Dental Auditing Course

Lesson 1 • Regulatory and Compliance Framework

Covers the regulatory environment governing dental practices, including privacy rules and payer contracts. Connects compliance obligations to audit triggers.

Lesson 2 • Audit Ethics and Professional Standards

Establishes ethical obligations and professional conduct standards for dental auditors. Sets the behavioral baseline for all audit activities.

Lesson 3 • What Dental Auditing Means

Defines dental auditing, its purpose, and its distinction from billing or coding review. Grounds all subsequent chapters in shared terminology.

Lesson 4 • Dental Procedure Coding Overview

Introduces dental procedure code systems and their structure as the language of dental auditing. Provides the coding literacy needed for all subsequent audit work.

Lesson 1 • Clinical Record Requirements

Defines mandatory elements of a compliant dental clinical record. Directly supports audit evaluation of record completeness.

Lesson 2 • Documentation Deficiency Analysis

Teaches systematic identification and classification of documentation gaps. Students apply deficiency frameworks to sample records.

Lesson 3 • Radiographic and Diagnostic Records

Covers standards for radiographic documentation, frequency guidelines, and diagnostic record retention. Radiographic records are a primary audit target.

Lesson 4 • Electronic Health Record Compliance

Examines EHR-specific documentation risks including auto-population, cloning, and audit trails. Connects EHR misuse to common audit findings.

Lesson 1 • Restorative and Endodontic Code Review

Evaluates restorative and endodontic procedure codes against clinical documentation and payer policies. Restorative upcoding is a leading audit finding.

Lesson 2 • Diagnostic and Preventive Code Auditing

Audits diagnostic exams, radiographs, and preventive services for coding accuracy and frequency compliance. These high-volume codes carry significant audit risk.

Lesson 3 • Prosthodontic and Oral Surgery Coding

Audits prosthetic, implant, and oral surgery codes for accuracy and benefit limitation compliance. High-cost codes attract heightened payer scrutiny.

Lesson 4 • Periodontal Code Compliance

Reviews periodontal procedure codes for medical necessity, sequencing, and frequency compliance. Periodontal audits frequently reveal unbundling and upcoding.

Lesson 1 • Audit Workplan Development

Guides construction of a detailed audit workplan including timelines, resource allocation, and data requests. A workplan ensures consistent, repeatable audit execution.

Lesson 2 • Sampling Strategies for Dental Audits

Covers random, targeted, and stratified sampling methods and their appropriate applications. Sampling design directly affects finding validity and defensibility.

Lesson 3 • Audit Tools and Technology Selection

Reviews software, data analytics platforms, and audit management tools used in dental auditing. Tool selection affects audit efficiency and data integrity.

Lesson 4 • Defining Audit Objectives and Scope

Establishes how to set measurable audit objectives and define scope boundaries. Clear scope prevents audit drift and ensures actionable findings.

Lesson 1 • Medical Necessity Evaluation

Applies payer medical necessity criteria to dental procedures under review. Medical necessity determinations drive the majority of audit overpayment findings.

Lesson 2 • Preliminary Findings Documentation

Structures preliminary findings into a clear, evidence-supported format for provider review. Preliminary findings initiate the provider response process.

Lesson 3 • Overpayment Calculation Methods

Demonstrates methods for calculating overpayments at the claim and extrapolated population level. Accurate calculation is essential for defensible audit results.

Lesson 4 • Claim-to-Record Reconciliation

Teaches systematic matching of submitted claims to clinical documentation. Reconciliation is the core analytical step of every dental audit.

Lesson 1 • Audit File Retention and Closure

Establishes standards for audit file organization, retention periods, and formal closure procedures. Proper closure protects against future disputes and supports re-audit readiness.

Lesson 2 • Audit Report Structure and Standards

Defines the required components of a professional dental audit report. A well-structured report supports defensibility and clear corrective action.

Lesson 3 • Payer and Regulatory Reporting

Addresses reporting obligations to payers and regulatory bodies following an audit. Timely, accurate reporting protects the auditing organization from liability.

Lesson 4 • Provider Response and Rebuttal Process

Guides auditors through evaluating provider rebuttals and additional documentation submissions. Fair rebuttal review is a professional and legal obligation.

Lesson 1 • Monitoring and Follow-Up Audits

Establishes processes for monitoring corrective action implementation and conducting follow-up audits. Ongoing monitoring sustains compliance gains over time.

Lesson 2 • Corrective Action Plan Development

Teaches the structure and content of an effective corrective action plan following audit findings. A strong plan reduces recurrence and demonstrates good-faith compliance.

Lesson 3 • Internal Compliance Program Elements

Reviews the seven core elements of an effective dental compliance program. Compliance programs prevent audit findings before they occur.

Lesson 4 • Overpayment Recovery and Repayment

Addresses overpayment demand, repayment negotiation, and voluntary self-disclosure processes. Proper repayment handling limits financial and legal exposure.

Lesson 1 • Multi-Provider and Group Practice Audits

Addresses the added complexity of auditing group practices, dental service organizations, and multi-site providers. Group audits require coordinated sampling and reporting.

Lesson 2 • Payer-Initiated Audit Defense

Prepares auditors to support providers in responding to payer-initiated audits and appeals. Effective defense requires documentation mastery and procedural knowledge.

Lesson 3 • Fraud Investigation Fundamentals

Distinguishes fraud from error and introduces investigation techniques specific to dental billing fraud. Fraud findings require elevated evidence standards and referral protocols.

Lesson 4 • Emerging Audit Risk Areas

Identifies evolving audit risk areas including teledentistry, implant billing, and sleep apnea appliances. Staying current on emerging risks is essential for audit relevance.