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Is your office like the sea?
Marianne Harper

Is your office like the sea – there's a high tide and low tide each month? I am referring to your practice revenue. You may be used to this reality and just expect that it's part of doing business. I have a message for you – it doesn't have to be.
When you are preparing to pay the practice bills, do you see that the checkbook balance is not sufficient to cover the bills? That's what can happen when you are in the low tide time of the month. At that time, do you then sit tight and hold off on paying whatever can wait? Do you find yourself anxiously awaiting the mail with the hope that payments will be in it? Do you wish that the time for sending statements could be moved up so that revenue would pick back up? Many dentists and staff deal with these concerns and thoughts all of the time. How frustrating!

So let me give you an answer.

One solution that I highly recommend is daily statements. You may think that this would be too time intensive, but the opposite is the case. By dividing statements up into daily batches, the daily process does not take long because the daily batch will not be large and it is far less daunting than mailing to all of the patients' accounts at one time. In addition, it facilitates the staff member who handles statements to look more closely at each account to determine if there are any problems. When all of the statements are sent at one time, or even twice a month, it is hard to review those accounts closely because it would increase the time for an already time consuming job and this can be very costly in the long run. Problems can be missed with so much to check.

Of course the most obvious benefit to daily statements is that it helps to keep the cash flow strong and consistent all month long.

As a former dental practice administrator and practice bookkeeper, I sent out statements daily for many years. I found it to be so much easier to do and I didn't have to put aside everything for hours to send out those statements. It took me less than fifteen minutes on most days and I would always catch any problems on a timely basis instead of finding them weeks later if statements had gone out only once a month. In addition, I was the one who paid the bills and I always found that the cash flow remained level throughout the course of the month.

If you are interested in implementing daily statements and aren't sure how to set it up, contact your practice management software vendor for instructions.

As a result of implementing daily statements, you will find nice smooth financial waters in your practice with little tide change.

An Important Point regarding Periodontal Maintenance (D4910)
Colleen Rutledge, RDH

On almost every consult I am asked when to use the periodontal maintenance code D4910. It's really quite simple! According to 2011/2012 CDT guidelines; the D1110 Adult Prophylaxis code is not used with periodontal patients. Therefore, all patients that have received periodontal therapy (SRP) are always classified as Perio Maintenance (D4910) at future hygiene visits, however every once in a while there is an exception to the rule. Once again I will refer to the 2011/2012 CDT guidelines: "if a treating dentist determines that a patient's oral condition can be maintained with a routine prophylaxis, delivery of this service and reporting code D1110 (Adult Prophylaxis) may be appropriate".

In my clinical experience it is rare that a patient reverts back to an adult prophy especially when compromised medical history or risk factors are present. Referring to the medical history and risk assessment as well as clinical indicators is necessary when making this decision. If your office is not utilizing a risk assessment form, email me at and I will send you one. It is an essential and often overlooked tool to distinguish between gingivitis and early periodontal disease.
  Insurance Alert
Are you comfortable with your coding? I have two suggestions to help you know that your coding is correct. The first is Coding with Confidence – The "Go To" Dental Insurance Guide. This dental coding manual provides the information that all practices need to know regarding what codes are the correct codes to use and when some codes may be the wrong choice. Every coder that I speak with who uses this manual finds it invaluable. In addition, Insurance Solutions Newsletter is another great source of coding information for both dental and medical claim filing. A subscription to this bi-monthly newsletter also provides a coding support service. Again, practices speak very highly of this newsletter. If you are interested in ordering either or both of these, please go to the Resources page of my website, to obtain an order form that can be either faxed or scanned to place the order.
Biopsy vs. Excision – If you are unsure which of these is the correct choice for your procedure, follow these guidelines:

Biopsy – the removal of a portion of a lesion to determine its pathology

Excision – Full-thickness removal of a lesion, including margins with a simple closure and which includes local anesthesia

  Time Line
Update your cross coding manual
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. The diagnosis code update is ready now, as this update was effective October 1, 2011. The procedure codes will update on January 1, 2012. Please order your updates ASAP by emailing Marianne at
November 8, 2011 – My webinar on disaster contingency planning will be presented by Mentor Health at 1:00 PM EST. HIPAA requires dental practices to have a disaster contingency plan in place to protect patient records and provide a way for patients to continue care. Please tune in to learn about being compliant with this rule. You can register for this seminar 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.
October 1, 2013 – ICD-10 (medical diagnosis codes new revision)

Favorite Quotes:
"Our professional and personal success depends on how we view ourselves".
Janice Hurley-Trailor

I had the pleasure of attending Janice Hurley-Trailer's recent webinar, Optimal Impact: Building Trust and Confidence – Every Day in Every Way! As always Janice provided wonderful tips on how to create an impact through how we dress and accessorize. However, early on in the webinar she stressed that how we view ourselves is the most important part of creating that impact. I believe that statement was the most important part of her message. Most of us tend to be too hard on ourselves by concentrating on what we perceive to be our negative qualities. Every one of us has special talents and our own unique beauty. Do some introspection – look for the positives – find your beauty. Trust me – it's there.

Points of Interest:
Abraham Lincoln was the only American president to have earned a patent. He invented a type of buoy and had it patented in 1849. He is also the only American president who ever worked as a bartender.

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