The Art of Practice Management's Dental Pearls
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  Articles
A Most Effective Communication Tool
Marianne Harper

Communication issues – do you experience them? Is there a chasm between clinical and business office? Many doctors and staff members over the years have communicated that to me. I have one solution that can minimize this problem – encounter forms. Some practices may refer to encounter forms as route slips, charge slips, or care slips. No matter the name, these forms provide a way for the doctor, clinical staff and business office staff to have a clear picture of what has transpired at each patient's appointment along with important patient information. You may ask how to begin using these forms. The easiest answer is to make use of what your practice management software provides. If you are not sure whether you can print encounter forms from your software, give the support line a call and ask. They can tell you where to access these forms and the best method for printing them. If not, you may consider creating your own form.

A good encounter form should provide the following information:
Patient demographic information
Medical alerts
Patient insurance information
Patient account balance
Special notes
Procedure information – encounter forms for recare appointments should provide the different possible codes that you set up in the software that apply to recare appointments. For operative appointments, the system should provide the procedure codes that were entered into the patient's treatment plan (treatment plans are an essentially important tool for practice management – a topic for another newsletter).
A place to indicate next visit information
A place to indicate any additional information
The beauty of these forms is that there is no question about what procedures were performed. Checkout goes more smoothly because all codes are listed and can be entered in the software ledger for the patient and the insurance claims will be correct. In addition, these forms aid in ensuring that data entry is correct at the end of the day. Each patient's procedure totals can be written on the form and all should be totaled at the end of the day and then compared with the end of day reports to be certain that production is in balance for the day.

I realize that practices are transitioning to being paperless but I still encourage the use of these forms. I have seen that medical practices that are paperless are still using these paper forms due to the communication benefits that they provide.

Medical Cross Coding and Encounter Forms
All of the benefits outlined above also apply to encounter forms for cross coded claims. However, dental practice management software does not commonly provide the ones that are needed for cross coding. The best encounter forms for cross coding are similar to the ones that you see being used at your medical provider's practice. These are usually large sheets with lots of codes on them, both diagnosis and procedure codes as is required with medical claims. I offer a number of different types of cross coding encounter forms on my website, www.artofpracticemanagement.com. The different types are listed below:
General
Perio and implant
Trauma
TMD
Sleep apnea
Pediatric
Endodontic
There are many codes that must appear on these forms because both diagnosis and procedure codes are necessary, so the form must address the many possibilities. These forms can be printed on one large sheet as you see in many medical providers' practices or they can be printed on one 8 1/2" x 11" sheet but printed on both sides, or it can be printed as a two page form.

Correct diagnosis coding is crucial to successful cross coded claims. These forms make it simpler for the dentist to see the different diagnosis codes that are available and choose accordingly. Business office staff should not be responsible for choosing diagnosis codes unless they have had the training to do so. These forms provide a way for the dentist to circle or check the appropriate diagnosis and procedure codes, thereby ensuring correct charges and insurance claims.

Take my advice – increase efficiency in your practice through the use of encounter forms. Click the link below to access the forms for cross coding and they can be downloaded directly to you. Take advantage of my special offer on these forms, too.
Order Your Encounter Forms Now!

The Speed Limit

Colleen Rutledge, RDH

Kids instinctively know certain things. Take my daughter, Danielle, for instance. She knows approximately how fast I’m driving. She observes her surroundings; the wind blowing a little harder on her face, the houses moving at a faster rate. This usually prompts her to ask me: "Mommy, are you going the "speed limit"? This comment got me thinking about the various comments made by patients, co-workers, and employers regarding the "speed" of a hygiene appointment.

Patients: "My hygienist is great! She gets me in and out of here fast!"
Dentists/Employers: "My hygienist never falls behind schedule."
Co-workers: "I love our hygienist because we always get out on time."
Hygienists: "My patients love me because I never make them wait."

Consider the above accolades; do they reflect reality or an illusion?

