#6 – Manages specialists: Pediatric Dentist | Dental Practice Coaching

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#6 – Manages specialists: Pediatric Dentist

Get to know your dentist

Dr. _________ sees patients ____________.  He will have 3-4 columns of patients when he is in our office.  His chairside assistants are __________. Each of his staff has a different function on the team. They are as follows:

  • EFDAs – Can do child prophys (cleanings/PC’s), place fillings, sealants. With specific training can do IV sedation or ambulatory consults.  Run their own columns and can finish treatment when it is documented in the clinical notes.  The doctor will prep the tooth and they can place the fillings in teeth.
  • Primary chairside assistant – Assists the dentist and manages C&S functions.
  • Coronal Polisher – Can do child prophies (cleanings/PC’s), place sealants.  Can do IV sedation or ambulatory consults.  Run their own columns.

There are a couple of extra things to remember when scheduling for the pediatric specialists.

  • Many times patients are referred to a Pediatric Dentist from outside general dentists.  If this is the case, schedule a 3u child comprehensive exam (D0150.3) for any child 3 years old and over OR for children 2 and under, schedule a 3u oral evaluation > 3 (D0145).  The child has possibly already had a cleaning and exam by their referring general dentist and we need only to evaluate and treat the patient’s cavities.  If the parent would like to have a cleaning for the child, Dr. is happy to do this, and almost always will also do a fluoride (D1208.2) application.  This visit can be scheduled in any column.  This time is also used for the dentist to get to know the patient and see if they can get the treatment accomplished without some level of sedation.
  • Try to avoid scheduling treatment with the Pediatric Dentist if he has not seen the patient.  If this cannot be avoided, then review the xray and chart with the doctor before putting the patient in their schedule.  You can email Dr. any xray or to ask about scheduling this patient if you are unsure.  If you must schedule per one of our GP docs, give Dr. at least an hour to do treatment.  Let the parent know if we can’t complete treatment due to behavior, there might still be a charge for the doctor’s time.  In any case, we may need to get the child back in for a re-check appointment before scheduling treatment so that they can assess whether or not the child will need to be sedated.

Managing Pediatric Dentistry 

In order to stay on top of everything, you’re going to have to take care of things on a daily basis, a weekly basis, and a monthly basis.  See the following schedule.

Daily-

  • Huddle
  • Print new patient referral letters (Pedo Thank You Doc Referring Letter)
  • Confirm any type of  Sedations
  • Check Ambulatory Consults and ensure folder/checklist is ready
  • Call Broken/Primetime list to fill schedule
  • Assign a staff person to do videos/pictures – to be signed off at end of day by Dr.
  • Follow up with patients on unscheduled treatment/sedations
  • Do afternoon How Feelings on all morning sedations
  • Every patient has a G-note for “walkout” for our collections/insurance person
  • Email our collections person at end of day list of patients with no insurance so she can track payments
  • Give Dr. a day sheet at the end of every day
  • Make sure pedo prep checklist complete

Weekly-

  • Schedule doc lunches
  • PTE’s
  • Fill Schedule
  • Marketing should be ongoing – keep on top of monthly/seasonal activities such as February Dental Health Month, School Visits, Dr. Mason independent marketing, etc. 

Pre-In Office IV Sedation:

  • Review financial arrangements on Ambulatory Cases (Day before ambulatory day)
  • Send Anesthesiologist a copy of the schedule via fax – she likes a copy of the schedule as well as each patient’s pre-op questionnaire/
  • Make sure Dr.  has a copy of the day sheet.  He uses this to make p.m. how feelings calls
  • Confirm lunch for all staff, including our anesthesiologist and staff – do this well prior to the lunch time
  • Set up a 2 week re-check when parents are waiting for child to recover
  • Make sure our anesthesiologist has her payments as well as a copy of all consent forms when she leaves

Monthly-

  • Pedo End of Month:
    • Case acceptance for “zzma” ortho
    • Case acceptance for IV sedation in-office and at Children’s Medical Center
  • Schedule Meeting/Lunch with dentist owner & Pediatric Dentist
  • Schedule Staff Meeting/Lunch
  • New patient/Emergency blocks in busy times (summer, spring break, school holidays)
  • Monthly prophy recall

Yearly-

  • February/March – Coordinate surprise gifts/cards for referral sources (Dr.  feels this will be more successful off season since offices flooded with these during Christmas)
  • October/November- Coordinate Christmas gifts/cards for referral sources
  • March/April- Confirm Docs’ Summer Schedule

Huddle

You can follow the GP side Huddle sheet if you’d like but generally, they only need the following information in their huddles:

