The Art of Practice Management's Dental Pearls
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Steps to Greater Productivity
Marianne Harper

A great idea pops in your head. You know that it is a wonderful idea but you have to plan out the process of making it happen. Do you ever find that you get so bogged down in the plans that the great idea never becomes reality? It happens to many of us. In our dental practices, we must always be moving forward and incorporating new ideas. Dental practices can be hectic and it's hard enough to get the routine tasks handled, much less adding a whole new project. However, how do we make advances without getting bogged down in the details?
I recently read an article1 written about Tony Wong who was referred to as a "project management blackbelt" and whose clients include Toyota, Honda and Disney as well as many others. His expertise is to keep people on task. In the article he was asked for his ideas on how to stay productive. I would like to share these tips below:
  1. Work backwards from goals to milestones to tasks - Don't get bogged down by the whole idea. The easiest way to accomplish a big plan is to break it down into its smaller parts. Basically you will need to keep cutting it back to its smallest elements, those that only require a few hours or less. You can map out a plan for these elements and list them in the order that they need to fall in order to accomplish the plan. As each part of the plan is complete, cross it off the list. My thoughts on this are that just that simple check off gives a person a feeling of success.

  2. Stop multi-tasking - He states that when we multitask, our IQ drops by 15 points for men and 5 for women (yes, women are three times better at multitasking).

  3. Be militant about eliminating distractions - Mr. Wong advises that we should lock our doors, put up a sign and go to a quiet area to complete one of the tasks. In the dental environment, this might be very difficult. My advice is to alert staff that you would not like to be disturbed if at all possible.

  4. Schedule your email - Email can be a constant distraction, so Mr. Wong suggests that one should set up a schedule two or three times a day for checking email.

  5. Use the phone - If your email will involve more than one response on your part, it is better and quicker to just use the phone and take care of the situation at one time.

  6. Work on your own agenda - By this, Mr. Wong means that you need to prioritize your goals each day. Start the day on the right foot by eating a good breakfast and creating a prioritized list of your goals for the day. He says that it's not a good idea to make checking email the first thing that one does in the morning, as it can throw off your scheduled priorities.

  7. Work in 60 to 90 minute intervals - The brain uses more glucose than any other bodily activity and, typically, it is within that 60 to 90 minute period of time that the brain will use most of it. Mr. Wong advises that we take breaks where we get up and move around and have a snack so that we can recharge.

So let's get moving on those big plans for our practices but follow Mr. Wong's advice for doing it in a much more productive manner.

Tongue Disinfection with Ultrasonics
Colleen Rutledge, RDH

Most of you know about the various over-the-counter tongue cleaners. But have you ever heard of a technique to professionally clean the tongue with ultrasonics? I first learned about this technique at a dental seminar for dental hygienists about seven years ago and have used it ever since. Additionally, it is one of the most sought after items in my consulting material.

According to Wikipedia: "The most common location for mouth-related halitosis is the tongue. Tongue bacteria produce malodorous compounds and fatty acids, and account for 80 to 90% of all cases of mouth-related bad breath. Large quantities of naturally-occurring bacteria are often found on the posterior dorsum of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleansed, and bacterial populations can thrive on remnants of food deposits, dead epithelial cells, and postnasal drip. The convoluted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacteria, which flourish under a continually-forming tongue coating of food debris, dead cells, postnasal drip and overlying bacteria, living and dead."

If it's one thing every patient wants, it's fresh breath! Using ultrasonics combines the mechanical action of a tongue scraper with the benefits of ultrasonics technology. It comfortably and thoroughly cleans the tongue and is a valuable service to offer patients, in both routine prophy appointments as well as comprehensive perio therapy cases.

Professional tongue disinfection is easy to do and takes less than a minute. Start at the tip of the tongue and move backward in small, sweeping motions. The bacteria will be mechanically removed with the strokes of the tip, the "acoustics" will compromise the cell wall, helping to destroy the endotoxins (lipopolysaccharides) and the "lavage" of water flushes all the bacteria off the tongue and into the suction. Most importantly: patients love it!

