The Art of Practice Management's Dental Pearls
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Embezzlement Wakeup Call
Marianne Harper

Yesterday was a wakeup call for me. I received in my email a LinkedIn discussion about a case of embezzlement and I decided to chime in with my thoughts about the controls that need to be in place in dental practices to avoid embezzlement. When I hit the send button I thought that I might actually be helping dental practices better safeguard themselves by reminding them that controls need to be in place in dental practices. I stated that dentists/owners need to take a more active part day to day by reviewing practice management adjustment reports and deposit slips/reports. I also indicated that one staff member should never be responsible for all revenue duties. Even for practices that electronically deposit the checks, cash should always be taken to the bank by the dentist or practice owner.

Shortly thereafter I noticed a new comment had been posted. This was a comment from David Harris, CFE addressing my post. David is the president and CEO of Prosperident, the only company in North America specializing in the detection, investigation and remediation of embezzlements committed against dentists. This is what David told me – "Marianne -- I agree that controls are necessary (predominantly reasons not relating to embezzlement), but most of the embezzlers who I see are completely capable of overcoming all of the procedures you are suggesting. The ingenuity that these folks apply to this issue is sometimes breathtaking. As you know, Marianne, we will not discuss specifics in a publicly-accessible forum like this (I have recurrent nightmares about educating thieves), but I'm happy to have a private chat sometime about some of the stuff we see. What we need to understand about thieves is that they are pushed by some pretty powerful forces and, as my learned friend Paul suggests, they tend to view controls as simply a "speed bump on the embezzlement highway". It helps that they know the doctor pretty well, and are also very aware of what controls are in place. I'll go one step further. There is a subset of dental embezzlers who get some kind of pleasure from stealing. Making it harder for them to steal INCREASES the jolt they get when they embezzle. So you are actually playing right into the hands of this group when you try to tighten things down. This cohort is certainly in the minority of embezzlers, but this factor is often overlooked."

So don’t let this just be my wakeup call. David Harris is definitely the man to contact if you have any concerns about embezzlement in your practice. He can be reached at

Breast Cancer and Blood Pressure
Colleen Rutledge, RDH

This summer I was visiting my friend in the hospital after a double mastectomy. She also had regional lymph nodes removed under her arm bilaterally as part of her mastectomy (this is not the case for everyone who has had a mastectomy).
The nurse came in to check on her and subsequently advised her that from now on she is to never let anyone take her blood pressure on her arm. This perked my interest as I routinely take blood pressure on my patients. She explained that lymph nodes filter or catch foreign matter and bacteria. If the nodes are removed, as was the case for my friend, the normal drainage has a reduced capacity to carry the lymph fluid.
During a blood pressure reading, pressure is exerted and the fluid backs up and can cause swelling in the arm. The accumulation of lymphatic fluid is called lymphedema. This condition is painful and puts the patient at high risk for infection. Future protocol is to have her blood pressure taken on her leg. Patients with lymph nodes removed from only one side could have their blood pressure taken on the unaffected arm.
There are other precautions to consider:
  1. Injections, IVs, or blood drawing should never be done in the affected arm
  2. Avoid strenuous movements with the affected arm such as pulling, pushing or scrubbing
  3. Avoid heavy lifting or carrying heavy objects (usually to 5 lbs. or less)
  4. Avoid tight jewelry or elastic bands around affected fingers or arm
  5. Wear gloves for housework and gardening
  6. Avoid cutting cuticles of the affected hand.
10% OFF SALE on every product in our store until September 15, 2013! Use code AUG13 at checkout. Please visit to shop now!
  Insurance Alert
Dental – Starting in 2013, dental code revisions occur annually. The changes in 2014 will include 29 new codes, 3 new code categories, 18 revised codes, 4 revised subcategories, and 4 deleted codes. Make your insurance system as efficient as possible by obtaining the 2014 codes. My recommendation for the BEST source of codes and coding help is both "Coding with Confidence" and a subscription to "Insurance Solutions Newsletter". To order "Coding with Confidence" download the Coding with Confidence Manual Order Form. To subscribe to the "Insurance Solutions Newsletter" download the Insurance Solutions Newsletter Order Form.
Medical – As announced in the last newsletter, the CMS1500 claim form has been updated to the 02/12 version. For all of the details on the changes, go to One of the significant changes is in box 21 because it provides a way to indicate which version of the diagnosis codes is being used (ICD-9 or ICD-10). This is necessary during the implementation period prior to the mandatory timeline of October 1, 2014 for ICD-10 only. Also, the form has expanded to provide for the reporting of up to twelve diagnosis codes as opposed to four on the prior form.
  Time Line
October 1, 2013 – This is the date for medical diagnosis codes to update. However, due to the impending change to ICD-10 in 2014, the only changes to the diagnosis code set deal with new technologies and diseases. Therefore, for purchasers of "CrossWalking – A Guide Through the CrossWalk of Dental to Medical Coding", there will be no update this year. I will notify you in December about the CPT code update.
September 23, 2013 - HIPAA Omnibus Final Rule – The updates to this rule were published on January 25, 2013. The compliance date is September 23, 2013.
January 1, 2013 – Updated CDT and CPT code sets
October 1, 2014 – The new date for ICD-10 implementation.

Favorite Quotes:

"The average Joe should be just as concerned about embezzlement, even more so, because it’s so easy to do. All you have to be is trustworthy to do it."

Peter Henning,


The high numbers of embezzlement in dental practices gives even more
reason for incorporating background checks into your hiring protocols.

Points of Interest:
According to a report recently published by Marquet International, "although the economy has been slowly recovering over the last several years, Marquet said what they found in the report is that a lot of embezzlement schemes that were hatched during the recession are now finally starting to see the light of day. However, while many people who were allegedly involved in these thefts did so out of financial need, others merely stole to create and maintain an extravagant lifestyle.
While the motivating factor among perpetrators was hard to ascertain in a majority of the cases examined in the study, those that were discovered varied widely, ranging from supporting gambling addictions to problems with substance abuse, a floundering family business or even providing for a loved one. Marquet said the average duration for one of these major embezzlement schemes is nearly five years and some have even lasted as long as 20 years before they are uncovered.

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