  • Production on last day they were in.
  • Projected production for the day
  • Mention daily goal
  • Are all notes completed by clinical staff?
  • Weekly schedule – is everyone up to date on any changes?
  • Staff present?
  • Medical alerts?
  • Review New Patients and who referred them
  • Review patients not new to HP but new to Dr.
  • Review Emergency appointments
  • Go over lab cases (seat appliances)
  • Ask if they have any issues/projects

Print New Patient Referral Letters

All new patients of our Pediatric Dentist that are referred by another doctor need referral letters.  These are printed in quick letters and are the “Pedo Doc Referral Thank You” letter.  You’ll need to ensure that the referring doctor is listed in the family file under “Referred By”.  You’ll want to build/view the letter and check for editing before you print the letter for Dr. to sign.  Be sure to note the next visit if it is a consultation with the parents so that it isn’t implied that they’ve scheduled treatment.

Confirm Oral Sedation

It is rare for our Pediatric Dentist to do Oral Sedation appointments.  He feels that the window of approximately 20 minutes that is really obtained with the medication, combined with numerous visits (each with an oral sedation fee), would be better scheduled as an in-office deep sedation appointment.  Also, Dr. medicates in any way as little as possible.  All oral sedation appointments need to be confirmed by a coordinator for Dr..  This is really important that mom and dad are reminded that their child can have nothing to eat or drink after midnight, because if they do have something, we can’t administer medication or do treatment.  Make sure that you note the confirmation in the appointment notes.

Be sure that you do not schedule a patient’s entire appointment during the time that Dr. is doing Oral Sedations.  This is the only type of sedation that is done when regular patients are in the office.  The doctor needs to give the patient an hour of uninterrupted time and we will have to reschedule any patient that is scheduled completely during this hour because of lack of time.  To keep this from occurring, 4u blocks are put in the schedule during the sedation time.  If a cleaning is scheduled with 1 unit of the appointment before or after the hour of sedation, this is fine.  This allows the doc to go in and check before or after the sedation and keeps the schedule running smoothly.  See the sedation section for more information on Oral Surgery.

Check Ambulatory Consults (Ambulatory means walking – this is a level of sedation)

Make sure that all scheduled consults have completed treatment plans and the folder is prepared with the completed checklist paperclipped to the front.  Make sure that the Dentrix treatment plan is in the document center.  Ensure the accuracy of the information and make notes if needed.  When you have Tx plan ready insert dateline in appointment and put paperwork ready.

Patient Follow-up

This is pretty self-explanatory.  You’ll need to make sure on a daily basis that you are making notes of who you talked to and note in your planner who you need to follow up with.  Parents will call upset if they don’t hear back from you and you don’t want that.  Put notes in the clinical notes. Our pediatric dentist prefers a how feeling call be done for each treatment patient, and a thank you call made to each new patient.

PTE’s

You will be given pediatric PTE’s along with your regular PTEs and unscheduled treatment report.  They will be noted on the Excel sheet that you use weekly for unscheduled treatment so that you do sufficient follow up.  If you don’t have any luck scheduling after two to three contacts, give the print-out to Dr.  to follow up with a phone call.

Scheduling Treatment and Re-care appointments:

There are differences in how a dental cleaning is handled for adults vs. children. Children normally do not have enough build-up on their teeth to require a hygienist go in and scale the build-up off of their teeth.  Normally the children come in and one of the assistants goes over brushing and flossing and good nutrition with the children.  Then the doctor comes in and looks at or “counts” the child’s teeth before doing a thorough polishing with a prophy brush (as needed).  This experience for the children is called a PC for ‘preventive care’ appointment and we charge out for a dental cleaning. Regarding the fee, if for some reason we don’t polish, we still charge for the PC or preventive care portion of the appointment and discount the charge by $10.

Another thing to keep in mind is that the timing is different for re-care appointments.  Be sure to schedule 3 units for each child prophy.  If you are scheduling sibs together there should be 3 units for the first child and 2 units for each additional child.  Dr. primarily likes to have a 1u anesthetic, 4u treatment for any child’s treatment visit.  He feels that the longest a child can sit comfortably is an hour and will try to get as much done per visit as possible.  Sealant visits can be scheduled with certain staff – usually 4 units as well. If anesthetic time is noted in the clinical notes, add the unit to the doc’s time.  Remember that the EFDAs get credit for placing all fillings, sealants, PC’s, and emergency exams so we can track their productivity.

Please take note when you see a flag for our pediatric dentist’s military patients.  These patients receive special discounts from him thanks to his military background.  On preventive care appointments, Dr. discounts the patient portion to make this visit “100%” covered (like our in-network patients receive).  On treatment visits, Dr.  will give his military patients 30% off of their patient portion.  You must be careful that you are looking at the estimated patient portion and not the visit total to calculate this correctly.

