Organizational Risk Management Planning

BUS4123

Quality Assurance and Risk Management

Introduction
A primary goal for risk management in the dental office is to avoid loss. Production is the main factor that determines the financial health of the organization. (Willis,2013) One major issue for dentists and managers’ is to determine how to avoid denial rates with insurance payments and keep collection rates consistent. A dental claim provides a common format for reporting dental services to a patient's dental benefit plan. (ADA, 2015) When a dental claim is processed correctly it provides income for the practice, which helps with operation cost.
Problem
The five common mistakes for claims being denied are claims are illegible, not specific enough, missing information, not up to payer standards, and are not filed on time. These mistakes are usually caused by employees within the office.(Young) As, risk manager it’s recommended to investigate and evaluate the reasons for claim denials by reviewing patients’ claim that have been denied. In order to start this process it’s ideal to review each patient’s claim and record. By reviewing patients’ records this can shed light on what improvements the organization needs to implement for gathering information to process claims correctly.
Purpose
The purpose for this dental risk management plan is to evaluate dental claim denials. Currently, the office is mailing out paper claims from a standard system. The office also uses paper records to obtain patients information and x-rays. For years, it has been the norm for dentists to use paper records. The issues with paper records are that they can be easily misplaced, time-consuming for staff, and they are subject to physical and environmental damage. (Dentrix, 2015) As, risk manager it would be in the best