How Do I Prepare My Clinic for a Dental Insurance Audit?

Concept of dental care on pink background

As a dental practice, the last thing you may want to hear about is your practice’s name and the word “dental insurance audit” at the same time. Unfortunately, this might happen sooner or later, and the only way you can adequately prepare for such a situation is to be prepared.

Today, we want to delve into dental insurance audits, talking about what it is, how to prepare for them, and how you can avoid getting one in the first place:

What Is a Dental Insurance Audit?

A dental insurance audit is an evaluation of a dental insurance plan by an independent third party. The purpose of the audit is to ensure that the plan is operating in compliance with all applicable laws and regulations.

The audit may review the plan’s marketing materials, provider contracts, claims data, and other financial records. The audit may also include on-site visits to provider offices and interviews with plan members.

The results of the audit will be reported to the dental insurance company and may be used to help the company make improvements to its plan.

How Do I Prepare for a Dental Insurance Audit?

No one likes to be audited, but dental insurance audits are a necessary evil. If you’re a dentist who accepts insurance, there’s a good chance you’ll be audited at some point. The good news is that there are some things you can do to prepare for an audit and make the process go as smoothly as possible.

Here are four tips to help you prepare for a dental insurance audit:

  1. Gather all of the required documentation in advance. This includes things like your dental license, proof of malpractice insurance, and tax returns. Having all of this documentation ready to go will make the audit process much smoother.
  2. Keep good records. This is important for two reasons. First, it will make it easier to provide the documentation the auditor is looking for. Second, it will help you defend yourself if there are any discrepancies in your records.
  3. Be cooperative. The auditor is just doing their job, so there’s no need to be defensive or uncooperative. Answer any questions truthfully and provide any requested documentation.
  4. Follow up. Once the audit is complete, make sure you follow up with the auditor to make sure everything is in order. If there are any discrepancies, be sure to address them as soon as possible.

Preparing for a dental insurance audit doesn’t have to be a nightmare. By following these tips, you can make the process go as smoothly as possible.

How Do I Avoid a Dental Insurance Audit in the First Place?

One of the best ways to avoid a dental insurance audit is to be proactive in your record-keeping. Be sure to keep detailed records of all treatment provided, including dates, procedures, and costs. It is also important to keep accurate records of all payments made by patients, as well as any payments made by the dental insurance company. Also, make sure your dentists are claiming under the appropriate dentist. If everyone makes a claim under one dentist, your data can be skewed.

In addition to all of that, it is also a good idea to have an accountant or other financial professional review your records prior to the audit to help ensure that everything is in order. If you are found to have overbilled the insurance company, you may be required to refund the overpayment, and you may also be subject to penalties.


Sometimes, a dental insurance audit is bound to happen. So, regardless of whether you think you’ll undergo an audit or not, it is never a bad idea to be prepared! Plus, being prepared means ensuring all your documents are in order and that your processes are done properly. Even if you do not get audited, these practices will ensure you are running your clinic effectively and efficiently, ensuring everyone’s happy!

Ash Dental CPA offers accounting services for dental and healthcare professionals. If you are looking for accountants in Framingham for your dental practice, get in touch with us today!

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