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Perio Therapeutics and Beyond
Implementing a Cross-Training System
Marianne Harper

Cross-training – the answer to that awful feeling in the pit of your stomach when you know that your practice will be short staffed due to illness, vacation or whatever other reason that keeps a staff member away from work.  The  last  "Dental Pearls"  newsletter
explained why it is so important to implement a cross-training program in a dental practice. If you did not receive that newsletter, please email me at to request that newsletter.

The question now is how to implement a cross-training program. The implementation should not be rushed into. The steps outlined below offer a guideline for implementation:
If your practice does not already have job descriptions in place, then begin that process. Get the staff involved and have each member create their own. Even without a cross-training program, having a set of job descriptions for each position is vital to staying functional when an employee leaves and new employee training must take place.
When hiring new employees, ask questions that will reveal if the applicant can multitask. Multitasking is essential to cross-training. According to Gail Garfinkel Weiss, the senior editor of "Medical Economics", "Cross-training starts with hiring the right people – folks who can multitask, want to learn new skills, and can shift gears quickly and effectively."1
Schedule a staff meeting to introduce the plan to the staff. Explain the benefits of adopting this system. Assure the staff that you are not just trying to get them to work harder but are, instead, being proactive in avoiding practice crises when employees are out. Tell them how proud you are of them and that you know that they have the talents to handle this well. Possibly consider some sort of reward or compensation for a job well done when this system is in place and working.
Ask for volunteers. Many employees look for chances to better their situation and this can be a good way to do that. The likelihood of success for cross-training is much greater when the cross-training involves this type of individual. Not everyone may be receptive to cross-training and, if an employee does not want to do this, don't force it upon him/her. It will impact on the effectiveness of the training. New employees should not be a part of cross training until they are comfortable with their own job duties.
Each participating staff member should only be cross-trained in one position. The plan cannot be effective if staff members are trying to learn too much. Ask for staff opinions on who should be paired with whom but also consider your instincts in making the decision. In addition, certain jobs require licensure or certification. In the case of certification, review the job description to look for those duties that can still be performed without the certification and let those tasks be the ones learned. Hygiene positions, because they require licensure, will be the only jobs that cannot be cross-trained at all. Try to find a hygiene temp agency or a part time hygienist who can fill in on short notice for him/her when the hygienist will be out.
Once the decisions on pairing have been made, provide each participant with the job description for the job that they will cross-train in.
Make a plan on when to start and try to do this during periods that are not too busy. Some practices have predictably slower days than others. If this is the case, schedule cross-training on those days. If this does not apply to your practice, then just schedule it. If it is not scheduled, it will probably not happen.
Do not do everyone's cross-training on one day. Divide it up so that it will not impact negatively on the practice.
Begin the process with job shadowing and gradually work into job exchange. Be patient with the staff during this process.
Make discussion of the cross-training system part of all subsequent staff meetings in order to evaluate the process and make recommendations for improvement. Let staff members give feed-back on their experiences. Take this opportunity to recognize their achievements and the contributions that they are making to the practice. Staff morale will be greatly increased.
With a cross-training system in place, those dreaded situations are not such a problem anymore. The day will run much smoother and you will be proud of how well your staff manages. So get started now – you never know when that phone will ring.
1 "The Benefits of Cross-Training Staff", Gail Garfinkel Weiss, Medical Economics,, 4/14/2007

Periodontal Evaluations
Colleen Rutledge, RDH

When asked what the single most effective ingredient to a successful hygiene department is, I always say: "You cannot build a profitable, high quality hygiene department without consistent six point periodontal charting on every adult patient". Periodontal evaluations should be performed at least once a year and include not only pocket depths – but also recession, bleeding, furcations, wear facets, abfraction lesions, etc.

Documenting all this information is so important! It elucidates the true periodontal status to the clinician, the patient and the insurance company. Patients should be informed that without this critical screening, an accurate diagnosis of periodontal diseases cannot be made.

Standardizing periodontal probes throughout the office is also very helpful. This helps tremendously in periodontal disease diagnostics, as pressure and angulation of the probe are two variables that are hard to standardize.

Stay away from "spot probing", as it encourages misdiagnoses!
  Insurance Alert
Dental Coding News:
Effective January 1, 2011, our CDT codes will be updated. As you know, this code-set updates every other year so this is the time to prepare for that. Preparation involves two areas. First of all, you will need to obtain the updated code set. The "CDT 2011-2012" is now available to purchase. Another source for obtaining the latest code-set is with Dr. Charles Blair's "Coding with Confidence: The "Go-To" Dental Insurance Guide". Purchasing either of these manuals now gives you time to learn about the new codes and find out what codes have been either changed or deleted. By doing so, you will be prepared for accurate coding next year. The second area deals with your practice management software. Make sure that you obtain the latest update so that the new code-set can be downloaded.

Medical Coding News:
Medical insurance carriers may now be requiring taxonomy codes to be entered on the medical claim form (CMS-1500 form). The taxonomy number is to be placed in box 33b, the shaded area to the right of where the billing provider’s NPI number is entered. If you are unsure about what your practice’s taxonomy code is, the following provides that information:
General Practice - 1223G0001X
Dental Public Health - 1223D0001X
Endodontics - 1223E0200X
Oral and Maxillofacial Pathology - 1223P0106X
Oral and Maxillofacial Radiology - 1223X0008X
Oral and Maxillofacial Surgery - 1223S0112X
Orthodontics and Dentofacial Orthopedics - 1223X0400X
Pediatric Dentistry - 1223P0221X
Periodontics - 1223P0300X
Prosthodontics - 1223P0700X
Denturist - 122400000X
  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, 2011 – ICD-9-CM (medical diagnosis codes) update
January 1, 2011 – The latest deadline for a decision by the FTC on whether dental practices will be required to enforce the Red Flags Rule
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:
"We are what we repeatedly do. Excellence, then, is not an act, but a habit."
~ Aristotle

"Habits are powerful factors in our lives. Because they are consistent, often unconscious patterns, they constantly, daily, express our character and produce our effectiveness... or ineffectiveness."
~ Stephen R. Covey

I am in the process of reading "The 7 Habits of Highly Effective People" and came across the Aristotle quote and the related quote from the author, Mr. Covey. Immediately I saw their importance to those of us in the dental profession. In order to have excellence in our practices, we must be ever diligent to form the types of habits that will foster excellence.

Hygiene Department Clinical Tips from Colleen
As stated in the articles above: "Stay away from "spot probing", as it encourages misdiagnoses!"
Business Office Tips from Marianne
Are you familiar with "Real Time" services? Companies such as MDE offer Real Time services that simplify patient checkout and provide instantaneous information on patient eligibility and co-insurance costs both for the current visit and for treatment plans. Help your patient and your bottom line by checking out these services.

Dental Humor:
Last week Grace went to the dentist's office for a checkup and music was playing. She was early for her appointment, but after waiting ten minutes, an elderly woman sitting beside her said, "Isn't that just like a dentist? A waiting room jammed with people, and the dentist is in there playing the piano."

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