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.

This decade has brought about fascinating changes in dentistry. I am proud to be a part of this profession and am always amazed by all that I read dealing with these changes. One area of change deals with risk assessments. One type of risk assessment is referred to as CAMBRA. According to the website CariFree, "the acronym CAMBRA stands for "Caries Management by Risk
Assessment". CAMBRA is a method of assessing caries (cavity) risk and making dental treatment and restoration recommendations based on a patient's caries risk."1 CAMBRA involves tests for oral bacterial levels; the examination of disease indicators; and risk factors such as current decay conditions, past decay conditions, medications, salivary conditions, diet, and the patient's oral hygiene methods. After performing CAMBRA the dentist can then make a decision on the most appropriate treatment based on the level of risk. These dentists will be treating the patient's bacterial infections that have caused the cavity as well as restoring the teeth, all based on the patient's risk factors in order to reduce the risk of failed restorations due to recurrent decay.

In addition to CAMBRA, today's state-of-the-art dental practices are also performing perio risk assessments. Perio risk assessments are performed to help predict a patient's likelihood of developing periodontal disease and help to determine appropriate treatment for patients. According to Chester W. Douglass, DMD, PhD in his article "Risk Assessment and Management of Periodontal Disease", he states that the clinical practice of risk assessment may reduce the need for complex periodontal therapies, can increase patient compliance and can reduce the costs of periodontal health care.2 One very important part of risk assessment involves having a comprehensive health history form for patients to complete. These questionnaires provide the pointers to conditions that can impact dental health. If you are unsure as to whether your form is adequate, please check my website for a free download of a health history form. It is lengthy but that's necessary to be comprehensive. In addition, I advocate recare update forms that not only update the patient's demographic and insurance information but also have a health change section. This form is also available on my website.

These risk assessments are great news for the patients of the practices that perform them. Aside from these benefits for patients, there is a not so obvious benefit for dental practices that perform risk assessments. We live in a very litigious society. Dental practices have to be constantly conscious of this and work hard to avoid litigation. Performing risk assessments is so important in helping to prevent claims of lack of care, negligence, or failure to diagnose. Yes, we seem to have been doing just fine for decades without risk assessments but, in the words of Edwin J. Zinman, DDS, JD, "Customary practice is no defense to a negligent custom. No matter how many do it wrong never makes it right. Accordingly, regardless of how few or how many provide CAMBRA care; it nevertheless is care that all reasonable clinicians should offer and provide. When the benefits of providing care exceed the risks, then not offering scientifically proven benefits to patients is unreasonable care, and thus careless."3 Today's patients are much more knowledgeable and have access to a multitude of information such as I have just quoted. Take heed of this warning.

Another benefit of risk assessments is for those dental practices that file dental-medical cross coded claims. Risk assessments and comprehensive health histories are great tools. Medical claims require diagnosis codes to prove the medical necessity of the procedures and these are the tools that can help you to determine medical necessity.

So if your practice has not yet started performing risk assessments, revise your practice's protocols by adding both types of risk assessments. There are sources of help to learn how to do these such as lectures, webinars, articles, and companies such as PreViser, as well as consultants who specialize in risk assessments. Safeguard your patients as well as your practice.

1, June 20, 2009
2, June 20, 2009
3Carri Cady, RDH, Sued Over Caries? The risks are real, which makes an established CAMBRA protocol that much more important, (Modern Hygienist, June 2009) p.22
Time Line
Red Flags Rule – My special edition newsletter in May provided information on the Red Flags Rule and what needs to be done to comply with it. August 1, 2009 is the deadline for compliance. In that newsletter I mentioned that a template would be made available by the FTC for businesses or organizations of low risk for identity theft such as dental practices. That template is now available. Go to:

HIPAA and Breach Notification – According to Total Medical Compliance in their June 2009 "HIPAA Special Bulletin", by September 2009, HIPAA will require that a Covered Entity notify a patient of any breach. A breach according to HIPAA is "The unauthorized acquisition, access, use, or disclosure of PHI which compromises the security or privacy of such information, except where an unauthorized person to whom such information is disclosed would not reasonably have been able to retain such information."
The exceptions to this are:
  • Any unintentional breach by an employee or Business Associate if the information is not further used or disclosed.
  • Any inadvertent disclosure by a Covered Entity or Business Associate to another person at the same entity.
Not Excluded – inadvertent disclosures:
  • Records faxed or mailed to the wrong person
  • Unauthorized conversations
  • Intentional disclosures of PHI to other members of the work force
  • Releasing PHI without a HIPAA compliant authorization form when an authorization is required
  • Releasing information in excess of what is allowed by law. Providing more information on reportable diseases than the law sets as the data to be provided
Further guidance on this will be made available by HHS in August. To prepare your practice now:
  • If electronic data leaves your office, be sure that it is encrypted
  • Secure and protect all data
  • Inform your Business Associates of these new requirements so that they will have policies in place to protect electronic data.
  • Train all employees to prevent breaches
  • Create an office policy that deals with breaches
  • Begin identifying possible breaches in your practice
  • Possibly contract with a company such as Total Medical Compliance to assist your office with HIPAA compliance

My Favorite Quotes:
"Time is the scarcest resource and unless it is managed nothing else can be managed."
Peter Drucker


For our patients and ourselves – Now that summer is here we will all find ourselves outside more in the sun. "SPRYLIVING.COM", in their June 2009 article "Don’t get burned", debunks several myths about protecting your skin from the sun.

  • You are safe in the shade – Shade may only provide an equivalent protection equal to 50 SPF but if you are on a beach or near water (even inside), the sun can find you. Always wear at least an SPF 15 sunscreen.
  • A T-shirt will protect me – If you can see the light shining through the T-shirt, UV rays will reach your skin. Wear sunscreen underneath your clothes.
  • Tanning beds that don’t contain UVB rays are safe – You are still exposed to UVA rays that raise the risk of skin cancer and contribute significantly to discoloration, sagging skin, and wrinkles.
  • Combining an SPF 15 moisturizer and an SPF 15 sunscreen will give double protection – Truth, the numbers don’t add up. Also, makeup that has sunscreen is not enough protection. The dime size amount used only adds up to about SPF 1 or 2.
  • My dark skin never burns so I don’t need to worry – The extra melanin in darker skin does offer some protection but you are still susceptible to skin cancer. Also, when a suspicious area is finally able to be spotted, it may be too late to treat successfully.

So as we speak to our patients, let’s remind them of the importance of the regular use of sunscreen.

Dental Humor for the quarter:

"A little boy was taken to the dentist. It was discovered that he had a cavity that would have to be filled. Now, young man, asked the dentist, what kind of filling would you like for that tooth? Chocolate, please, replied the youngster."

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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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The contents of this publication reflect the opinion of the author only. This publication is for informational purposes only.
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