Checklist template

Patient payment and insurance claim controls for dental practices

A ready-to-use checklist with 108 items in 6 sections, covering Collections, Adjustments, Refunds, Claims, Cash drawer, Reports. Use it as-is in InspectLoop, or adapt it to your own standards in minutes.

  • 6 Sections
  • 108 Items
  • 86 Yes / No checks
  • 6 Scored ratings
  • 116 Points

Use this template How audits work

1. Collections 18 items

  1. Each patient portion left unpaid at check-out today has a reason noted on the account Yes / No 1 pt
  2. A receipt generated by the practice management software is printed or emailed for every payment Yes / No 1 pt
  3. No manual receipt book is in use at the front desk Yes / No 1 pt
  4. Payments are posted to the patient ledger when they are received, not held for posting later in the day Yes / No 1 pt
  5. Payments from the last 5 working days sampled Number
  6. The tender type posted (cash, check, card) matched the actual tender for each payment sampled Yes / No 1 pt
  7. Sampled payments where the posted tender type did not match Number
  8. Checks are stamped "for deposit only" as soon as they are received Yes / No 1 pt
  9. Card numbers are not written on paper or typed into patient notes Yes / No 1 pt
  10. Payments arriving by mail are opened and listed by an employee other than the one who posts them Yes / No 1 pt
  11. Each payment plan has a written agreement signed by the patient Yes / No 1 pt
  12. Payments from third-party financing are posted from the lender's funding report Yes / No 1 pt
  13. Each front desk employee posts payments under a personal user name Yes / No 1 pt
  14. The software is set so that a closed day cannot be changed without a manager's password Yes / No 1 pt
  15. The software is set so that a posted payment cannot be deleted, only reversed with a record of who did it Yes / No 1 pt
  16. Treatment for employees and their families is entered at the full fee, with the discount posted as a separate adjustment Yes / No 1 pt
  17. Unapplied credits on patient accounts are reviewed every month Yes / No 1 pt
  18. Collection of the patient portion at the time of service Rating
    • Collected on every visit observed 5 pts
    • Missed on some visits 3 pts
    • Rarely requested 1 pt

2. Adjustments 17 items

  1. Each kind of adjustment has its own code (insurance write-off, courtesy, employee, senior, bad debt) Yes / No 1 pt
  2. No adjustment in the last month was posted under a miscellaneous or general code Yes / No 1 pt
  3. The right to post adjustments is limited to named users in the software's security settings Yes / No 1 pt
  4. Adjustments above the limit set by company policy carry the written approval of the dentist or the manager Yes / No 1 pt
  5. Last month's adjustment report is signed by a reviewer who does not post payments Yes / No 1 pt
  6. Total adjustments last month (dollars) Number
  7. Adjustments last month as a percentage of gross production (%) Number
  8. Adjustments sampled Number
  9. Each adjustment sampled has a note stating its reason Yes / No 1 pt
  10. Insurance write-offs sampled equal the contractual difference shown on the explanation of benefits Yes / No 1 pt
  11. No account sampled shows a cash payment and a courtesy adjustment posted on the same day without an explanation Yes / No 1 pt
  12. Bad debt write-offs sampled follow the collection attempts required by company policy Yes / No 1 pt
  13. Accounts written off to a collection agency appear on the agency's placement list Yes / No 1 pt
  14. Co-payments and deductibles are waived only under the written hardship policy Yes / No 1 pt
  15. The report of adjustments by user is reviewed monthly for employees with unusually high totals Yes / No 1 pt
  16. Procedures deleted or changed after check-out appear on an audit report that is reviewed every week Yes / No 1 pt
  17. Control over adjustments and write-offs Rating
    • Coded, approved and reviewed 5 pts
    • Reviewed but with gaps in approval or notes 3 pts
    • Not reviewed 1 pt

3. Refunds 17 items

  1. Each refund starts with a written request showing the credit balance on the patient ledger Yes / No 1 pt
  2. Refunds are approved by a person other than the employee who prepared them Yes / No 1 pt
  3. Patient refunds are never paid in cash from the drawer Yes / No 1 pt
  4. Refund checks are signed by the dentist-owner or issued by head office Yes / No 1 pt
  5. Card refunds go only to the card used for the original payment Yes / No 1 pt
  6. Refunds on the card terminal require a manager's password Yes / No 1 pt
  7. Refunds issued last month Number
  8. Total amount refunded last month (dollars) Number
  9. Each of 5 refunds sampled traces to an overpayment recorded on the ledger Yes / No 1 pt
  10. Refunds are posted with a refund code, not as a negative payment Yes / No 1 pt
  11. Last month's refund report from the card terminal matches the refunds posted in the software Yes / No 1 pt
  12. Overpayments by insurance carriers are refunded to the carrier and recorded in a log Yes / No 1 pt
  13. The credit balance report is run every month Yes / No 1 pt
  14. Credit balances older than 90 days Number
  15. Refunds payable to employees or their relatives are reviewed by the regional manager Yes / No 1 pt
  16. Voided refund checks are marked void and kept on file Yes / No 1 pt
  17. Control over refunds Rating
    • Requested, approved and traceable 5 pts
    • Traceable but approval missing on some 3 pts
    • Not controlled 1 pt

