Killer #1: Conflict
eight hours or more a day, week-after-week you spend more time with
your staff than your own family. Like most workplaces, your office
is probably an eclectic mix of different personalities,
educational backgrounds and socio-economic standards. On a good
day the team is in sync. The stress is under control. The different
perspectives, opinions, and backgrounds lend themselves well to
managing the challenges and pressures of the day. When the team
is working together effectively energy is high
and potential soars.
conflict between just two employees can shatter the working
balance with one heated conversation. Lines are drawn in
the sand. Whispering campaigns are launched. Eyes are rolling. And
everyone is trying to mask the tension from the patients who see
right through this charade.
As much as you may dislike and try to avoid conflict, it is as common
in the dental practice as demanding patients and harried schedules.
In fact, conflict is a normal part of any workplace, and when channeled
constructively it can significantly strengthen the mutual
respect and effectiveness of the team as a whole. However,
and that’s a big however, too often team members,
including the dentist, are terrified of conflict. Although they
likely encounter it regularly, dental teams often have little if
any idea how to handle and resolve conflict as it arises.
they’re not alone. It is estimated that managers spend 25%
to 30% of their time attempting to resolve workplace conflicts.
That’s just the manager’s time; add to that all the
additional staff time that is taken up by team squabbles and all
out wars. If Carol and Jane are currently battling it out, they
are probably spending a fair number of hours each week venting their
frustrations to other team members and creating widespread stress
and discomfort. They are distracted. They are irritable. They are
likely compromising patient service and perhaps
even patient care.
unaddressed or dismissed as just the latest office tiff, ongoing
workplace conflict is costing the practice far more than just a
few ruffled feathers. It’s an enormous drain on productivity
– a.k.a. your income.
conflict often appears to be personal, typically it starts with
a lack of understanding and system breakdowns. Differing
personality styles can be one of the most significant contributors
to team fractures. You have Betty on the one hand who calls it as
she sees it. She makes a five star general look like a slacker and
wishes everyone would just buck up. Then you have Ellen on the other
hand who is so sensitive the grocery list could move this woman
to tears. She can hardly bear to tell little Johnny that he has
to settle for the red toothbrush because the blue ones are gone.
arises for numerous reasons, but the most common contributors
are poor or lack of communication, different values, personal agendas,
lack of resources - both human and financial, and poor employee
performance. The result: negative attitudes, unresolved misunderstandings
and arguments, and low morale. Employees, including the doctor,
do not like coming to work and tension is high. In a word, it’s
week, the eight step plan to conquering conflict.
you have any questions or comments, please email Sally McKenzie
in having Sally speak to your dental society or study club?
YOU FIND YOURSELF WAIST DEEP IN
HERE TO ANSWER THESE
10 EASY QUESTIONS
to improve management techniques through your technology platform
VP Professional Relations
Last issue, [see
article], I discussed how to track patient retention with your
practice management software.
This week I want to focus on a fairly common question from e-Motivator
readers. “How do I know which insurance plans are
the best for my practice? How do I know which ones are
the worst for my practice?”
bet some of you just sat up and took notice. Good. Let’s get
everything set up so you’ll know in the future.
sides to the equation
Basically, insurance participation is a trade-off. The dental office
writes off a percentage of their fees in return for new patient
flow from participating members of the plan. Philosophical arguments
aside, let’s start here and keep it that simple.
#1 – Write-offs
Most dental practices have (use) one write-off code as a debit adjustment.
Most dental practices call it “insurance adjustment”
and simply adjust the patient’s balance by what they see on
the EOB when the insurance payment comes in. The problem is, with
only one write-off code – you never really know how much you’ve
written off for each individual insurance plan.
All you get is a report of ALL of the adjustments to EVERY plan
you participate with. Better than the old pegboard system but not
up to today’s advanced management standards.
Side #1 – Get it set up properly for the future
I want you to add a new debit adjustment code to your database for
EVERY insurance plan with which you participate. For instance, let’s
say you participate with Delta, Blue Cross - Blue Shield, and MetLife.
