Code of Conduct & Compliance

The Code of Conduct is required as part of the Practice Compliance Plan and applies to all employees of the practice including the owner. Dentists, hygienists, clerical and support staff, billing staff, and any other staff including contracted staff and individuals employed by another entity on behalf of the practice must understand the Code of Conduct as well as sign and date an Acknowledgement of Receipt when given a copy of this manual. Stay familiar with the Code of Conduct and Compliance Plan and contact your practice’s Compliance Officer or the HQRC Officer with any questions or concerns. 

Standards Relating to Billing and Coding

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Collecting Insurance Information.  Medicaid requires that all providers, including dental practices, bill other primary payors before billing Medicaid, and that they maintain a system that is reasonably designed to identify payors other than Medicaid so that incorrect billing and Medicaid overpayments can be prevented. As a result, HQRC has instituted, in conjunction with our clients, procedures that will allow it to determine the primary and secondary payors are for all patients, so that it may bill appropriately.

Credit Balances. On a periodic basis, HQRC will generate on behalf of our clients reports of the status of any credit balances owing to Medicaid or other third-party payors. To the extent that such credit balances reflect the actual receipt of payments to which the client dental practice was not entitled, we will so notify the client and work with the client to make any required disclosures and/or refunds to the appropriate payor in a timely and reasonable manner, and as may be required by law.

Providing Professional or Other Courtesy Discounts.  Our client dental practices do not provide professional courtesy discounts to other providers or professionals or their families.  Discounts based on patient status are thus not permitted except for employees or immediate family of employees.  Otherwise, appropriate discounts will be provided only when there is documentation that the patient is suffering from a financial hardship.

Waiver of Co-Insurance or Deductibles.  HQRC and its client dental practices do not  waive patient co-insurance or co-payment amounts or deductibles, unless there is documentation that the patient is suffering from a financial hardship. 

Retention of Records. All billing records that demonstrate a client dental practice’s right to receive payment from third-party payors, and all medical and other records that disclose the nature and extent of services, items and tests furnished and their medical necessity will be retained by the client for a minimum of ten years.  HQRC personnel will not destroy or tamper with any medical records.  

Compliance with Licensure and Registration Requirements.   

          All providers employed by or contracted with a client dental practice must at all times meet all applicable New York State licensure and registration requirements. HQRC will assist its clients in ensuring that these requirements are met and will not submit any claim for payment to any payor for services provided by a provider it knows or has reason to know is not in compliance with such rules.

          HQRC thus conducts in conjunction with is clients background checks, verifies credentials and evaluates provider-specific information in accordance with the National Committee for Quality Assurance (NCQA) standards, and state and federal regulations.  In addition, HQRC also assist it clients in ensuring that the Practice enrolls each provider with Medicare, Medicaid and other third-party payers in accordance with applicable requirements, and will seek reimbursement for an individual provider's clinical services only if such provider is properly enrolled with the applicable payor.