Of course, you all know my specialty is working with dental teams and optimizing your Dentrix software. Being a trusted partner in your dental practice involves helping optimize your Dentrix software, creating better systems, learning best practices … and also helping you protect your doctor’s license. If you have a complaint from a patient or are subject to an insurance audit, your livelihood is at risk and your practice could have a significant financial setback.
I am not an attorney and do not give legal advice. The guidance I give is based on listening to experts in the dental industry and reaching out to my colleagues and then applying that advice into the software.
There are five key points in this article that I want to point out because they are the most frequent issues I see out in the field and, in my opinion, could cost you if you don’t pull your head out of your __________ (you can fill in the blank). Three of the five points are on the clinical side and two are focused on the admin team. It is a team effort to keep your doctor’s license safe and it is up to you to protect it.
- The Health History Update is critical in having a “snapshot” of your patient’s health at any point in time. With changes in patient medications, medical conditions and new scientific studies always coming out, it could be devastating if you don’t have this information at your fingertips. You could be facing a medical emergency or litigation and if you don’t have the information readily available, you could be at risk. I am begging you . . . remove the words “no changes” from your clinical documentation.
- I was in an office last year and I was concerned because there were no periodontal chartings on any patients. The hygienists said they only do it if they have time and this was not very often. My response to the doctor was, “Your hygienists are not only putting their own license at risk, but yours as well.” We were able to put a system in place that allowed the hygienist to perio chart once a year. Perio charting is a diagnostic tool that must be implemented into your routine. Otherwise, you are not only putting your patient at risk, but you are putting your practice at risk.
- Your clinical documentation must contain more information these days than ever before. My good friend and insurance expert, Teresa Duncan, states that the recare exam documentation must contain the reason “why” you are taking X-rays and that they are reviewed by the doctor. Many offices do not include this information. Also, I had a doctor refund a major insurance company thousands of dollars because he did not document the anesthetic he administered. These two examples might sound simplistic, but you would be amazed at the lack of critical details left out of the clinical notes.
- Let me ask the admin team this question . . . “Has a patient ever asked you to bill something differently so they could receive insurance benefits?” Or “Could you bill that next month because I am maxed out and my insurance benefits renew next month?” If you say yes to either of these two questions, you are putting your practice at risk. You must code properly so the patient’s chart and billing accurately represent how you are treating your patient. No exception! This might take some new verbal skills and for you to grow a backbone, but it is up to you to protect your doctor’s license.
- The second piece to this is making sure what you are billing matches your patient’s clinical documentation. You and your hygienist should never say to a patient, “We will bill this as a prophy so your insurance will cover it” and then your hygienist charts that she did scaling and root planing. I don’t mean to pick on the hygienist, but this is where it happens the most. Your patient might also ask you to bill out a PFM instead of a porcelain crown, so they get better coverage. These are sometimes difficult conversations to have with patients and it requires some training. I would recommend Teresa Duncan’s book “Insurance Conversations” as a resource for your admin team with these kinds of situations. CLICK HERE to order Teresa’s book.
After reading this article, you might be asking yourself what your action plan is. First, check your systems and see if you need to make any improvements in any of these areas. Next, have a conversation with your risk management department or your malpractice company and discuss these recommendations with them. Finally, if you need help in any of these areas, reach out to a specialized trainer or join our online Dentrix community.