One thing that you will see that is different with the pediatric patients is that the docs do what is called a pulp treatment or a “baby root canal”.  Try to avoid the word root canal if you can.  This tends to strike fear in the hearts of young and old alike.  These pulp treatments fall into the endodontic category of treatment and are abbreviated on the salmon sheet as follows:  vital pulpotomy (pulp), indirect pulp-cap (ipc), or a pulpectomy, which Dr.  uses the most often.  Insurance normally only covers pulp treatments at 50%, if they will cover them at all.  Be sure to change the default coverage to 50% in the treatment plan.

Another thing that you will see frequently is space maintainers.  These are used to hold the teeth apart when a baby tooth is extracted or missing.  These are considered preventive.  You can have a unilateral space maintainer or a bilateral space maintainer.  Unilateral is to replace one tooth on an arch and bilateral is to replace two teeth on an arch.  Insurance normally covers space maintainers at 100% so be sure to check on this in the treatment plan.

The pediatric dentists also make baby dentures (pediatric fixed partial) for extreme cases where all teeth must be extracted or have not developed correctly.  Baby dentures are sent out to a lab.  Check with the insurance on coverage for these.  Also, be sure that you notify our insurance staff person when sending an appliance to insurance because she can usually get better coverage if she bills it out as orthodontic treatment.  This is important because many times the insurance will deny coverage for an appliance if our insurance person doesn’t get it sent correctly.

Sedation options:

Our pediatric dentist does three types of sedation appointments.  These are usually costly and require special care when scheduling and dealing with the parents.  Be sure to use the checklists.  The checklists have been created to keep everyone on the same page with sedation patients.  They help maintain consistency and help us to avoid mistakes as well as angry and frustrated parents.  These are invaluable.  These visits are not billed as higher fees – Mom and Dad will pay the same as every other parent in our practice.  However, each type of sedation does have an applicable Administrative fee that we use due to Dr. closing his practice for the day and dedicating himself just to these patients.  He will not do doc checks or be in any other part of the building except for this one.  In addition, the practice takes on a lot more responsibility when seeing these patients in this capacity.

The second thing you’ll have to remember is adding the appropriate sedation fee. These are in the system under “Other”.  You have an Oral sedation code, a “Treatment Coordination fee” for ambulatory/IV sedation, and a “Hospital Surgery fee”.  These fees are not normally covered by insurance and are the fee for doing the procedure in this manner.  They help to cover the additional staff, risk, and special time that are dedicated to the child being sedated.  Most parents don’t question this, some may.  Remember to send a PTE for all sedation cases as soon as possible.  This information is very important and will avoid collection issues.

Oral Sedation or “sleepy juice” as it is sometimes called is liquid that will relax the child making them more agreeable for treatment to be completed.  This type of sedation does not put the child to sleep.  It makes them feel very similar to an adult taking a relaxant such as Valium.  Dr. uses oral versed, a sedative that usually relaxes but very rarely may excite.  Once given it takes 15 minutes to work and then he’ll have 20-30 minutes of working time.

The Oral Sedation fee is $251 and is not covered by insurance.  Be sure to default this to $0 paid by insurance.  The parents need to follow our standard financial arrangements for the treatment + the sedation fee. The sedation fee is not refunded if the treatment cannot be accomplished. Be sure to let your parents know this.

To schedule an oral sedation, these are done first thing in the morning and the child is not to have anything to eat or drink after midnight the night before.  This is also called NPO for short. There is no anesthetic time for this appointment.  Dr. will administer the sleepy juice when the child arrives (after getting child’s weight).  This medication does sometimes take about 15 minutes to take effect.  Make sure you have Mom/Dad sign the Oral Sedation Consent Form before we start treatment.  After the sleepy juice takes effect, Dr. will perform treatment in the quiet room.  In some cases more then one visit will be necessary.   Remember not to schedule other patient’s appointments completely within the parameters of the hour it takes for Dr. to do the sedation.  The dentist will tell you the times needed per patient.  He blocks 4 units in every column (9:30-10:30).

IV sedation or Ambulatory is when a child is sedated (sleeping) completely.  ______ is a board certified pediatrician who is also licensed to do anesthesia.  She assists with these cases in our office.  She has 12 years hospital experience with both adults and children.  She  has been doing IV Sedation in our office for ____ years. She has done over 1,000 cases with the docs without complications!

