Preparing x-rays for OIG delivery
The OIG relies on provider record reviews as a tool to address fraud, waste and abuse (FWA) in Medicaid-supported dental services. Reviews typically focus on comparing provider clinical records, including x-rays and treatment notes, with documentation of the Medicaid billing and payments to identify potential FWA.
Providers may be chosen for a review as a result of a referral to our fraud hotline from the public, a Dental Maintenance Organization or another provider. They may also be flagged for consideration through the OIG’s use of data analytics and at the beginning of a Fraud Detection Operation (FDO).
A provider’s role in the process
Dental providers are required by their contracts to supply the OIG with all x-rays in a Medicaid client’s dental record if that client’s treatment by the provider is under review. An important question is whether a patient’s x-rays were of diagnostic quality. If a dental provider bills Medicaid for x-rays that were not of diagnostic quality or if the x-rays are missing, the OIG may seek to recoup the money paid to the provider for the x-rays and related services.
Providers can assist their reviews by ensuring x-rays:
- Are organized by chronological date.
- Include the patient name and date(s) (mm/dd/yyyy) of when the image was taken.
- Are labeled by tooth number or tooth range and by orientation to right (R) and left (L) side of the mouth.
For x-ray films
When client records contain x-ray films, the OIG requests that exact duplicates (size and quality) be provided. Original x-ray films will be accepted if they cannot be duplicated. It is generally not acceptable to take pictures of x-ray films or print them on paper or photo paper.
For digital x-Ray images
Dental providers must supply all x-rays for all dates of service for each client on the request list. Providers can aid the review process by supplying the OIG with x-rays of the same diagnostic quality as are contained in the patient’s record. Providing quality images on first submission can reduce the need for multiple requests from the OIG.
A clear picture
When taking x-rays, image quality matters. Poorly exposed images may not contain the details to validate a claim. Notice the difference between the diagnostic and non-diagnostic images on this page.
Preparing x-rays for OIG delivery
Dentists sometimes mount x-rays as if standing in front of the patient. However, the industry standard is to mount and send x-rays is as if you actually were the patient. That means the films representing the left side of the patient are mounted on the right side of the image. X-rays should not be mounted upside down, should be labeled to clearly indicate the orientation, and should also reference the date of service. Confirming tooth numbers also helps prevent misinterpretation of the x-ray.
Dentists will find more information about requirements for maintaining patient records in the Texas Medicaid Provider Procedures Manual, American Dental Association Guidelines, and the Texas Administrative Code.