9.7.07 - Issue # 287 Forward This Newsletter To A Colleague
Team Advice
Training Software
Coding Errors

Team Members: Show You’re Worth Every Penny and More
by Sally McKenzie CEO
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I’ve been here a year. I show up on time every day. I do my job and I am a loyal employee. I deserve to make more money.” Many dental employees are convinced that those are the only criteria they have to meet to receive a pay hike.  

It never even occurs to many workers that if the dental practice itself isn’t bringing more money in, the doctor cannot afford to pay more out in salaries – no matter how hard working, dedicated and conscientious the employees might be.

So before you ask for more money, consider the financial realities of the dental practice you work in.  For example, if the practice’s current monthly collections are $48,325 per month and team salaries are $9,353 a month, a $2 hourly raise for the dental assistant from $15 to $17 working a 36 hr. week will increase existing salaries to $9,665, which is within the 20% industry benchmark. However, if current monthly collections are $39,000, existing wages are $9, 353 that puts salaries at 24% collections and well above the standard. Meaning, you’ll need to do something to boost revenues before you expect the doctor to increase expenditures.  

And there is plenty you can do. The fact is that employee productivity has a huge impact on the profitability of the practice and can directly improve your income potential provided you make one very important commitment: Focus on delivering measurable results daily. Follow these steps to make that happen.

  1. Develop clear, results-oriented job descriptions.
  2. Work with the doctor in establishing your own performance objectives/job expectations that are consistent with the doctor’s overall practice goals, such as scheduling to meet production goals, keeping the hygiene schedule full, eliminating the insurance backlog, improving the new patient process and materials, enhancing your assisting skills, etc.
  3. At the monthly business meeting be prepared to report to the entire team the status of your area of responsibility. If you are the scheduling coordinator and last minute cancellations and no-shows are pounding the production goals, what strategies and procedures will you propose to control the problem? Seek suggestions from your teammates. Bring the issue to the table, so that it can be addressed. Don’t take the attitude that no-shows and cancellations are just a fact of life. You don’t have to have all the answers but you do have to be open to changing systems that aren’t working and to implementing new strategies to address challenges that are costing the practice money. Remember, your success is directly tied to the practice’s overall success.
  4. Develop a list of specific steps you can take to be a valuable asset to the business. Monitor your progress and your accomplishments using concrete numbers whenever possible. For example, if you developed a new patient welcoming procedure and materials that increased the number of patients coming into the practice and pursuing recommended treatment plans, document your strategy, measure the outcomes, and report the results to the doctor and team.

Consider a few other areas that have a direct impact on your income potential in the practice. How well do you follow instructions? Has the doctor attempted to teach you a specific procedure multiple times but you just don’t seem to get it? Are you cooperative or confrontational? What is the quality of your work product? Do others have to come in and clean up after you? Do you take the initiative to solve problems immediately or do you routinely hand them off because it’s “not your job”?

Do you communicate openly and respectfully with the doctor, your teammates, and the patients? Are you flexible? Or do you become difficult when schedules and best-laid plans spin out of control? What steps do you take daily to improve your specific area, the operation of the practice, the patient experience? What steps do you take daily to reduce practice expenses, save time, or increase revenues, improve treatment acceptance?

Remember, you may be a hard working loyal employee but the practice simply may not be able to increase your salary at this time. Squelch the urge to use threats or make demands. Requesting a raise with the attitude "if I don't get it, I'm leaving" will only tell the doctor and team that you are uncompromising and only out for yourself. Be professional and, if your job is worth keeping, be willing to better the practice and you’ll likely better yourself as well. 

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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Belle DuCharme CDPMA
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New Technology, Software? New Definition for “Experienced”

Help Wanted
Experienced Dental Scheduling Coordinator for 2 Doctor practices in North County. Excellent customer service skills, computer skills and team player necessary.

