3.12.10 Issue #418 Forward This Newsletter To A Colleague

Doctor, We Need Help!
by Sally McKenzie CEO
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It’s picking up out there again as we see more dental practices experiencing an uptick in patient activity. Along with the very real and welcome increase in business comes the perceived increase in “busyness,” thus pleas for the office “helper” are growing a little louder in many offices.

The office helper - that seemingly magical solution for everything that needs to be shored up, picked up and powered up in the practice. What the “helper” is capable of seems to border on superhuman abilities and what staff would have you believe they can bring to your practice are, well, virtually limitless. “If we had a helper we would never work into lunch again. The days of running late would be over. We could keep up with everything. Why, the helper could answer the phone, clean the instruments, seat the patients, tidy the reception area, and, and, and …” And take care of all those things that no one else wants to do.

Certainly, when the practice is busy and the team is stressed, it’s easy to convince yourself that if you just had a couple extra hands on deck maybe in the front, or the back, or after school, or on the weekend – here, there, anywhere, you could all just be that much more efficient. And, let’s face it, when things aren’t getting done it’s easy to convince yourself that throwing another body into the mix will take care of the problem and silence the troops – at least temporarily.

But before you tell your business manager that she can hire her niece to work a few hours a week, I suggest you consider a point or two. First, conduct an “it’s not my problem” inventory. By this, I’d like you to consider how many people in your practice have a tendency to utter those words on a pretty regular basis. “It’s not my problem that there are holes in the schedule, so and so is supposed to take care of that. It’s not my problem that instruments are stacking up, I have to worry about x y z. It’s not my problem that the phone is ringing off the hook, that’s what the answering machine is for.” And so on.

What you may discover is that the lines of demarcation are too clearly drawn. Rather than a team of professionals working for the common good of the practice, you have a collection of individuals staking their claim on what they will and what they won’t do. On the one hand, you may argue that these employees do their jobs and don’t step on each other’s toes. On the other hand, I would argue that this attitude represents a lack of team engagement. They are not invested in the success of the team or the practice as a whole. They are focused on their “to-do” list, get the job done and get out the door. They are not encouraged to look at the big picture as there is no ownership attitude that is fostered. They merely take their orders and expect the doctor and/or office manager to handle the problems and tell them where to fall in line.

Or perhaps in your practice you have just one or two employees that are driving the push for additional help. They are inflexible, they refuse to step up to the plate, yet they constantly make demands. You know the ones; they wouldn’t answer the phone if their next paycheck depended on it. “Make confirmation calls to patients? You must be kidding!” Their favorite phrases are, “I don’t have time to do her job” or “Doctor doesn’t pay me to do that” or “That’s not in my job description.”

Could your existing team actually handle the current demands if you addressed the “not-my-problem” employees who are pulling your productivity down? Perhaps so, if there were greater emphasis on employee engagement and in nurturing a true team environment and attitude.

Before you throw another person into the mix, consider making the most of your current staff. Many practices have sincerely committed professionals who want to feel like they are contributing to the success of the whole, but the environment doesn’t foster that. Look at team building opportunities such as the McKenzie Management’s California Cruzin’ coming up in June. I guarantee it will make a huge difference in the success of your team and it just might save you a fortune in staffing.

Next week, look at the systems before you look to hire more staff.

Interested in speaking to Sally about your practice concerns? Email her at sallymck@mckenziemgmt.com. Interested in having Sally speak to your dental society or study club? Click here.

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Carol Tekavec
CDA RDH
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When Should An Office Report the Full Fee?

Many offices have questions concerning when it is appropriate to report a dentist’s full fee for a service. This is typically because dentists nationwide are often involved in dental benefit plans where they may have accepted a “network fee schedule” mandating fees that are less than the dentist’s “normal” fee. Some dental plans request that a dentist working in their network always report the fee they have agreed to when filing a claim, not their normal fee. Making the situation even more confusing are plans that require a participating dentist to charge a patient a network specified fee, even for services for which the plan is not going to pay anything! (The Rhode Island Dental Association recently was successful in getting legislation passed in that state prohibiting this practice.) This would include fees reported for services provided after the patient’s maximum annual benefit has been reached.  So, here are the issues:

  1. When a dentist has contracted with a plan, should he/she report the plan “fee schedule” fee when filing a claim for a patient?
  2. Which fee should be filed if a dentist is a network provider for more than one plan?
  3. Which fee should be filed if a patient has more than one benefit plan?  
  4. Which fee should be filed when a patient is receiving services after their maximum benefit has been reached?
  5. How do dental plans come up with their fee schedules in the first place?

Let’s look at question #5 first.  Many plans refer to their fee schedules as “UCR” or “Usual, Customary and Reasonable.” However, these fee schedules are actually tables of fees derived from the fees reported by dentists and then broken down by percentages in a geographic area. They are not necessarily what the majority of dentists in an area are “usually, customarily or reasonably” charging. 

More simply put, all of the fees that are reported by dentists to benefit companies are entered into certain data bases. These data bases may be maintained internally by a specific carrier or a carrier may purchase the data from a central source, gleaned from carriers across the nation. When an employer purchases a plan, they look at this fee data base as it relates to the premium cost. Fees that are in a higher percentage spectrum require a higher premium.