The Illusion
Many dental offices are still practicing with antiquated hygiene department protocols. Long gone are the days when a "cleaning" took thirty minutes. Limited hand scaling, a quick polish and four bitewings are no longer acceptable standards. Providing a high quality preventive care visit entails a comprehensive approach which requires more time.

The Reality
Clinical data is necessary to appropriately access a patient and requires time. Services ranging from gathering a thorough medical history and risk assessment to a six-point periodontal charting are the fundamentals of a high-quality hygiene visit. Time is necessary for all too often disregarded topics including smoking cessation, bruxism, oral cancer screening, oral hygiene instruction, sleep apnea and nutritional counseling.

How much time
You may be thinking: "How much time should I give my hygienist?" The answer is different for each office, but can be generalized with these guidelines:

New adult patient: One hour twenty minutes
Adult recare: One hour
Periodontal maintenance: One hour
New child patient: Forty minutes
Child patient: Thirty minutes

We have an ethical and moral obligation to provide high-quality hygiene services to the people entrusted to our care. Start by giving your hygiene department the proper amount of time to provide these services. It not only increases productivity but will provide optimal care and increase referrals.

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  Insurance Alert
Dental – Are you using Box 35 of the dental claim form effectively? This is a great place to enter your narrative information. However, keep in mind that the insurance carrier's scanners limit the number of characters that they will scan in that box and if the box is completely filled in, it will not be completely scanned. So be concise and provide only the pertinent details. Anything longer should be submitted as an attachment.
Medical – Box 19 of the CMS1500 claim form (medical claim form) can be used in the same way with the same requirements to be concise.
  Time Line
Update Time is Past Due – Medical Codes and Dental Codes for 2013
And your updated medical coding manual contains the new CDT codes also
CPT Code (medical procedure code set) will update as of January 1, 2013. Purchasers of "CrossWalking – A Guide Through the CrossWalk of Dental to Medical Coding" and/or the "Quick Look Up Cross Code List" – you should have received an email that provides information on the way to order the update. Medical insurance carriers will not accept outdated codes and will deny claims for that reason. I am offering a less expensive update to the paper manual this year in an electronic format. So take advantage of the savings and keep your codes up to date.
CDT Code UpdatePast Due – The ADA has announced that CDT codes will update on January 1st of every year. If you haven't already purchased your 2013 code set, now is the time. I recommend Dr. Charles Blair's "Coding with Confidence." It is the best source for all the detail that you need to understand the CDT codes. In addition, consider a subscription to "Insurance Solutions Newsletter." Not only will you receive a newsletter packed full of great coding information but the subscription also includes a coding support service. You can't go wrong with that kind of help. To order either or both of these, please click here.
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.
October 1, 2014 – The new date for ICD-10 implementation.

Favorite Quotes:
"The single biggest problem with communication is the illusion that it has taken place."
George Bernard Shaw

Tips – For our Patients:
Dish up some pineapple – for your health
"Pineapple is high in manganese, a mineral that is critical to development of strong bones and connective tissue. A cup of fresh pineapple will give you nearly 75% of the recommended daily amount. It is particularly helpful to older adults, whose bones tend to become brittle with age. Regular ingestion of at least one half cup of fresh pineapple daily is purported to relieve painful joints common to osteoarthritis. It also produces mild pain relief. Those individuals who eat fresh pineapple daily report fewer sinus problems related to allergies. In and of itself, pineapple has a very low risk for allergies. Pineapple is also known to discourage blood clot development. This makes it a valuable dietary addition for frequent fliers and others who may be at risk for blood clots."
From email – author unknown

Points of Interest:
Next month you may be celebrating St. Patrick's day. Irish lore is interesting and we often hear about leprechauns. A leprechaun was considered to be a small and mischievous sprite who could reveal the hiding place of a treasure to those who could catch him. The origin of the term comes from the Old Irish luchorpan. This term is broken down into "lu" for small and "corp" for body. I may try to find one of these leprechauns and get my treasure.

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The Art of Practice Management
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www.artofpracticemanagement.com   •   a.p.m.1@suddenlink.net
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