Dear Belle,
I am a Business Manager for a two doctor general practice.  We see about 30-40 patients a day.  I have had to let two scheduling coordinators go in the last year because they did not have enough “experience” to do the job.  I made the mistake of not checking their experience on the software program before I hired them.  I put each one through training on the software but neither was able to learn it to the point where they made few errors.  I now have hired another scheduling coordinator.  This time I made sure to have her do a working interview that included doing certain tasks on the computer.  This was a big help to determine if she was really “experienced” in the areas where I needed it and if she was able to learn new skills quickly.  I have learned that there is a vast difference in the word “experienced.”
Shellie M., Business Administrator

Dear Shellie,
As technology becomes more of a necessary component to the success of the dental practice in these competitive times it becomes a challenge to find people who are truly skilled at this technology.  Managing a dental practice has always demanded excellent customer service skills and knowledge of dental business systems such as scheduling, financial arrangements, insurance processing, collection and billing, recall etc.   A college degree in business was not a requirement to get a position in the dental business office and many people employed at the front office were former dental assistants or people who were trained on the job in another practice.  With today’s technology most young people are exposed to computers at an early age but if they do not go on to college the skills often remain primary.  When hiring someone to manage the now million-dollar practice, formal business training and more than primary knowledge of computer software is an essential.  The practice management reports that can be generated by today’s sophisticated software can tell you if your practice is growing or declining, what procedures are your “bread and butter” and what other services or products you need to market, how many new patients are coming in and how many patients are leaving, how many children you see and how many adults, what percentages of your practice is insurance and private and what percentage of the insurance base is Delta Dental or AETNA.  The list is endless.  The old days of the pegboard and ledger card are passé.

Going “paperless” is the new wave to freedom and it will be that way for everyone someday.  You will not be able to go paperless if you have staff that is intimidated by computer software technology.  Hiring someone who is “experienced” does not have the same meaning as the past unless this person has had formal business training and can demonstrate more than “e-mail” skills on the computer.

How do we get these people?  To implement any new technology into your office environment requires TRAINING.  Choosing the right candidate can start with asking them to demonstrate their skills.  Make up a “dummy” patient on the computer and have the applicant put together a treatment plan and then schedule the patient for multiple appointments. Have them post from the treatment plan.  Have the applicant gather insurance information on the “dummy patient”. Have the applicant create a treatment proposal and a financial option sheet.  These are basics.  You will be able to observe skill level and the need for training.

Having the software trainer back in with a list of particular skills you would like the staff to learn is more effective than just having them back for another training.  One person needs to be in charge of writing notes on how to create reports and documents so that these instructions can be placed into a training manual.  Your office needs to design a DENTAL BUSINESS TRAINING MANUAL.  In this manual you will have a check off skill list where each trainee will have shown that they have completed each section of the training to the satisfaction of the person in charge.

We have new technology; it requires people with skills or with the ability to learn new skills.  At McKenzie Management we have been involved in the education process of the dentist and dental business staff for many years.  It has been our passion to provide Advanced Business Training for dental personnel.  For Advanced Business Training and creating systems to work with new technology, call us today. 

For more information on McKenzie's Advanced Training Programs for Office Managers and Front Office, email training@mckenziemgmt.com, call 1-877-777-6151 or visit our web-site at www.mckenziemgmt.com.

Interested in having Belle speak to your dental society or study club? Click Here.

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Carol Tekavec
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Avoid These Common Coding Errors

Your patients count on their dental insurance to help them receive the dental care they want and need.  In fact, recent surveys reveal that 60% of patients, who have visited a dentist in the previous year, have dental insurance. Clearly, insurance is important to many patients, even though it was never designed to cover the total cost of dental treatment.

Whether you file claims for your patients, or they send in the claims themselves; you can help them get the benefits they deserve by using correct treatment codes and narratives. They get the best benefit possible, and your office gets paid on time!

