negative adjustments in the patient’s chart?
      • If so, what are they? Do they match the EOB adjustments?
  • Is there a balance due on the account?
    • Is the balance due from the patient portion or from the dental plan?
    • What is the balance for copayment, deductible, etc., and what is the plan to collect this money (i.e., payment plan)?
  • Check the rest of the family account, if applicable.
    • Is a refund due to a patient? If there is, research why. If the refund is legitimate (e.g., the plan overpaid for the treatment), return the money to the appropriate party. 
    • Is there a patient credit? If yes, be sure to process a refund to the patient within 30 days of reconciling the account or contact the patient to inquire about keeping the credit on the patient’s account for a future appointment.
    • If there is a refund due to the patient and you cannot locate the patient, refer to the following CDA resource for guidance on unclaimed patient credits.
  • Do all members have an email on file for appointment reminders, etc.?
  • Were there any major adjustments for any member of the family in the last 12 to 24 months?
    • Were you aware of the adjustments?
    • Do you have a policy in place for large adjustments? Are the adjustment reasons documented in the ledger?