Excellent article on “Fraudulent Billing” (Staff Rx column, September 2005 issue). I identified immediately with “Concerned Hygienist” about his/her specific incidences of fraudulent billing “norms.”
I especially loved the four bite-wing - then, a week later, the full-series trick. I see that all the time. If there were truly as many “leaky and broken margins” in our daily practice as insurance companies receive narratives for, then may the Tooth Fairy help us all!
It has been my unfortunate experience as well to be thrust into the face of widespread dishonesty in our profession. I agree with Dianne Glasscoe’s opinion and have seen it firsthand as well. Unethical behavior will deteriorate a dentist’s staff morale, and, more critically, important team members will leave the practice. Patients notice turnover and will begin to question everything.
As a full-time dental hygiene substitute with a practice history of nearly 10 years, I have had the opportunity to work in many different offices and clinics. I have witnessed both polarities of ethics, with most offices falling within the middle of the bell curve. I have played the “code game” too; every office that accepts insurance has to.
I have found that working in offices that do not accept insurance, (fee for service only) are very ethical in a de facto way.
There is no need to deceive the insurance company when you are not required to play any game by their rules. The patient receives full disclosure of fees, and, if the patient so chooses, they file their insurance claim themselves. This gets the patients more involved with understanding what their policies cover and saves the billing department a tremendous work load.
A.D. Riley-Burns, RDH, BA
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