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Uncover the critical connections between HIPAA compliance and dental billing practices in our episode featuring host Ericka Aguilar. Discover how safeguarding patient privacy extends beyond ethical boundaries to play a pivotal role in averting billing fraud in dental practices. We delve into the cutting-edge strategies employed by insurance companies, such as predictive analytics, to detect inconsistencies and initiate audits without relying on whistleblowers. Erika sheds light on the risks associated with common pitfalls like inappropriate code adjustments and the negligent waiving of co-payments that insurers might interpret as fraudulent activity. By gaining a deeper understanding of insurance audits and adhering strictly to HIPAA's privacy, breach, and anti-kickback policies, dental professionals can uphold their practice's integrity and maintain the trust of insurance companies.

Explore the heightened scrutiny dental offices face due to the rise of AI in insurance auditing, as Ericka highlights the dire consequences of billing inaccuracies, including high denial rates and the ominous threat of clawbacks. With the potential for significant financial repercussions, she emphasizes the importance of accurate billing and the dangers of fraudulent resubmissions. Learn how diligent denial tracking and effective appeals can be your defense against unnecessary audits and penalties. Hear practical advice on how to navigate the complexities of maintaining compliance, including when to involve the insurance commissioner to protect your practice from potential pitfalls and maintain ethical billing standards.

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Would you like to set-up a billing consultation with Ericka? We would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you.

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https://calendly.com/ericka-dentalbillingdoneright/30min

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

Want to know what your fee should be for D4346? Send Ericka an email to [email protected]