Once the employer has decided on the premium cost they are willing to accept, the correlating fee becomes that plan’s UCR.  So, even if few dentists in a geographic area are actually charging a certain fee, that fee, the “negotiated fee,” can become the fee a dentist must accept when becoming a network provider for that employer’s plan. When the patient is required to cover a co-payment, such as 50% for crown and bridge procedures, that 50% is not derived from the dentist’s regular fee, it is taken from the negotiated fee, which is probably much lower. (Future articles will detail how to explain this complicated issue to your patients.) Therefore it is easy to see that since the data bases of reported fees are where plan fees are derived, dentists must report their regular fees in order to prevent lower and lower fees from being listed.

Now we know the answers to questions 1 through 4. A dentist should always file his/her regular, full fee when sending in a claim for a patient. The plan will pay what it will, the patient pays according to their policy, and then an adjustment can be made to the patient’s account to reflect the dentist’s network provider agreement. Again - dentists file their full fees and make adjustments later.

The ADA House of Delegates finally took a stand on fee reporting at the 2009 Annual Session in Honolulu.  Here is their Resolution 44H-2009:

  1. A full fee is the fee for a service that is set by the dentist, which reflects the costs of providing the procedure and the value of the dentist’s professional judgment.
  2. A contractual relationship does not change the dentist’s full fee.
  3. It is always appropriate to report the full fee for each service reported to a third-party payer.

Carol Tekavec CDA RDH is a speaker on dental records, insurance coding and billing, and patient communication for McKenzie Management.  Interested in having Carol speak to your dental society or study club?  Click here

 Interested in knowing more about how to improve your hygiene department? Email hygiene@mckenziemgmt.com.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
coach@ mckenziemgmt.com
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Whether You Think You Can Or Think You Can’t, You’re Right!

From time to time we all experience negative thoughts as well as angry or depressing feelings. Ups and downs are a part of life. But overall, do you see the best or the worst in situations? Is your glass half full or half empty?

The frame by which you see the world defines what happens to you. Perhaps you remember reading The Little Engine that Could - the small train competing with the powerful new locomotive. Although this children’s book has become a popular view of optimism, the story provides an erroneous concept of positive thinking. Optimism is far more complex than simply saying “I think I can, I think I can.” Just like physical exercise, mental agility requires dedication and practice. It begins when you appreciate the goodness in your life instead of dwelling on how bad things are. The research on happiness indicates that in addition to gratitude, taking a “half-full” perspective reduces stress and promotes creative problem-solving.

Consider the story about two shoe salesmen that sailed to a faraway island to sell shoes. After the first day, each of them sent back telegrams. One said, “This place is a disaster. No one wears shoes.” The other telegram read, “This place is a gold mine. No one wears shoes!” From the ability to sell treatment to increasing your immune responses, your success begins with how you think. Optimistic people are more successful – in business endeavors, athletic performance, personal relationships. Remaining positive in the face of adversity could mean big bucks for your practice and it is likely to improve your overall sense of well being too. The really good news is that you can learn to be more optimistic!

During childhood and adolescence you developed thinking habits based on your life experiences as well as the role models around you. Your explanatory style was formed directly from your view of your place in the world – whether you thought you were important and deserving, or insignificant and doomed to failure. Over time you constructed a belief system about how the world operates and your place within that world. It was the foundation upon which you make judgments and decisions. Even if that belief system helped you to survive a difficult start in life, it may not be working any longer. Stop and examine your thinking.

There is now scientific evidence showing that our thoughts actually have energy. The way it works is that we operate our lives based on assumptions - our “mental models.” These are the rules we follow to make decisions and choices in our life. For the most part, assumptions are unspoken and operate at a subconscious or even an unconscious level. What you believe and expect ultimately becomes your reality. If you focus on problems and obstacles you will find yourself moving further into a downward spiral. Perhaps you have fallen into the trap of griping (even if only thinking it) about the shortcomings of your employees. Of course your scheduler could chat less and focus more on filling holes in your calendar. Your clinical assistant could be a better record keeper. Reduced tension between the front and back office would be grand.

Be careful. Each grumble puts you into a mindset of depreciation. It’s akin to the half-empty vs. half-full perspective. The former provokes feelings of loss - that something is missing - while the latter leads to feelings of optimism. But when you appreciate what you already have you attract more of the same, so start the gratitude process today! Take a look at what is right. Value those gifts no matter how small. Appreciation stirs our feelings, excites our curiosity, and provides inspiration to the envisioning mind. It draws our eye toward the essentials of life.

Rid yourself of quick judgments, fixed perspectives, and old opinions. Make room for discovery and innovation. The ability to open your thinking to different views, to connect with other people, and to shake outmoded paradigms is within you when you adopt the spirit of appreciation. Remember, “As you think, so shall you become.” 

Dr. Haller provides training for leadership effectiveness, interpersonal communication, conflict management, and team building. If you would like to learn more contact her at coach@mckenziemgmt.com

Interested in having Dr. Haller speak to your dental society or study club? Click here.

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