The first step in scheduling an ambulatory patient is to have the parent(s) or guardian(s) come in for a consultation appointment.  You’ll schedule two units with the pediatric dentist and then two units with the pediatric coordinator.  A formal treatment plan and paperwork will need to be put together for this appointment.  See the “Preparing a Pedo Treatment Plan” section for further information.  There is a strict financial arrangement policy for Ambulatory patients.  They must follow our financial arrangement guidelines – they may not have the appointment & pay later. Be sure that you have firm financial arrangements and take good notes to prevent problems in the future.  Follow the checklist!!  Sedation coordination fee $329.00, insurance will not cover this fee.

IV sedation is scheduled as needed. We will set back to back (one on top of the other) blocks for ambulatory appointments in Dentrix.  This is because Dr.’s ambulatory cases can sometimes have more treatment than Dentrix will allow us to have in one appointment.  You’ll make one appointment in the doctor’s column and then under it make another appointment block with the doctor as the provider also.  Dr.’s appointments typically are an hour and a half or less.  Schedule the first visit for one hour, then shorten the second one to 30 minutes.  If all treatment fits into the first block, then that block is all you need.

Because she is a medical doctor, we cannot bill for our anesthesiologist’s anesthesia charges. A deposit of $400 is required to schedule a visit for IV sedation, with the coordinator making clear to the parents that the rest will be due upon completion of the visit.  The medical insurance company may reimburse for the anesthesia charges but the parents will have to take care of this.  We will give the parents a letter of medical necessity to submit to the insurance.  This form is located in __________ in Word.  Open this document and insert the correct patient information, date, and time that sedation lasts.

We keep track of the anesthesiologist anesthesia deposits, charges, and payments on an excel spreadsheet.  This form is located in ___________.  There is a new sheet for every day that she is in.  The day before she comes in, fill out a new form for her.  This helps us track payments and if any amounts are still due.  At the end of the day when all of the appropriate information is entered on the spreadsheet, you’ll need to print one for the anesthesiologist and include this when you give her the envelope at the end of the day with her payments and sedation consent forms.

Our anesthesiologist has a website that parents can visit to find out more about her and her staff.  All paperwork that is given during the Ambulatory Consult can be downloaded on her website as well.  She does have videos on her website that show a typical IV sedation in progress.  Since this content is not meant for children to see (only parents), a password is needed for viewing.

The third type of sedation is done at Children’s Medical Center.  Normally this is done when a child is too young or has a medical history or condition that does not make it safe to do the treatment in our office.  Sometimes it is also the case that a parent will request that the procedure be done in the hospital simply for peace of mind.

You will need to go ahead and schedule a conference with the doctor and the pediatric coordinator for the parents to come in and talk to us.  Be sure to send a PTE as soon as possible.  At the conference you’ll want to urge the parents to call their medical insurance to obtain an idea on their medical coverage.  You will call the medical insurance only to find out if they require precertification or not.  Most do not since this is out-patient surgery but will ask you to fax the letter of medical necessity just to have on file.  You can contact Children’s and let them know that pre-cert is not required and they will want to know who you talked to at the insurance company and what phone number you called, so make sure to notate this in clinical notes.  If they don’t hear from you, someone from Children’s Medical Center will call and ask for a precertification number.

If insurance doesn’t pick up the anesthesia and room costs for the treatment to be done at CMC the parents may choose to self pay but this is expensive.  They could end up with a bill of $8,000 or more.  A checklist is available to follow.

The financial arrangements are different for hospital cases.  Because the treatment is done at Children’s, the parents don’t come to our office to check out.  Therefore, they need to pay in full to schedule.  I wouldn’t recommend scheduling until you have the payment from the parents.  Our pediatric dentist  has privileges at Children’s.  To schedule at CMC you’ll have to block Dr.’s schedule here.  Dr. prefers that we schedule more than one case at CMC if possible.  If it’s not possible though, it is okay to go ahead and schedule one case.  Once you’ve blocked the time in Dr.’s schedule, you’ll need to fill out one of CMC surgery scheduling forms on the patient and fax it to the surgery scheduling department.  They will send you another fax usually within 24 hours to confirm the time.  Make sure you note the confirmation number.    Once you’ve had the Ambulatory conference, Dr. will call CMC to obtain a time for the appointment.

Pediatric Huddle

  1. Is everyone present and clocked in?
  2. Consults for today:
  3. Assistants – do you have the project list? Do you have time for projects?
  4. Do we have any money or client problems?
  5. Total number of new clients  ____, ____ referred from docs
  6. Person to take pictures_____________ And Testimonials____________
  7. Production:

Yesterday you were scheduled for $___________, you did $_____________

Today you are scheduled for $_____________.

  1. How did yesterday go?
  2. Open time for the future 3 days out:_________________________________
  3. Do we have any appliances to be seated? If so who:
  4. Any Medical Alerts?
  5. Who is checking charts for tomorrow  ____________
  6. Do we have time for emergencies  _________
  7. Anything unusual?
  8. Any Above and Beyond?