Coding Errors Delay Claims

The HIPAA (Health Insurance Portability and Accountability Act) of 1996 mandated that all dentists and insurance carriers use the most current form of the ADA treatment codes. Right now this is the Current Dental Terminology (CDT)-2007-2008. With this in mind, here are three common coding mistakes.

  • Using D1201-Topical Application of Fluoride (Including Prophylaxis)- Child; for a child receiving a “cleaning” and fluoride treatment.  Code D1201 was deleted for 2007-2008.  Offices should now use D1203-Topical Application of Fluoride (Prophylaxis not Included)-Child in addition to D1120-Prophylaxis-Child to report a child prophy and fluoride treatment.  There is also a new code for fluoride varnish, D1206-Topical Fluoride Varnish.  This service is described as being appropriate for moderate to high caries risk children or adult patients. For quicker payment, how might you indicate “high caries risk” on the claim?  Use a narrative (section #35-Remarks on the ADA claim form) pointing out previous decay, current decay, (especially cervical caries) or other patient specific issues.
  • Using D2970-Temporary Crown (Fractured Tooth) for a temporary crown placed during crown/bridge fabrication. That type of temporary is considered to be “all inclusive” with the cost of a final restoration. Therefore, using a separate code is inappropriate. To be sure that finances are covered, any costs associated with the placement of a temporary crown while a “permanent” crown is being made, should be included in the fee being charged for the final crown. When is D2970 appropriate? Interestingly, D2970 was deleted in the CDT-2005-2006, but reinstated for 2007-2008.  It is said to apply to prefabricated crowns placed as short term restorations for teeth that have been damaged, have pulpal involvement, or have a questionable prognosis.  A “fracture” is essential to the use of the code by virtue of its description.  If your patient has these issues, the use of a narrative describing what the crown is for may prompt an insurance benefit.  For example: “#8 and #9 were injured by a thrown baseball.  Temporary crowns are being used as short term restorations until it can be determined if endodontic treatment is required.”  If a benefit is provided for D2970, there may be time limits before a “permanent” crown will be covered, (6 months, 2 years, 5 years are sample time limits).  Within the framework of these time limits, any amount paid toward the D2970 before the time “runs out” may be subtracted from the payment for a final restoration, whatever that restoration might be. 
  • Charging out a separate “exam” code when the patient receives a D4910-Periodontal Maintenance, but the dentist does not examine the patient.  While it is appropriate to file a separate exam or evaluation code and fee at the same time as D4910 when the dentist performs his/her exam, it is not appropriate as a “routine” part of the perio maintenance visit. For example, if a hygienist performs D4910, and the dentist is out of the office that day, or does not evaluate the patient that day, it is incorrect to charge out any evaluation code.  According to the ADA description, “The collection and recording of some data and components of the dental examination may be delegated; however, the evaluation, diagnosis and treatment planning are the responsibility of the dentist”.  This means that only a dentist may perform an exam. Most carriers will pay toward two D4910 procedures and two evaluation procedures of any type annually.  Most often a D0120-Periodic Oral Evaluation is covered at the same appointment as D4910.  It is very common for many periodontal patients to require more than two D4910 and two D0120 services per year.  However, any more than two are the patient’s responsibility.

Be sure that your office is using correct coding and adequate narratives. It can make a big difference in patient satisfaction and the office’s financial situation.  You might be interested in my insurance coding reference book, The Dental Insurance Coding Handbook, which features all ADA codes for 2005-2008, as well as guidance on their use, narrative language, and typical plan restrictions.  This handbook is available from McKenzie Management.

With 33 years in the dental field, Ms. Tekavec is the president and owner of Stepping Stones to Success. She is a well known author and lecturer.  She has appeared at all of the nation’s top dental meetings, as well as providing programs for local dental societies and study clubs.  Still practicing clinically, she is a consultant with the ADA Council on Dental Practice and was the columnist on insurance for Dental Economics magazine for 11 years.  She has written over 200 magazine and journal articles as well as designing a “Patient Brochure” series.

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