Laws and Threats and Compliance / Whatever happened to the real world of running a dental practice?

Lions and Tigers and Bears! (Laws and Threats and Compliance!)

Between HIPAA laws, OSHA laws, insurance contracts, state board laws and the constant threats of insane levels of fines and jail time, what happened to running a dental practice with common sense and courtesy? On one side, I understand that there are guidelines in place to protect our patients and staff, to establish the rules for how finances flow between dentists and vendors and contracts needed for when a substantial difference of opinion occurs. On the other side, we are losing (have lost?) any reality of what it actually takes to run our practices and come anywhere near meeting these laws.

Clinical Notes

For example, I have read the clinical note for a limited exam recommended by a popular compliance company. . . it is 4 pages long. Four pages. For a limited exam that dentists work into their schedule often in a side column, so truly there is no time allocated for staff to handle this patient in the first place. How long do you imagine it would take to edit a four page long clinical note? At least 15 minutes is my guess. And that’s only if you had all the data needed to enter the note in the first place.

This is a complete break from reality in a dental practice.

HIPAA Security

Next, let’s consider compliance for our credit card machines to meet the HIPAA security requirements. Now, this has been several years ago but I had a well-trusted IT company owner tell me that unless we unplugged the machine, there was no way to actually meet the specifics outlined. This conversation was a result of my trying to follow the steps outlined in the binder we bought from the ADA on HIPAA security. Again, I was told that no other practice that this IT company worked with had even tried to follow these rules.

Dental Insurance

My most recent disappointment with laws vs reality hit me just the other week when I was told that offering a pay in full discount to a PPO patient was considered fraud. And, even worse, that in most PPO contracts it says we are not supposed to collect any money before treatment is completed at all! In the same conversation with this insurance expert, it was also acknowledged that every office still does this, and has to if they want to have any control over their accounts receivables.

This break with reality makes me furious.

The frustration is for two reasons:

  1. That the laws and contracts exist and are dictating to dentists how they must behave and that this has somehow become accepted.
  2. That there can be no conversation about how to really run a dental practice

So, dear readers, let me be one to say that my goal for this blog and all the training I provide is to be a real resource for how to run a dental practice. I am not a PPO contract expert or certified for compliance. I am operations. I want my offices to follow these laws and do the right thing by patients and vendors and all governing boards. I also want to be able to talk about the real world of running a dental practice that will actually help dentists and office managers make measurable progress in their profits and quality of care.

Friends, we have a problem with running our practices! Our accounts receivables are way too high, our profits are way too low and our teams lack confidence to handle patients with the customer service we desire. And, as our industry merges and consolidates like the pharmacists and physicians before us, I have to wonder if our best chance to keep clinical care at the forefront is to be honest about how to run the practice for real?

The best thing about attending conferences in person is that you can have a real conversation about your practice with others in the field. I love working with dental office managers because they are generally upfront and honest about the challenges facing their practice. They want to find real solutions that work for other offices so they can best serve their doctors. However, fewer and fewer dentists are attending conventions, much less bringing their teams along, so how will managers find good resources for dental practice management?

I hope that this blog is one such place.

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One of the biggest challenges to managing a dental practice is managing dental insurance. With dental insurance handled, then dental marketing for new patients becomes a primary focus. In today’s day of online reviews, handling patient complaints well is essential. As your practice grows, hiring dental staff becomes more important. With 18+ years of dental practice management experience, I’m open to your questions to help you run a successful dental office.


All my best to dentists and managers who are working hard to manage a dental practice!

AUTHOR: Jill Nesbitt
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