 

Preparing a Pedo Treatment Plan

You’ll want to have all treatment plans and paperwork done the week before they are scheduled to come in for their ambulatory consult.  The treatment plan template for Children’s Hospital cases is saved __________ and the template for in-office IV sedation is in the same place but called “In-Office IV Sedation”.

Open this document and insert the appropriate information.  It should then be saved in _____________ according to the patient name.

To save the financial arrangement contract to the patient’s family file document center:

  • With the FA contract open, click file, then Save As
  • Now, go to patient family file
  • Select document center
  • Click aquire, paste from clipboard
  • Select document type as “patient treatment”
  • Type Document type as “Pedo FA contract”
  • Click ok
  • Contract should be saved 

You’ll need to include in the packet of information a “Relaxing Children” brochure, the appropriate “Worksheet for Deep Sedation”, a copy of the treatment plan, and any appropriate “Sealants” or “Fillings” brochures.  Additionally, you’ll need to include in the document center another copy of the treatment plan, a financial arrangement sheet, a copy of the treatment plan presenter from the computer, and a consent form for our pediatric dentist to do the Tx.

Review Financial Arrangements (FA’s) for Ambulatory Cases

On ambulatory cases, you’ll need to review the FA’s and make sure all payments are in at least a week before we do the procedure to give you enough time to follow up if you need to.  Additionally, you’ll need to fill out our anesthesiologist’s anesthesia payment worksheet.  We keep track of her anesthesia deposits, charges, and payments on an excel spreadsheet.  This form is located in ____________.   There is a new sheet for every day that our anesthesiologist is in.  The day before she comes in, fill out a new form for her.  This helps us track payments and if any amounts are still due to her. At the end of the day when all of the appropriate information is entered on the spreadsheet, you’ll need to print one for Dr. and one for our administrator.

Procedures for collecting Anesthesiologist money

Our Anesthesiologist’s entire fee should be collected before the IV sedation appointment.  Dr. will take credit cards.  She will do check, cash, flex or HSA cards.  If the parents pay with cash give them a receipt and place payment in an envelope that says “for Dr. _____” and the date of the upcoming sedation.  Store this envelope under the money tray in the locked cash box.  These payments will go to Dr. at the end of the sedation day.  Keep track of how people pay for each ambulatory day.

Resetting Recall Dates for Ambulatory Cases

Obtain list from 2 years ago, last year’s cases should be on a 4 month recall for 1 year following Ambulatory Treatment done.  List includes name, date of last visit and when due date.  Many patients choose to continue seeing the referring dentist, some come from a long distance, go to dentist with rest of family, or already see a pediatric dentist.  Watch list for patients that never had treatment done, or are collections problems, or dates that don’t jive.  You may need to pull charts to check on these.  Ideally, the patients have been on a 4 month recall, have come in at recall times (4 months) and we need to switch to 6 month recalls – if doesn’t have reoccurrence of decay problems, to do this follow these steps.

  • Click on Family File, File – click on Select Patient
  • Enter Last name – ok
  • Click on Cont. Care
  • Click on Prophy – child
  • Check Due Date – keep current date in mind
  • Check with arrow if 4 or 6 month recall.

When you are on the month the date will change to 6 months from today.  You will have to make sure it is 6 months and one day from last cleaning appointment; you will probably need to change date.

Make necessary notes on list, some points may be past due slightly – they will be called to see if they want to schedule.

Handling treatment changes during IV Sedation or Oral Sedation

It is important for everyone to understand that changes can occur at any time during the course of treatment.  Dental staff and parents need to understand that our pediatric dentist does his best to be conservative in doing only necessary treatment.  If changes occur, it is our goal as a team to be made aware of these changes & immediately begin to discuss treatment with parent(s) of the child being treated, gain permission to continue treatment, and change financial arrangements.  Ideally, all treatment would be planned before the child’s scheduled appointment time.  However, as we all know, things happen!  Cavities become large, become infected, other teeth become affected.  It is our job as a team to take it all in stride, do our best to communicate with each other and our patients and parents, and expedite our services in a friendly manner.

When changes in treatment are noted, clinical staff should write these down (or change in the treatment planner) and deliver to the front desk staff handling finances. The front desk person will then enter the changes into the computer so that the difference can be noted.  This will be done while the clinical assistant is discussing the changes with the parent, answering any clinical questions.  Then the front desk person discusses financial arrangements with the parent, has the treatment changes consent form signed, and Dr. is given permission to continue treatment.