If you are interested in a copy of Tongue Disinfection Protocol with ultrasonics, email me at
  Insurance Alert
Audit Protections
I recently was asked by an attorney to work with her on a fraud case involving a dentist. I learned a lot during this process and realized that dental practices need to be reminded of the important steps that need to be taken to avoid audits or to have a positive outcome to one. Thorough documentation for all procedures performed is essential to avoiding negative consequences to any potential audits. This patient's record must include at least the following:
The procedures performed
The dental or medical necessity of the procedure(s)
The correct CDT codes for the procedure(s)
In addition:
The fee for the procedure must be the same for all patients no matter what type of insurance plan or if there is no insurance at all
Procedures must not be improperly "upcoded" or "unbundled"
Procedures must meet at least the basic clinical standards of practice
Audit Protections
The same fraud case that I just mentioned dealt with a dentist who had filed cross coded medical claims. The biggest problem with his claims was that the documentation was very poor - he never explained the medical necessity of the dental procedures. This must always be done any time that dental practices file with medical plans.
Delay in Implementation of ICD-10
The proposed date for implementation of ICD-10 (medical diagnosis code set) of October 1, 2013 has just been postponed. There is no set date as of yet for the future implementation. A reason given for this postponement is that medical practices are so burdened with their requirements for electronic health records that they are unable to handle that and ICD-10 implementation.
  Time Line
Update your cross coding manual –
The 2012 update is now ready
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 is now time to update your manual. Please order your updates ASAP by emailing Marianne at
July 5, 2011 – Medicare now requires 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
January 1, 2012 – Prior to this date, make sure that your software providers are prepared for the 5010 format. All covered entities listed below are required to upgrade to HIPAA 5010 Standards which are new sets of standards that regulate the electronic transmission of specific healthcare transactions including eligibility, claim status, referrals, claims, and remittances. Covered entities may use a clearinghouse to assist them with complying with the rules.
Additionally, even though software vendors are not included in the list of covered entities, in order to support their customers they will need to upgrade their products to support HIPAA 5010 and NCDPD D.0 as a business imperative.
2012 – Upcoming series of one-hour webinars that I will be presenting on dental-medical cross coding
1. Dental-Medical Cross Coding – The Why and About for Dental Practices
  • Friday, March 2, 2012 – 12:00 PM EST - Register Now
• Wednesday, March 7, 2012 – 1:00 PM EST - Register Now
2. Dental-Medical Cross Coding – The Medical Code Sets
  • Thursday, March 15, 2012 – 12:00 PM EST - Register Now
• Friday, March 23, 2012 – 1:00 PM EST - Register Now
3. Dental-Medical Cross Coding – How to Complete the Medical Claim Form
  • Wednesday, March 28, 2012 – 12:00 PM EST - Register Now
• Thursday, April 5, 2012 – 1:00 PM EST - Register Now

Favorite Quotes:
"If you don't know where you are headed it is a cinch you will miss your goal. Spend some time writing a description of what you want. Make it clear, go into great detail, create a vivid description that anyone can see."

It is Children's Dental Health Month at which time our goal is to help children achieve better oral hygiene. We know that it's not always easy for us to motivate children to spend the necessary time to thoroughly brush their teeth. A study was done by the company, Brush Buddies, evaluating brushing habits of children. They found that children using a manual brush brushed an average of 63 seconds while those that used talking or singing toothbrushes averaged 109.2 seconds, a 73% improvement. Based on those results, we might consider suggesting such brushes to parents.

Points of Interest:
Have you ever wondered where the expression "it's raining cats and dogs" came from? It actually dates back to the 1500's when houses had thatched roofs and there was no wood underneath that thick straw. In winter, small animals would nest in the roof to stay warm. However, when it rained, it got slippery and the animals would slip and fall off, hence – "it's raining cats and dogs.

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