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Healthcare compliance is extremely important and you should take all possible steps to minimize government scrutiny and liability risks. It is necessary you eliminate the occurrence of wrong and forged patient records, poor physician documentation and ensure safety and security of all patient information. Your practice needs to be compliant with the latest government regulations, laws, guidelines and policies. 

Dental practices need to ensure that insurance claims and processes are clean, honest and compliant to the government and payer requirements. This prevents accusation of insurance frauds and malpractices. Compliance also reduces rejection of claims.

Make sure you properly document and bill the services provided. Have patient details, medical assessment of patients and treatment procedures well- recorded. Good documentation and billing policies enhance patient care.

Here are a few suggestions to improve the healthcare compliance of your dental practice.

Documentation is essential to maintain clear records of your services and treatment procedures. It includes screening services, diagnosis and treatment, and preventive care services. Children can be provided medical care at any age based on their dental health and concerns. They require medical help to cure infections, provide pain relief, treat tooth decay and maintain good health. 

Proper documentation is the key to excellent healthcare compliance. It is important you document the medical or dental necessity which called for treatment procedures. All details of the specific disease condition need to be documented including the X-rays and laboratory tests used for diagnosis. The various stages of treatment also need to be documented. 

Claims are valid only when you can provide clear evidence of medical necessity. You also need documentation to validate multiple or follow-up treatment meted out in specific cases. You may also need to explain how diagnosis and treatment was administered in the absence of X-rays and tests, if such a case occurs rarely. 

A good compliance program ensures the profitability and reputation of your dental practice. It involves proper documentation of medical necessity, explanation of the choice of medical treatment and proper billing of services rendered. Smile Design Dentistry follows a comprehensive compliance program.

Following factors play a defining role in good compliance programs.

1) Well-Defined Policies– This is especially important in small practices with few employees and high employee turnover. There should be a written policy which makes it necessary for all employees to properly document medical necessity including the diagnosis of the disease or the medical condition of the patient.

2) Compliance Officer – A compliance officer helps the dental practice manage the documentation concerns in all departments and phases, and also address concerns of individual employees. 

3) Consistent Training – Employees should be given regular training to keep them updated on all the new regulations and government policies.

4) Internal Auditing – Dental practices should ensure that insurance claims are properly lodged, tracked and assessed. If there are any documentation problems or denial of claims they should be looked into and remediated. There should be regulated standards to measure the compliance of various departments and personnel.

5) Disciplinary Policies and Internal Communication – If any errors or mistakes have been detected in documentation of medical necessity or implementation of compliance policies, suitable disciplinary action should be initiated against the erring personnel. 

There should be open and free communication between employees and responsible persons. Employees should fearlessly point out errors and malpractices which should then be remediated at the earliest.

An issue that has been the cause of grave concern is the lack of privacy and security when sharing patient records and data. Sensitive and confidential patient information needs to be shared between dentists, laboratories and specialists.  The Health Insurance Portability and Accountability Act makes it mandatory for all healthcare practitioners to ensure safety and security of patient data while saving, accessing or sharing it. 

Here are a few steps that can be followed by dental practices to ensure compliance with HIPAA.

1) Proper Risk Assessment – Most healthcare practices store patient data on electronic health recording systems. New HIPAA standards are strict and forbid the use of several conventional methods of data storage and transfer. Most forms of email communication like Gmail, Outlook, Apple Mail and Hotmail are not compliant. Online storage sites like Dropbox and Skydrive are also not compliant with these standards. So run a proper risk assessment and adopt more efficient and compliant means of data storage and data transfer.   

2) Guard against Disasters – Always protect your valuable patient data from corruption and loss. You should regularly back up all medical data being handled by your practice in a safe off-site location. This guards the data from potential damage in case of incidents like fire. Install updated anti-virus programs in all computers to prevent theft, destruction, corruption and misuse of data. 

3) Purchase Compatible and Compliant Medical Equipment – When you purchase new medical equipment ensure it is compatible with the existing data systems and is safety-compliant. They should be able to merge seamlessly with your existing operating procedures. 

4) Properly Trained and Updated Staff – Dental practices should regularly and systematically train their staff in best safety practices and protocol. The safety and security of all information systems depend on the way it is operated and handled by the employees. Employees need to be consistently trained and updated to ensure optimum safety to data storage and transfer.

The Occupational Safety and Health Administration (OSHA) also have stringent regulations and rules regarding workplace safety. Regulations have been put in place regarding the use of X-ray equipment, and laboratory tests and treatment involving dangerous blood-borne pathogens. Proper hazard communication and regulated exit routes in buildings are also mandatory. It is important you follow the best safety and health practices to avoid disciplinary action by the government and regulatory bodies.

Good healthcare compliance ensures all the procedures, policies and practices at your practice are accurately maintained and organized. This improves efficiency and productivity of your business. Good compliance procedures ensure patient retention and growth, good publicity and a better brand value for your practice.