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Originally Posted by NuclearFart
Well I'm not a dentist so I will never know the whole truth, but its my own anecdotal opinion based what I have seen and heard from others.
Of course dentists wouldn't be so stupidly blatant to have an official two tiered billing structure, but it is easily done within the system by manipulating which codes they chose to charge as has been already alluded to in this thread. Maybe not in your practice, but it would certainly appear that some downtown practices are rather "generous" in their baseline billing structure when they know 99% of their clients are going to have coverage and won't question it.
My suspicion is that the default billing structure told to the front office staff would change rather drastically if the government were involved, becoming more in line with that seen in a medical practice.
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Forensic audits conducted by insurance companies will find the billing discrepancies if they are there ... and they have done so resulting in significant penalties to the dentist.
Insurance companies also will do a "code audit" on all of their claim submissions and see if a particular provider is using it more than the average .... once again, leading to a request for further information or an audit.
It is not as "easily done" as you might think.