What if the office fails the dental audit?
The likelihood of a dental office actually failing a quality assessment audit is fairly low — probably nonexistent. Again, the purpose of the audit isn't so much to evaluate the office as to enable the dental plan to assure the state Department of Managed Health Care that it has a high-quality network of providers. The subject of the audit is really the plan, not the provider, and in this sense, it is in the interest of the plan that its offices pass.
Nevertheless, a given office may show a need for improvement in one or several audit categories. The plan should always provide the office with the results of the audit. If the discovered deficiencies are minor, the plan may simply instruct the dental office to check off each item when the deficiency is corrected and return the checklist to the plan. If a deficiency is more significant, the plan may ask for specific documentation that it has been corrected. If a large number of deficiencies are discovered during an audit, the office may be put on a list to be re-audited the following year, to ensure that the corrections have been made. Other than this, there will likely be no penalty for failing to meet audit categories. However, a dental office that has been audited a number of times and has shown reluctance or inability to correct deficiencies may be dropped from the dental plan's provider network. There is no legal or regulatory penalty for offices that fail to achieve a 100 percent score in an audit.
Dentist Problems In Billing Forms With Patients
Common questions & answers with patients insurance collections and dental benefits plans.