The Art of Practice Management's Dental Pearls
The Art of Practice Management
A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.
Marianne Harper Recession Depression Blues?
Are you and your staff feeling the down effects of the economy? Many dental practices would probably answer yes. These are very difficult times and not just for individuals and small businesses. You read or hear almost every day that most businesses, both large and small, have been affected. The media paints a very gloomy picture, possibly gloomier than the reality of the situation, and this worsens the effect. It appears that there is no quick fix for the economy and that this recession will continue for many months. So how should a dental practice deal with recession depression?
We must react in a positive manner in order to survive. In other words, we need to make lemonade out of the sour lemons that have fallen in our paths. To do this, we must consider the practice both internally and externally.
  • The internal aspects are both human and business. Our practices have owners and employees, each possibly facing difficult challenges in their personal and professional lives. As fellow members of a practice, we need to be especially thoughtful and considerate of each other. Negative responses or actions may occur due to the stress that a boss or employee is dealing with. We can’t really “walk in their shoes” but we can empathize with them by offering to listen and possibly provide a shoulder to cry on. I am not suggesting that it is alright to bring our personal problems to work but, in reality, it is not always possible to cover up depression. Boss’s have an especially difficult time because they are responsible for the livelihood of their employees and their own families – for most they have families to support and a business to stay profitable – a tall order these days. Employees can be helpful by working as a team to reduce expenditures, verbally market the practice, take spare time to mine the charts for incomplete treatment plans, take CE courses, rev up customer service, and be supportive and understanding of the difficulties that the boss must deal with. Work with the schedule to create some open time to schedule staff meetings where the team can focus on the practice vision again and discuss ways to handle the suggestions listed above.
  • And then we must focus on the patients. Many may well be dealing with enormous financial strain and feelings of depression. This is the most important time to focus on your usual great customer service but, on top of that, we must all be exceptionally good listeners, observers and communicators. Now, more than ever, is the time that we must not only care for our patients’ oral health but for their emotional health also.
  • With respect to their oral health, we need to provide good estimates on their cost of treatment prior to beginning work. Now is not the time for surprises. As much as you would like to help your patients financially, your practice should never become a lending institution. Companies such as CareCredit and Wells Fargo are wonderful financial tools to offer to your patients. Always remember to document your discussions with your patients. When a patient elects to postpone treatment, you do not want to be liable for a claim of neglect of care.
  • Lastly, monitor your accounts receivable very carefully. Don’t wait to contact patients when the account is over ninety days past due. When an account is over thirty days, a patient has probably already received two statements. You should never accept that it is okay to send more than two statements. Contact patients ASAP once the accounts have been billed twice and not been paid. Approach the patients in a helpful manner but be firm that the balance needs to be paid now. Dealing with accounts in this fashion is mutually beneficial.
Invest time in your staff meetings to discuss these issues. Growth is often generated from adversity. These need to be the times that your practice will face the issues, deal with them, and grow to be a far greater practice than before. Keep that thought in mind as you beat those recession depression blues.

Time Line
Dental Coding
CDT 2009 is now the code-set required for dental claims (and medical using HCPCS codes) and will be required through 2010. The following are the changes in CDT 2009:
  • Four new codes
  • Twenty-two code descriptor changes

The four new codes are as follows:

  • D0417 – Collection and preparation of saliva sample for laboratory diagnostic testing
  • D0418 – Analysis of saliva sample
  • D3222 – Partial pulpotomy for apexogenesis, permanent tooth
  • D5991 – Topical medicament carrier

The first two codes deal with saliva testing which is considered by some insurance carriers to be experimental. I encourage practices to collect their fee in full at the time of service and to inform patients that their carrier may deny benefits

Medical Coding
ICD-9-CM (diagnosis codes) and CPT 2009 (procedure codes) are now in effect and must be used. Medical insurance carriers do not offer grace periods on the use of deleted codes or on the incorrect use of modified codes. The 2009 update for “CrossWalking – A guide Through the CrossWalk of Dental to Medical Coding” is now available. Protect the investment that you made in your medical coding manual by ordering your update, thereby keeping your manual current and preventing unwanted denials or delays in benefit payments. If you have any questions regarding the update, please contact me by phone or email (do not reply to this newsletter).

Red Flag Rule Update
There has been an update to the implementation date for the Red Flag Rule. The Red Flag Rule requires a written plan to be in place for financial institutions and creditors to prevent and detect identity theft. The FTC considers businesses that don’t receive payment in full at the time of service to be creditors and this includes most healthcare providers. The original compliance deadline was November 1, 2008. However the American Dental Association would like the Federal Trade Commission (FTC) to review their decision that dentists are creditors. A letter from the ADA was sent to the chairman of the FTC asking that the FTC postpone indefinitely application of the Red Flag Rule to dentists until a decision is reached.

A ruling on this matter may be a long time in coming while the deadline of May 1 is not far off. Therefore, it is important that your practice prepare now for implementation by that date. There are sources available for help in this implementation. Webinars dealing with the Red Flag Rule are available over the internet.

For our patients

Are you recommending products containing xylitol to your patients? If not, you need to. Briefly, xylitol is a natural sweetener with a low glycemic index of 7 compared to sugar’s 83. Xylitol has 40% fewer calories than sugar too. More than 1500 clinical and laboratory studies prove xylitol has many other health-promoting benefits some of which are the following:

  • Reduces the risk for dental caries
  • Promotes a healthy oral environment
  • When certain bacteria and fungus are exposed to xylitol, they lose their ability to stick to the tissues in the mouth, nose, and upper respiratory tract

Xlear, Inc. has an extensive line of products, all based on xylitol, that are available for our patients. Their line of products include the Spry brand of oral rinses, toothpaste, infant and children’s tooth gel, chewing gum, and mints in addition to their Xylo Sweet sweetener. Products that can be recommended for upper respiratory use are Xlear Saline Nasal Spray with Xylitol and Kid’s Xlear Saline Nasal Spray. We like to offer our patients full service dental care that doesn’t stop at the enamel. We are in the health care business and offering care to those suffering from decay, or infections of the nose or ear is one small way to do more.

For staff
Medical Gloves
Effective December 19, 2008, the Food and Drug Administration (FDA) made their final rule on the barrier quality of medical gloves. The Acceptable Quality Levels (AQL) for patient exam gloves was reduced to 2.5 while the AQL for surgical gloves was reduced to 1.5. Most glove manufacturers do meet these guidelines but it would be wise to make sure that your gloves meet these standards.


Dental Humor for the quarter:

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The Art of Practice Management
2217 Fox Horn Road  •  New Bern, NC 28562  •  Phone: 1-252-637-6259   •
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