Month End

At the end of the month you’ll need to work up our pediatric dentist’s end of month specialist worksheet.  This is kept in _________ in Word.  These are to be kept on file for at least one year for future reference. You may need to ask our administrator for some of the numbers.  Be sure that you give Dr.  a copy of this.

Case Acceptance Totals

A report is run and gives the totals of everything at the end of the month.  Be sure to include this information on the month end worksheet.  Given to the administrator and the pediatric dentist.

Schedule Staff Meeting

Once a month our pediatric dentist likes to have a staff meeting during the lunch hour.  Be sure that you block time in their schedule for this to be done.  The pedo coordinator will create an agenda for this so everyone stays on track.  Other monthly meetings include time with the dentist owner.   An agenda will be created for this meeting as well.

Oral Sedation Blocks

Because of the way that the pediatric dentists schedule their sedations you’ll want to make blocks in the schedule holding future sedation time.  Since Dr. does so few of these visits, he will usually come in early on one of his regularly scheduled days.  If Oral Sedation appointments increase enough to call for them, do these at least six weeks in advance to cover the schedule.  See “Oral Sedation” for Dr.  4u block in all columns.

Double-check Schedule

You’ll want to check with the docs on a regular basis to make sure they don’t have any upcoming trips or anything else that will require them to be out of the office.

No Decay Club

The assistants do this monthly.  Come up with a theme to decorate the bulletin board in the waiting room.  Make shapes for the kids to write their names on.  Keep these shapes in the yellow folder at the front desk for the assistants to give to the kids.

Checklist for Oral Sedation Patients

Patient name:  ___________________________________

Time of initial exam:

Initial Appt. with Pediatric Dentist

o  Exam – date: __________________

o  Check health history, anything unusual? _________________

o  Send PTE to dental insurance.  Date sent:  _______________

 

Schedule appointment

o  Tx plan in computer

o  Default Oral Sedation fee to pay $0 by insurance

o  Change, if applicable, SSC’s and endodontic treatment to pay at 50% in Tx plan

o  Secretary – check payment history to let parents know what estimate is actually based on, accurate payment history or default coverage. Call insurance

o  Secretary discuss insurance and make financial arrangements – signed financial arrangement sheet

o  Oral Sedation appointment scheduled – date: _____________

 

Day of Procedure

o  Any special Tx notes? _______________________________

o  Consent forms signed

o  Changes in Tx? Yes or No?

o  If changes in Tx, prepare Tx Changes form:

o   Assistant to discuss and review changes in Tx with parents

o   Secretary to review cost and get form signed by parents

o  Discussed with parents, post-op instructions

 

Notes: ____________________________________________________________

 

 

Check list for Hospital IV Sedation                              Patient Name: _________________

Initial Appt. with Pediatric Dentist

□       Exam – date: __________

□       From Parents:  Birth Weight, Current Weight, and Health History of Child to bring to consult.

□       Get copy of medical and dental insurance cards

□       Confirm treatment on salmon sheet and estimated time needed

□       Needed pictures taken? ________

□       Check health history – anything unusual? __________

□       Consultation with parents – date: ___________

□       Treatment plan in computer – Hospital Surgery fee (9996), ins to pay $0

□       Change – if applicable – SSCs and endodontic treatment to pay 50%

□       Call dental insurance – maximum, deductibles, percentages, benefits used, etc.

□       Prepare formal treatment plan and paperwork for ambulatory consultation

Include: 2 copies of typed treatment plan (one signed and we keep)

Appropriate brochures – include hospital brochure/video

Pre-Op Questionaire (fill out and we keep)

Pre Op instructions

Consent for surgery (sign and we keep)

After care instructions

Insurance Coverage worksheet

Medical necessity letter (we keep one copy)

Scheduling Information Form

Request for Anesthesia Consult

□       Send PTE to dental insurance – Date Sent: __________

□       Give Doctor treatment plan to review

 

Ambulatory Consult Appointment – 2u doc time, 2u secretary time

□       Dr. explain treatment and answer any questions

□       Consent for Dental Treatment w/Hosp Anesthesia signed

□       Treatment plan signed

□       Secretary check payment history to let parents know if estimate based on accurate payment history or default coverage – check PTE

□       Explain to parents they need to contact medical insurance company for coverage

□       Secretary discuss insurance and make financial arrangements, potential changes and unexpected additional fees

□       Received PTE back from insurance?

