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ADA resolution calls for peer to peer Medicaid audits

November 09, 2017

By Michelle Manchir

Photo of Dr. Sidney Whitman
Dr. Whitman
Dentists willing to serve patients who are eligible for Medicaid benefits should have fewer bureaucratic hurdles.

This was the guiding principle of the ADA Council on Advocacy for Access and Prevention's Medicaid Providers Advisory Committee, which oversaw the October passage of a resolution addressing Medicaid audits during the 2017 House of Delegates meeting in Atlanta, said Dr. Sidney Whitman, committee chair and a New Jersey pediatric dentist.

The resolution, 33H-2017, states that the ADA encourages all state dental associations to work with their respective state Medicaid agencies to ensure that Medicaid dental audits are conducted by dentists who have similar educational backgrounds and credentials as the dentists being audited. It also calls for the dental auditors to be licensed within the state in which the audit is being conducted, as there are specific regulations and circumstances that make each state unique. Medicaid audits can be conducted by a variety of different people, some of whom are not dentists, said Dr. Whitman. In some cases, dentists audit other dentists who are trained in different specialties, he said.

"It makes no sense for an oral surgeon to evaluate root planing and scaling by a periodontist," he said. "In fairness to all involved, with the goal of providing services that are cost efficient, a dentist in the same discipline has a better understanding of the variety of procedures that are necessary in certain instances and when a procedure is most prudent."

Furthermore, having an auditor with a license in the same state means the auditor is more likely to better understand the needs of the community and the Medicaid system in the state, Dr. Whitman said.

The 2017 resolution builds on a 2015 resolution the ADA House of Delegates passed calling for state dental associations to work with their state Medicaid agency in hiring a chief Medicaid dental officer who is a member of organized dentistry. The 2015 resolution, 85H-2015, also encouraged state dental associations to actively participate in the establishment or continuation of an existing Medicaid dental advisory committee that is recognized by the state Medicaid agency as the professional body to provide recommendations on Medicaid dental issues.

These actions have helped some states improve the oral health of Medicaid-eligible individuals, said Dr. Whitman.

"Our goal is to serve this population," Dr. Whitman said. "We are trying to remove the impediments to providing quality care for those willing to serve."