I want you to add debit code for each. Below are some examples.
Make sure you put them in the debit category of codes.
Code = adj-delta
Code = adj-bcbs
Code = adj-metlife
When your EOB’s come in and you post the insurance payments,
start using your new adjustment codes. Once a month, you would run
a production report on each to find out exactly how much the office
wrote off with each plan.
#2 – New patients and referral value
Depending upon your system, this might be a bit tricky but believe
me, it’s worth the time. In general, what you’re trying
to do is determine how many new patients came into the practice
through your insurance plan participation. This gets trapped in
your computer system during the new patient interview process either
over the telephone, in person, or on a written welcome form the
patient completes at their first visit. The value of your insurance
participation should not be limited to ONLY the new patients it
generated. You must take into consideration, the patients referred
by the new patients who were brought in through plan participation.
To do this properly, you must be consistent and accurate
when recording every new patient source.
to your referral source database and add all of the insurance plans
with which you participate. You probably have “Yellow Pages”,
“Welcome Wagon”, and other outside marketing efforts
listed in this database already. Using the example above, I want
you to add “Delta”, “BCBS”, and “MetLife”
to your incoming referral list.
#2 – Reporting the new patient and referral value in your
Each month, run a referral report for each referral source (insurance
plans – “delta”, “bcbs”, “metlife”)
individually. In this case you would have 3 different reports. Ask
your system to tally all production from all patients who were brought
into the practice from these referral sources and to list the patients
individually. Highlight the total production number from these sources.
The next step is the labor intensive part, but it’s worth
it. I want you to go through each patient on the list and tally
the production value of ALL the patients THEY
referred to the practice. Add the two numbers together to get a
true read on the revenue generated by your participation.
Now you have all of the money you wrote off (Step 1) for participating
AND you have all of the new production generated for participating
Log these two numbers month by month for each plan with which you
participate. I guarantee you will have a more accurate outlook on
the “should I participate” or “shouldn’t
I participate” debate. What you don’t know, will usually
hurt you in the long run – so go find out!
welcome any and all readers to email
me with specific questions, problems, requests and challenges.
Who knows? Maybe your inquiry will lead to a new Tips For Today
article! Don’t worry, your inquiry will remain anonymous unless
you want credit for the question.
in having Mark speak to your dental society or study club?
DOES YOUR OVERHEAD
Coding for Perio Therapy
Dr. Allan Monack
Hygiene Clinical Director
realize there is a lot of confusion when it comes to sequencing
treatment. Many insurance companies will not reimburse for certain
procedures if they are not performed in a particular order.
Many dental insurance companies do not follow the same rules on
reimbursement causing further confusion.
I have never been a believer in tailoring the needs
of the patient to conform with insurance
rules. If it compromises the best treatment for your patients you
should do the right thing and not worry about the reimbursement.
Sometimes it takes the insurance companies awhile to change their
policies. The pharmaceutical companies have been very helpful in
lobbying the dental insurance companies and making them aware of
the best way to keep treatment costs low and minimizing more costly
surgical procedures. You need to understand the different insurance
codes in order to properly submit the treatment you render for reimbursement.
code that is most misused is D4355, gross debridement.
The ADA defines the use of this code to remove plaque and calculus
that interferes with or inhibits the diagnosis of the periodontal
condition. If there is sufficient plaque and calculus present such
that it is impossible to document pockets, bleeding, mobility, or
the condition of the soft tissue, then gross debridement should
be performed so that a proper evaluation can be done. This code
is not to be used to charge for one visit of a two visit prophylaxis.
Gross debridement should always be followed by periodontal pocket
recordings and a comprehensive periodontal examination.
scaling and root planing by quadrant, will be reimbursed
if proper documentation is submitted with the procedure. Most insurance
companies will allow up to two quadrants treated at the same visit.