□       Call parents to discuss changes from original estimate and PTE received

□       Schedule 2 week follow up appointment if you have surgery date already

 

Schedule Appointment

□       Confirm dental and medical insurance with parents

Medical Pre-Cert #: ___________________        Dental: $___________

□       Treatment paid

□       Ambulatory appointment scheduled – date: ________

□       Fax Surgery Block form to hospital

□       Fax Hospital forms:    Scheduling Information Form

Request for Anesthesia Consult – if needed

Surgery Block Time Modification Form

 

Day of Procedure (or day before)

□       Any special treatment notes? __________________________

□       Confirm consent forms signed

□       Give chart copies with post op instructions to doctor

□       If cancellation, fax Surgery Modification Form and  Release of Block Time to hospital

 

Post Procedure

□       How feeling – By the doctor day of surgery, by staff day after surgery

□       Schedule 2 week follow up if not already scheduled – date: __________

□       Review changes in treatment, if any, with doctor same day or next

□       Review changes in treatment, if any, and changes in patient portion (FAs) with parents

□       Extend FA’s if necessary

□       Change fee schedule back to #2 from #5

□       Edit recall date to 3 months

□       Confirm doctor has added any notes from surgery into record

 

 

Check list for Hospital IV Sedation                              Patient Name: _________________

Initial Appt. with Pediatric Dentist

□       Exam – date: __________

□       Get copy of medical and dental insurance cards

□       Check health history – anything unusual? __________

□       Consultation with parents – date: ___________

□       Treatment plan in computer – Treatment Coordination Fee (IV Sed) D9998, ins to pay $0

□       Change – if applicable – SSCs and endodontic treatment to pay 50%

□       Call dental insurance – maximum, deductibles, percentages, benefits used, etc.

□       Prepare formal treatment plan and paperwork for ambulatory consulation

Include: 2 copies of typed treatment plan (one signed and we keep)

Appropriate brochures

Anesthesiologist Pre-Op Questionnaire

Anesthesiologist Fee Schedule

Anesthesiologist Information Sheet for IV Sedation

Anesthesiologist Pre-Op Instructions

Anesthesiologist Consent for In-Office IV Sedation

Anesthesiologist Privacy Promise

Anesthesiologist Post-Op Instructions

Anesthesiologist Patient/Parent Compliance

□       Send PTE to dental insurance – Date Sent: __________

□       Give Doctor treatment plan to review

 

Ambulatory Consult Appointment – 2u doc time, 2u secretary time

□       Dr. explain treatment and answer any questions

□       Consent for Dental Treatment w/In-Office Anesthesia signed

□       Treatment plan signed

□       Patient/Parent Compliance Signed

□       Secretary check payment history to let parents know if estimate based on accurate payment history or default coverage – check PTE – is PTE back?

□       Explain to parents they need to contact medical insurance company for coverage

□       Secretary discuss insurance and make financial arrangements, potential changes and unexpected additional fees

□       Schedule 2 week follow up appointment if you have surgery date already

 

Schedule Appointment

□       Anesthesia Paid

□       Treatment Paid

□       Enter payment in Anesthesiologist Excel Sheet

□       Ambulatory appointment scheduled – date: _________________

□       Confirm dental and medical insurance with parents

Medical Pre-Cert #: ___________________        Dental: $___________

 

Day of Procedure (or day before)

□       Any special treatment notes? __________________________

□       Confirm consent forms signed

□       Faxed Dr. Devany information packet (2 days before)

□       Give Anesthesiologist Medical Necessity Letter to Parents (Change per patient)

□       Review changes in treatment, if any, and changes in patient portion (FAs) with parents

□       Anesthesiologist’s total:  ____________________________

□       Update Anesthesiologist Excel payment sheet

□       Scan all anesthesia monitoring paperwork and consent forms

□       Give Anesthesiologist final payment and consent forms (AFTER SCANNED)

□       Schedule 2 week follow up appointment

 

Post Procedure

□       How feeling – By the doctor day of surgery, by staff day after surgery

□       Schedule 2 week follow up if not already scheduled – date: __________

□       Extend FA’s if necessary

□       Edit recall date to 3 months

□       Confirm doctor has added any notes from surgery into record

 

Ambulatory Consult

Good morning, Mrs. Jones, my name is Dave and I am your treatment coordinator.  (start tape here if needed)  Dr. _____’s responsibility is to provide Kyle the best possible treatment and my job is to make sure that everything goes smoothly for you.  I have put together a packet that we’ll review today that should answer most of your questions.  I’ve included my business card in case you have any other questions or concerns.  I’m the person you should talk to.

I have reviewed Kyle’s treatment that you and Dr. _____ agreed upon.  I have seen Dr. ______ do this type of treatment many times.  He is wonderful.  The treatment will be done well and Dr. _____ is so kind to children.  Do you have any questions regarding Kyle’s treatment plan?

(No)

Ok, then let’s go through some more information that I have for you.  Before I get started, I want to let you know that you do not have to feel you have to remember everything that I say.  I am going to give you all this paperwork and you’ll get copies of everything.  Plus, this packet has my business card in here with my direct extension, so if you walk out of here and think of 10 more questions you wish you would have asked, feel free to call me.

