The Importance of Accurate Reporting of Treating Doctors in Dental Practices

Accurately reporting the treating doctors in dental practices is crucial for ensuring ethical billing practices and avoiding potential fraudulent activities. This article will discuss the risks associated with improper reporting and highlight the significance of following correct billing procedures.

Understanding the Risks

Improperly reporting the treating doctor can have serious consequences for dental practices. One potential risk is fraudulent billing, where practices misrepresent the treating doctor to receive higher reimbursement rates. This can lead to legal repercussions and damage the reputation of the practice. Additionally, improper reporting violates legal and regulatory requirements, which can result in investigations, penalties, and even loss of licensure.

How to Accurately Report Treating Doctors

To maintain integrity in billing practices, dental practices must adhere to accurate reporting of treating doctors on insurance claims. Let’s explore the proper procedures for reporting treating doctors in different scenarios.

When a new associate performs an oral evaluation, and the hygienist performs hygiene services, it is essential to accurately report the treating doctor. The doctor supervising the hygienist and performing the evaluation should be listed as the treating doctor for both services.

In the case of locum tenens doctors filling in for the owner doctor, it is essential to report the treating doctor accurately on the insurance claim. The name and National Provider Identifier (NPI) number of the locum tenens doctor who actually performs the treatment should be reported. The 2024 ADA Dental Claim Form, effective January 1, 2024 addresses how to more accurately disclose to the payer that the provider is a locum tenens. Read more about the 2024 ADA Claim Form changes.

When reporting treating doctors, it is important to be aware of any exceptions and guidelines provided by preferred provider organizations (PPOs). Some PPOs may allow the owner’s name and NPI on the claim form in specific circumstances. It is recommended to consult with dental payers and seek advice from a healthcare attorney for clarity.

Conclusion

Accurate reporting of treating doctors is essential for maintaining ethical and lawful billing practices in dental offices. By following correct procedures and seeking expert guidance, dental practices can ensure compliance, integrity, and fair reimbursement. Don’t risk your practice’s reputation and legal standing – report treating doctors accurately and ethically.

Guidance from the ADA regarding Locum Tenens

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