The audit released by Mr. DiNapoli represented nearly one-third of the amount GHI paid dentists for this procedure over a four-year period.
The New York State Department of Health recommends that dentists perform scaling and root planing procedures on no more than two quadrants of a patient’s mouth during a single visit. Dentists are also discouraged from scaling and root planing the same quadrant more than once every three years.
These procedures are more extensive than a routine dental cleaning and more costly. DiNapoli’s audit looked at payments made by GHI between Jan. 1, 2005, and Dec. 31, 2008, and found that they were frequently made outside of these guidelines.
GHI never questioned one dentist who billed GHI for performing scaling and root planing procedures on the same patient’s mouth seven times in a four-year period. Also, auditors visited two dentists that frequently billed outside the accepted parameters and found the dental records often did not support the billings. Auditors tested GHI’s compliance with its own internal processing procedures that required proper dental charts before payment and found GHI paid many claims without proper supporting records.
GHI generally agreed with the audit’s findings.
Read Mr. Thomas DiNapoli’s announcement of the GHI audit.
Read other coverage about healthcare billing and collections:
– 6 Common Collections Mistakes and How to Avoid Them
– AAPC Announces Audit Services Division
– How Percentage of Ownership by a Hospital Impacts ASC and HOPD Billing
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