48: The importance of internal insurance audits with Hilary Tien

Hi folks, this Ben Tuinei and it's my pleasure to introduce today's topic. Today, I audited a client office and found over $150,000 money they should be collecting from insurance payments! I'm amazed at how many dental offices are leaving on the table when it comes to money they rightfully deserve, but insurance doesn't pay them. This is not negotiated revenue, or negotiating PPO fees, this is money lost resulting from under-coding to not being persistent in your appeals and simply not knowing where the problems are with insurance A/R. Today we interview Hilary Tien and she explains the insurance auditing process. When performing an insurance audit here is her checklist: Date-of-service Correct provider assigned Clinical notes match the ledger Ledger matches EOB that was processed Insurance was billed Date insurance payment was received EOB was scanned EOB entered into ledger correctly Correct adjustments were made Denial noted, correct action taken Other pending claims reviewed Family ledger reviewed Statement sent Hillary goes through her process of how to perform an insurance audit and how often you should be auditing your numbers. Major corporations audit their numbers regularly. Some as often as each month and in an effort to make sure they are collecting every penny they've earned from their clients. We highly recommend performing an insurance audit of your own, or having Hilary perform an audit, to help you find and capture insurance money that is not reaching you. To ask Hilary a question email her at [email protected]. To contact our hosts please email [email protected].