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Hygiene Department
Implementing a Cross-Training System
Marianne Harper

Examine this scenario: a husband and wife, who are your patients, start their day in the following manner:
Husband – Each morning he wakes up and feels very unrested. He has a delivery job and is behind the wheel all day. Coffee becomes his best friend, his best method to try to stay awake. In the evening, he falls asleep in front of the television early in the evening.
Wife – She wakes up after a fitful evening of . . .wake . . . sleep . . . wake . . . sleep due to her husband's loud snoring. She worries about his safety and the safety of those on the road with him, as she knows that he has not slept well. She has no companionship in the evenings because her husband is so often asleep in his recliner. She is seriously considering sleeping in the guest room on a permanent basis so that she can get some quality sleep every night.
You might be surprised to know that a similar situation might be occurring in many of your patients' households. According to Ashley Truitt, RDA, BBA in her article "Snoring and sleep apnea: Are they a nuisance or disease continuum?" (Hygiene Tribune, July 2011), the U.S. Department of Health and Human Services states that more than 45 million Americans suffer from obstructive sleep apnea (OSA). In addition, an estimated 800,000 patients are being diagnosed with OSA per year in the United States while only approximately 10 percent are being treated.

You might ask how this can possibly happen. The answer is that OSA is not being actively screened by primary care providers and, for those who are diagnosed with OSA, many are intolerant to the common method of treatment, continuous positive airway pressure (CPAP) machine.

OSA is a "killer disease" and it is sad that so few medical and dental practices are screening their patients for this and that those who are being treated with CPAP are not being successfully treated.

Your practice can rise to the challenge. A first step would be to read Ms. Truitt's article.
It details the roles of each dental team member in implementing effective OSA therapy once the dentist has been trained. She mentions the importance of the team asking the right questions of patients. I might add that good health history forms and recare update forms can help by also asking those important questions. Once you begin, you will realize just how many of your patients actually suffer from OSA and, by treating them, you will begin to make a significant difference in the lives of so many of your patients and their families.

Our practices can also help these patients afford their OSA treatments by filing these procedures with their medical plans. I can help you with this process through the use of my eBook, "Abra-Code-Dabra, How to Easily Transform Dental Codes To Medical Codes for Non-Surgical Sleep Apnea Procedures." This eBook will give you the know-how to more easily implement dental-medical cross coding and help your patients both medically and financially. I can also help you with current health history forms and recare update forms.

So what's stopping you? Let's make a difference!

Employ a Medical Model and Increase Hygiene Department Profitability
Colleen Rutledge, RDH

When interviewing a new client, the majority of offices describe what I call a "mechanical model", which means the focus of the perio therapy is on removing calculus one or two quadrants at a time. This approach usually fails, as after completing one or two quadrants, many patients do not complete their treatment. A year later you see them again and the treated quadrants are re-infected by bacteria from the untreated quadrants. Sadly, the patient is back to square one.

My recommended approach is using a "medical model" which is focused on decreasing the bacterial load in the entire mouth with treatment completed within 24 - 48 hours. Although longer appointments are necessary, proper use of ultrasonics increases efficiency, utilizing one or two one and one half hour appointments rather than four one hour appointments. The incorporation of locally applied antimicrobials during initial therapy as well as maintenance enhances clinical outcomes and substantially augments the services and profitability of the hygiene department.

Utilizing the "medical model" easily transforms hygiene departments from "loss leaders", producing $800 - $900 daily, to "production leaders" achieving $2500 or more when employing a comprehensive periodontal therapy program. Practices offering services based on current research and trends in periodontal therapy see hourly production rates soar from $90 - $120 to $150 - $400, with the average patient producing $400 - $700 or more. Embracing this model, hygiene departments can flourish into indispensable channels of both quality and profitability.
  Insurance Alert
Regarding those problem responses to your claims where the insurance carrier is requesting a reply from your office, a good protocol to follow is the following:

Respond in a timely manner.  Not doing so will affect your accounts receivable

Include a good cover letter

Don't alter or add records

Be sure to address their requests

Seek help if you are unsure how to respond (e.g. Insurance Solutions Newsletter's subscription offers an excellent support service. If you are interested in subscribing, I can send you an order form)

Review everything prior to mailing

Either make a copy or scan a copy of this response to the patient's record

The same information just listed for dental applies to your cross coded medical claims

ICD-9 codes will update on Oct. 1, 2011.  Be sure to contact me regarding the update

  Time Line
For those practices that have purchased my cross coding manual, "CrossWalking – A Guide Through the CrossWalk of Dental to Medical Coding", please take note that it will be time to update your manual before October 1, 2011. Please order your updates ASAP.
January 1, 2011 – CDT Code biennial update (If you haven't updated your practice management software codes, be sure to do it ASAP) (If you haven't gotten a copy of the new code-set, do that ASAP)
January 1, 2011 – Medical CPT Code (medical procedure codes) update (be sure to update your manuals and CPT codes that are entered in your software)
July 5, 2011 – Medicare will require that all physician and non-physician practitioners that submit Medicare claims must be enrolled in PECOS (Provider Enrollment, Chain and Ownership System) as well as all ordering and referring practitioners, or claims may not be paid. Practitioners can enroll online at
October 1, 2013 – ICD-10 (medical diagnosis codes new revision)
January 1, 2014 – The date that the US government has chosen for requiring all medical and dental practices to be paperless

Favorite Quotes:
"People who are cocky and arrogant say, "I know that" and move along. People who are confident and positive ask themselves, "How good am I at that?" and seek to improve."
Jeffrey Gitomer's Little Gold Book of Yes Attitude

The quote above really speaks to me. To question ourselves is not a sign of weakness but, rather, a sign of courage and openness to do better at whatever task we take on. How does it speak to you?

Points of Interest:
According to "Inside Dentistry", Americans have chosen the toothbrush to be the number one invention that they could not live without.

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