Many Nebraska dentists have opted not to take any more Medicaid patients after being audited for $22 prophies, a pediatric dentist told a recent U.S. Senate hearing on Medicare and Medicaid.
Hundreds of Nebraska dentists recently were sent letters from the state's Medicaid recovery audit contractor (RAC), Health Management Systems (HMS), asking for charts containing adult and pediatric billing codes for prophylaxis, according to an ADA News story.
During her testimony at a July 9 Capitol Hill hearing, Nebraska pediatric dentist Jessica Meeske, DDS, who chairs the Nebraska Dental Association's Medicaid Committee, said the Medicaid RAC audit process lacks transparency and opportunity for feedback, and she offered recommendations to improve the process.
The hearing focused on Medicare audits and acknowledged growing concerns about Medicaid RAC audits, which began in some states in 2012.
Dr. Meeske described her experience with an RAC audit. She said one billing code involved a $22 cleaning fee, and noted that dentists could be audited if they billed the state for prophies that were done one day short of a patient's six-month visit.
RACs were created to find and recover overpayments and underpayments in the Medicare program, which were expanded to the Medicaid program by the Patient Protection and Affordable Care Act. Dr. Meeske said that neither she nor any dentists she knew had received compliance training, and there was no collaboration with the dental community on the audit process.
Nebraska's provider manual language was revised a decade ago to give dentists flexibility in the six-month prophy frequency, depending on the patient's risk for caries. Current language recommends a six-month frequency but also notes that the "frequency [will be] determined by the dentist," Dr. Meeske said. This corresponds with the American Academy of Pediatric Dentistry's dental schedule for children and allows high-risk children more frequent visits, when appropriate, to prevent more serious dental issues.
As a result of the audits over $22 prophies, Dr. Meeske said many of her colleagues simply paid the amount requested in the audit and have opted not to take any more Medicaid patients.
