The Art of Practice Management
Insurance Alert
Time Line
Favorite Quotes
Dental Humor
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Perio Therapeutics and Beyond
Marianne Harper
The end of 2010 is fast approaching and this time of year often becomes a period of reflection. Dental practices can look back at what has worked and what has not and take adjustment steps to improve systems and make 2011 a more productive, profitable and enjoyable year.
All dental practices are dealing with a struggling economy. The practice itself is impacted due to its own costs but also, on the revenue side, by its patients who may be dealing with their own financial struggles. We can make some system changes to areas that are under our control. All dental practices need to put in place the systems that will answer the question of where has the money gone.

Does your staff consult with you or your office manager prior to placing dental and office supply orders? Is there a system in place in your office that monitors all expenditures? Have you developed a practice budget and then followed it? In many practices, the answer to these questions is a resounding "NO". You may be asking yourself "where has all the money gone?" and with good reason.

Practice profitability is directly tied to the establishment of accounting systems relating to the control of practice expenditures. The first step involves setting up a budget. Looking back at expenditures from prior years is essential to determining the areas in your practice that need improvement. Dental consultants and CPA's can be of assistance in this process. The major guideline areas for budgeting are as follows:

Dental and office supplies     7%

Laboratory fees     9%

Facility and equipment costs     6%

Staff     27%

Marketing     2%

Administration, Accounting, and Continuing Education, etc.     2%

The second step and most important is following the budget. Your bookkeeper must be trained to spot the areas that exceed your budget guidelines and alert you so that adjustments can be made. Staff must have all supply orders authorized prior to placing them. Major facility and equipment purchases should be reviewed with a CPA prior to purchase to determine the profitability of the expenditure.

Budgeting is one of the most effective ways to grow your practice into a financially healthy one, to reduce your stress, and to never have to ask again "where has the money gone".

Colleen Rutledge, RDH
I often hear comments like "We don't need Atridox, we already have Arestin" or "We don't use PerioChip because we use Arestin". As a hygiene consultant, I recommend all three products, as they serve a unique propose in a non-surgical periodontal therapy program.
As of CDT 2011-2012, there is still only one code designated for a locally applied antimicrobial: D4381. For purposes of internal tracking I recommend creating a ‘house code" for all three products. This is important because each product has different fees. It also provides a means of tracking how much of each product is being used and which provider is using which products.

Consider the examples below:

PerioChip   -   D4381.P  $35

Arestin   -   D4381.AR  $40

Atridox  -   D4381.AX   $180

  Insurance Alert
The 2011/2012 CDT Manual is now available for purchase. Be sure to be prepared for January 1, 2011 by making sure that your practice management software is updated and that you understand the use of the new codes. The eight new codes are listed below:

D1352 Preventive resin restoration in a moderate to high caries risk patient - permanent tooth

D3354 Pulp regeneration - (completion of regenerative treatment in an immature permanent tooth with a necrotic pulp): does not include final restoration

D5992 adjust maxillofacial prosthetic appliance, by report

D2993 maintenance and cleaning of a maxillofacial prosthesis (extra or intraoral) other than required adjustments, by report

D6254 interim pontic

D6795 interim retainer crown

D7251 coronectomy - intentional partial tooth removal

D7295 harvest of bone for use in autogenous grafting procedure

I recommend either the ADA's code book or Dr. Charles Blair's "Coding with Confidence" as excellent sources of learning about these new codes and also to determine what codes have been revised. There are no deleted codes in this update.
Need for prior approvals
Those practices who have their own CT scanners and who will submit the fees for these scans to medical insurance need to be sure to inquire from the insurance plan if a prior approval is needed. If it is, be sure to ask for a prior authorization number that can be entered in box #23 on the CMS1500 medical claim form. If you don't do this, the insurance carrier may reduce payment levels.

Very exciting news - Cross Country Education has scheduled a dental practice insurance "boot-camp" in Las Vegas, NV on January 20 and 21, 2011. Dr. Paul Bornstein will present his seminar on dental insurance on January 20th while I will present my seminar on dental-medical cross coding on January 21st. Check out their website for additional information and to register so that you can attend these very important seminars. You always hear the expression "what happens in Las Vegas will stay in Las Vegas". Let's change that – now you can bring back lots of what happens in Las Vegas.
  Time Line
For those of you who have purchased my dental-medical cross coding manual, "CrossWalking – A Guide Through the CrossWalk of Dental to Medical Coding", it is now time to update the manual with the new, changed, and deleted diagnosis codes. Please be sure to email me at to obtain your update.
October 1, 2010 – ICD-9-CM (medical diagnosis codes) update
January 1, 2011 – According to the ADA, “a bill that will exempt dental practices and other small businesses from the Federal Trade Commission's (FTC) Red Flags Rule was passed by the Senate and the House and sent to President Obama for signature. The ADA expects that the president will sign the bill into law before the FTC's delay in enforcing the rule expires on Jan. 1, 2011.”
January 1, 2011 – CDT Code biennial update
January 1, 2011 – Medical CPT Code (medical procedure codes) update
January 1, 2014 – The date that the US government has chosen for requiring all medical and dental practices to be paperless

Favorite Quotes:
I want to share a Swedish proverb with you as opposed to a quote. Please take a few moments to reflect on its message.
"Worry often gives a small thing a great shadow"

The Linda Harvey Group is presenting a "Dental Risk Prevention Series" that will be a continuum of risk prevention and risk management strategies. All dental practices need this information. The conference will be held on Friday, January 21, 2011 at the Hyatt Regency in Jacksonville, Florida. To register, please check The Linda Harvey Group website.

Dental Humor:
I DREAD going to the dentist. Once, to ease my tension, I listed my middle name as "Wimp." The receptionist read it, laughed and assured me that many patients felt the same way. Half an hour later, the receptionist came into the waiting room. Looking directly at me, she said, smiling, "The doctor will now see the wimp." Three other people got up with me.

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The Art of Practice Management
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Perio-Therapeutics & Beyond
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