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  Sally McKenzie's
 Weekly Management e-Motivator
  5.28.04 Issue #116

Productivity Killer #1: Conflict

Sally Mckenzie, CMC
McKenzie Management

      Side-by-side, elbow-to-elbow, 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.

Conversely, 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.

And 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.

Left 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.

While 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.

Conflict 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 ugly.

Next week, the eight step plan to conquering conflict.

If you have any questions or comments, please email Sally McKenzie at

Interested in having Sally speak to your dental society or study club?
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Tech Tips For Today!

Designed to improve management techniques through your technology platform

Mark Dilatush
VP Professional Relations
McKenzie Management

      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?”

I bet some of you just sat up and took notice. Good. Let’s get everything set up so you’ll know in the future.

Two 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.

Side #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.

Side #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.

Go 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.

Side #2 – Reporting the new patient and referral value in your database
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.

Contrast and Compare
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 (Step 2).

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!

I 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.

Interested in having Mark speak to your dental society or study club?
Click here


Insurance Coding for Perio Therapy

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

         I 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

company 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.

The 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.

D4341, 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.

Most 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.

Follow 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.

You should establish your treatment protocol that best helps your patients improve their periodontal health. Then submit the insurance codes for the treatment you performed.

If you have any questions concerning your hygiene program submit them to me at allan@ and I will answer them in future articles.

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

McKenzie Management’s Hygiene 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 HERE

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Sally's Mail Bag Townie Posting

Dear Sally,

I'd 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 equal amounts).

If 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?

Dr. Townie

Dear Townie,

If 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.

Best regards,
Sally McKenzie, CEO

Office Managers
Financial Coordinators
Scheduling Coordinators
Treatment Coordinators
Hygiene Coordinators

For a FREE
Educational Video
e-mail us at:
The Center for Dental Career Development
Advanced Business Education for Dental Professionals
737 Pearl Street, Suite 201
La Jolla, CA 92037

Dr. Allan Monack,
Hygiene Clinical Consultant for
McKenzie Management,
develop a profitable
Hygiene Department

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Enrichment Program
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This issue is sponsored
in part by:
The Center for Dental Career Development
San Diego Workshop Series
Spring & Summer Schedule
 Date Seminar Instructor(s)  
 June 4
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Belle DuCharme, RDA, CDPMA  
 June 11
 9:00 - 4:00
10 Vital Skills to Master Management of Your Dental Practice Belle DuCharme, RDA, CDPMA  
 June 25
 9:00 - 4:00
The Top ADVANCED Management skills for a Successful Practice Belle DuCharme, RDA, CDPMA  
 July 9
 9:00 - 4:00
How to Become an EXCEPTIONAL Front Office Dental Employee Belle DuCharme, RDA, CDPMA  
 July 16
 9:00 - 4:00
The Top ADVANCED Management skills for a Successful Practice Belle DuCharme, RDA, CDPMA  

The Center for Dental Career Development has been approved under the Academy of General Dentistry, Program Approval for Continuing Education (PACE). Starting 10/19/03 through 10/18/07 members of the Academy of General Dentistry can receive AGD credits for all seminars and workshops sponsored by the Center for Dental Career Development.

Please visit to view a list of upcoming seminars and workshops.

To Register 877-900-5775 or
McKenzie Management Upcoming Events
Date Location Sponsor Speaker
June 25-26 Atlanta, GA Endo Magic Root Camp Sally McKenzie
July 8-11 Anaheim, CA Academy of General Dentistry Sally McKenzie & Exhibiting
July 16 Medford, OR S. Oregon Dental Society Sally McKenzie
Aug 7 San Diego, CA Dental Manufacturers Association Sally McKenzie
Sep 10 -12 San Francisco, CA California Dental Association Sally McKenzie & Exhibiting

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