This code should also be used for individual isolated pocket even
if they are in more than two quadrants. Sometimes there are pockets
present on three to six teeth in the mouth. You can treat these
pockets and submit under the D4341 code. List each area treated
separately and submit 1/5 of the quadrant fee per tooth up to a
maximum of one quadrant scaling and root planing fee. If there are
5mm or greater pockets present then you should place an intra-pocket
medication such as Arestin™, Atridox™, or Periochip™.
Use D4381 for insurance reimbursement.
insurance companies do not reimburse for D9630, gingival
irrigation, or D1330, oral hygiene instruction. However,
if you perform and charge a fee for these procedures you should
submit them to the insurance company.
up maintenance and reevaluation is important to stabilize and monitor
the patient’s periodontal health after completion of soft
tissue therapy. Insurance companies want you to use D4910,
periodontal maintenance visit after periodontal scaling
and root planing therapy or periodontal surgery. Insurance companies
will allow periodontal maintenance visits every three months. There
are many different philosophies on monitoring and maintaining your
patients periodontal health. Most professionals feel that once a
patient has had periodontal disease they should remain on three
month intervals for life. Others feel that after a period of stability
a patient can increase the periodontal maintenance interval to four
months and eventually to twice yearly. D4910 should be used every
time a patient returns for their three month maintenance. D1110,
adult prophylaxis, should only be used when the patient stops the
three month visits. Insurance companies will not reimburse again
on D4910 unless scaling and root planing or periodontal surgery
is performed again.
should establish your treatment protocol that best
helps your patients improve their periodontal health. Then submit
the insurance codes for the treatment you performed.
you have any questions concerning your hygiene program submit them
to me at allan@
mckenziemgmt.com and I will answer them in future articles.
in having Dr. Allan Monack speak to your dental society or study
YOU LIKE TO IMPROVE YOUR HYGIENE DEPARTMENT?
Clinical Practice Enrichment Program is
designed to improve Hygiene Clinical Skills and develop
and implement a step-by-step Interceptive Periodontal Therapy
Program that will immediately bring greater productivity,
with enhanced patient care. For more information...GO
PAST ISSUES OF OUR E-MOTIVATOR NEWSLETTER?
than it is?. . .
. . . but not sure
where to start?
to Know Why Your Employees Act and Interact The Way They Do?
How Personality Types Can Affect Your Practice Success
in dental offices are caused by a breakdown in communications
due to different personality styles. Understanding your employees'
personality traits can help to better match your staff with the
work they are likely to do best.
will learn how their personality affects their ability to successfully
manage the business and its employees.
like to put my assistant and receptionist on a salary bonus in place
of an annual increase. Since dental payroll is nationally 23% of
overhead (excluding the doc), if a months collections goes up, why
not just simply multiply that months collections by 23%, and any
excess $$ over your current payroll salary, you split that amount
between my assistant and my receptionist (assuming they both merit
there’s no increase in collections, or even if it goes down
in any given month, they won't get any increase for that month,
and they will never go below their fixed salaries, so no suffering
there. Seems simple enough without a lot of mumble jumbo, or am
I missing something here?
the collections go down, you are still paying base salaries. In
this scenario “you are suffering”. Where will you get
the money… from profits. If collections go up, they get base
+ a bonus. In this manner they always win and you win/lose. There
is no fairness in this situation. What happens when you need
to hire another person and the % for payroll goes up with the new
person and collections don’t increase? Do you think they are
honestly going to want you to hire another employee? NO! Based on
our past analyses of practices, assistants are not directly tied
to the success of collecting money. If the front desk person decides
not to ask a patient to pay, this puts the assistants possible bonus
in jeopardy and not in her control. There is no fairness in
this situation. You are basing a reward only on one measurement
of the practice, i.e., collection. Collections can be good but in
the meantime your patient retention is lagging, (an example). By
only having the bonus tied to one area, it sends the message to
the staff that as long as we collect we are successful. In the meantime,
for example, you haven’t increased the # of hygiene days per
week in the past year. There is no fairness in this situation.
If giving bonuses were that easy, everyone would be doing it. If
you want to visit more on this, feel free to email me.
Sally McKenzie, CEO
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