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A Carrier's Perspective on Compliance Audits and Utilization Management [Webinar]

Screenshot image of webinar title slide

Some of the most worrisome concerns reported to the ADA by member dentists are utilization management reviews and compliance audits. On March 20, 2018 the ADA Center for Dental Benefits, Coding and Quality presented a webinar that provided a basic understanding of why third-party payers have implemented utilization management reviews and conducted compliance audits and how these may affect dental practices.

“Dentists who have been placed on a focused review or have been chosen for a compliance audit want to know why they were chosen and what they need to do to comply,” said Dr. Christopher Bulnes, vice chair of the ADA Council on Dental Benefit Programs. “No matter what the cause, a pending audit can be a stressful and sometimes costly process for the dental office.”

This one hour webinar features a dentist who had undergone a post-treatment review audit and what that dentist had to go through to comply with the audit. Also included is a dental director from a large carrier who explained how dentists are chosen for audits, what the dentist should expect during the audit and what it will take to successfully complete the audit.

About the presenters

Dr. Linda Vidone

Dr. Vidone is Vice President of Clinical Management and Senior Dental Director at Delta Dental of Massachusetts. Dr. Vidone has 20 years of dental experience that includes clinical private practice, dental school faculty as well as the dental benefits industry.

Dr. Vidone is a board certified dental consultant and a hands-on leader in the dental insurance industry setting clinical policies and performing routine claim review, while staying abreast of innovations in oral health care. She shares her unique knowledge of being on both sides of the claim form while lecturing nationwide on all aspects of dental benefits, dental coding and claim accuracy.

Dennis McHugh

Dennis McHugh is the manager, third party payer advocacy for the American Dental Association and works in the Practice Institute’s Center for Dental Benefits, Coding and Quality (CDBCQ). CDBCQ is the ADA agency responsible for promoting resources and information on dental benefit plans to employers and member dentists.  In addition, CDBCQ responds to requests and helps resolve problems from member dentists regarding concerns with third party payers and the Code.

Dr. Christopher Bulnes

Dr. Bulnes is a general dentist in Tampa, Florida. He received a Bachelor of Science degree in Chemistry from the University of South Florida in Tampa and his Doctor of Dental Medicine degree and a certificate in Advanced Education of General Dentistry from Southern Illinois University in Alton, Illinois. Chris is an ADA Council on Dental Benefit Programs member and serves as Vice-Chair.

Nick Messuri

Nick Messuri is vice president and deputy general counsel for fraud prevention and recovery at Delta Dental of Massachusetts. He oversees a team of investigators and manages a national anti-fraud and abuse program for Medicaid, Medicare Advantage and commercial membership. 

He is past president of the National Association of Medicaid Fraud Control Units and past chair of the National Association of Attorneys General Multi-State False Claims Act Committee. Currently he is a board member and chair elect to the National Health Care Anti-Fraud Association.

Dr. Cynthia Olenwine

Dr. Cynthia Olenwine received her doctor of dental medicine degree from Temple University School of Dentistry. Following graduation she completed a general practice residency at Muhlenberg Hospital, Bethlehem, Pennsylvania. She is an attending dentist in the general practice residency program at St. Luke’s University Hospital Health network.

She started in dentistry as a dental hygienist, expanded functions dental assistant and an office manager. Dr. Olenwine has a keen knowledge of office management and the business of dentistry. She currently serves as a volunteer on the ADA Council on Dental Benefit Programs and also the Code Maintenance Committee.