4. Claims 19 items

  1. Claims are submitted on the day of service or the next working day Yes / No 1 pt
  2. Claims not yet submitted for visits more than 2 working days old Number
  3. Claims sampled against the clinical record Number
  4. The date of service on each claim sampled matches the date of the clinical note Yes / No 1 pt
  5. Procedure codes on each claim sampled match the treatment described in the clinical note Yes / No 1 pt
  6. The treating provider named on each claim sampled is the provider who signed the clinical note Yes / No 1 pt
  7. The fee billed to the carrier on claims sampled equals the office's standard fee for the procedure Yes / No 1 pt
  8. Crowns, bridges and dentures on claims sampled are billed on the date the payer contract allows (preparation or delivery) Yes / No 1 pt
  9. Radiographs, periodontal charting and narratives required by the carrier are attached to the claim Yes / No 1 pt
  10. Narratives on claims sampled reflect what the clinical note records for that patient Yes / No 1 pt
  11. Insurance payments are posted line by line from the explanation of benefits Yes / No 1 pt
  12. Electronic insurance payments are matched to the bank statement before they are posted Yes / No 1 pt
  13. Explanation of benefits documents are scanned to the patient's account or filed by date Yes / No 1 pt
  14. Denied claims are worked within the number of days set by company policy, with a note on the claim Yes / No 1 pt
  15. Claims outstanding for more than 60 days Number
  16. The outstanding claims report is worked every week Yes / No 1 pt
  17. Secondary claims are sent once the primary carrier has paid Yes / No 1 pt
  18. No claim has been submitted under the name of a dentist who has left the practice Yes / No 1 pt
  19. Agreement between claims sampled and clinical records Rating
    • Full agreement 5 pts
    • Minor differences, corrected on the spot 3 pts
    • Differences in dates, codes or providers 1 pt

5. Cash drawer 19 items

  1. The change fund is counted at opening by the employee responsible for the drawer Yes / No 1 pt
  2. Change fund counted during the visit (dollars) Number
  3. The change fund counted during the visit equals the fixed amount set by company policy Yes / No 1 pt
  4. The cash drawer is locked whenever the front desk is unattended Yes / No 1 pt
  5. The drawer key is held by a named employee during the day Yes / No 1 pt
  6. Cash payments go straight into the drawer, not into envelopes, charts or desk drawers Yes / No 1 pt
  7. Cash is counted at closing by two employees, who both sign the count Yes / No 1 pt
  8. The deposit slip lists each check separately Yes / No 1 pt
  9. Deposits are taken to the bank daily or within the number of days set by company policy Yes / No 1 pt
  10. The bank receipt for each deposit is attached to that day's day sheet Yes / No 1 pt
  11. Bank deposits of the last 5 working days match the cash and check totals of the day sheets Yes / No 1 pt
  12. Cash and checks awaiting deposit are kept in a locked safe Yes / No 1 pt
  13. The drawer holds no personal checks, IOUs or notes in place of cash Yes / No 1 pt
  14. Petty cash is kept apart from patient payments Yes / No 1 pt
  15. Each petty cash payout is supported by a receipt Yes / No 1 pt
  16. Overages and shortages are recorded on the day sheet Yes / No 1 pt
  17. The safe combination is changed when an employee who knows it leaves Yes / No 1 pt
  18. Date the safe combination was last changed Date
  19. Cash handling at the front desk Rating
    • Counted, secured and deposited on time 5 pts
    • Small gaps in counts or deposit timing 3 pts
    • Cash unsecured or deposits late 1 pt

6. Reports 18 items

  1. The day sheet is printed or saved at closing every day and signed by the person who closed Yes / No 1 pt
  2. Card totals on the day sheet agree with the terminal's batch report for the last 5 working days Yes / No 1 pt
  3. A comparison of yesterday's schedule with the day sheet showed charges posted for every patient seen Yes / No 1 pt
  4. The month is closed and locked in the software within the number of days set by company policy Yes / No 1 pt
  5. The dentist-owner or the regional manager signs the month-end summary of production, collections and adjustments Yes / No 1 pt
  6. The bank statement is reconciled monthly by a person who neither posts payments nor makes deposits Yes / No 1 pt
  7. The accounts receivable aging report is reviewed every month Yes / No 1 pt
  8. Total accounts receivable (dollars) Number
  9. Statements are generated by the software for every account with a balance, with no accounts skipped by hand Yes / No 1 pt
  10. Patient calls disputing a balance or a payment are logged and reviewed by the manager Yes / No 1 pt
  11. The list of software users was reviewed in the last 6 months Yes / No 1 pt
  12. Users who left the practice have been deactivated in the software Yes / No 1 pt
  13. No passwords are written on notes at the front desk Yes / No 1 pt
  14. Employees who handle payments take at least 5 consecutive days off each year while another employee covers their duties Yes / No 1 pt
  15. Findings from the previous review have been corrected Yes / No 1 pt
  16. Name of the practice manager Short text
  17. Overall control of payments and claims Rating
    • Strong 5 pts
    • Partial 3 pts
    • Weak 1 pt
  18. Findings and corrective actions Comments

About this template

This checklist is part of the InspectLoop template library. Yes / No checks score 1 point when met; ratings score the points shown for each option. The overall score is the percentage of points earned, with N/A answers excluded. In InspectLoop you can add photos, assign corrective actions, require sign-off and compare results across sites.

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