(Usually gets big sigh & smile out of mom)

First of all there are a lot of great things about having treatment done with IV sedation.  This brochure walks you through some of the benefits.  (I usually highlight a couple and tell a personal story about a great experience with my niece.)  (Open brochure) The anesthesiologist we will be working with for your appointment is Dr. _____.  Here is some information about Dr. ____ and her phone number, so if you have specific questions for her, feel free to give a call.  (I usually put a star next to her name on the brochure)

This brochure walks you through some of the guidelines for eating and drinking – I’m sure Dr. ____ already reviewed with you, but it’s very important not to eat or drink anything after midnight the night before treatment.  (I usually point out this section in the brochure) Do you have any questions on the sedation part of the appointment?

Ok, for this treatment, it looks like it will take Dr. ______ about 1.5 hours to complete everything.  The total cost for dental treatment is $2,500 and the cost for the anesthesia is $550.  I like to think of the cost in two groups – one for the dentistry and one for the IV sedation (I usually use hand gestures to communicate this also).  Let’s go through each.

For the dental treatment, the total cost is $2,500 and we estimate your insurance will cover $1,000.  I wish we could tell you exactly what your insurance will pay, but that’s not how they work.  Here’s a brochure that explains how dental insurance works.  It really is wonderful that you have this coverage, but don’t be surprised if your coverage is a little different from what we estimate.

For the IV sedation the fee is $550.  Do you have health insurance for Kyle?  (Open the brochure again) Medical insurance may help to pay some of the IV sedation fee.  What I recommend is for you to call your medical insurance company and follow the script that we have in this handout (again, refer to brochure- I usually read this section & have them follow along).  You have all the information that your medical insurance needs to make a decision – you have the list of treatment, the length of the sedation appointment and our total fees.  So when you call them, be sure to have them talk to you in terms of dollars, not percentages – and I always recommend getting the name & direct number of the person you talk to so you can follow up.  The reason we recommend that you call your medical insurance is that you are paying for this insurance and often you get a better response than we do.  However, I have to tell you, most of the time, health insurance does not cover this fee – but sometimes they do –it’s worth the call.

If they do say they will pay some part of the fee, they usually will give you a confirmation number.  The way this works is that you will pay the total amount to the Anesthesiologist and the day of the appointment, she will fill out a form for you to submit to your health insurance and they will reimburse you.

Do you have any questions on your dental or medical insurance?

(No)

Okay, then let’s discuss financial arrangements.  Looks like with your insurance covering about $1,000, your portion will be $1,500 for the dental treatment and $550 for the sedation, which will be $2,050 – How would you like to take care of that?

Then, follow the regular financial arrangements guidelines.

Once that is complete, write up the agreed upon financial arrangement on the form & have the parent sign.

Schedule the appointment.  As you can see, Dr. ____ and Dr. _____ schedule only one patient at a time for IV procedures.  If, for any reason, you must cancel this appointment, please give us a minimum of 3 days’ notice.  This will allow us enough time to give this appointment to another child who is waiting.  Also, it’s very important that you be here on time.  Dr. _____ has arranged enough time to complete all of Kyle’s treatment.  If you are late and Dr. _____ is not able to do Kyle’s treatment, the appointment will have to be rescheduled. Once scheduled there is a $175 rescheduling fee if appointment is cancelled.

Note in the appointment the financial arrangements.  Note in the clinical notes that you did the consult & the result.  Give all paperwork to Mom to take home after scanning everything into the document center.

If Mom doesn’t work out financial arrangements, then work out specific date that you will call to follow up.  Put this note in daybox.

That’s all there is to it!  Now it’s time to try out your new skill.  You will pass this task when you have a tape of a session your Team Leader approves.

When you want to tape a sessions, say “Mrs. Jones, if it’s alright with you, I would like to tape our meeting to refer back to when I make my notes on how we can best meet your needs.”  On the next page is a checklist of what Team Leader will be looking for.  You may need to make several recordings before you have one you feel covers all the bases.

Checklist for the pediatric consult

1.    My role

2.    Review tx & answer questions

– discuss warranty

  1. Compliment docs
  2. Schedule am/pm – skip this for ambulatory consult
  3. Review dental and medical insurance coverage
  4. Set financial arrangement
  5. Next step

 

Procedures for Collecting Dr. Devany Money

If someone pays for their treatment with cash or is paying with a check you write a receipt and the money or check needs to goin the cash drawer (inside the sealed envelope) the same day that is collected.

 

This envelope will remain locked in the cash box until sedation day.

 

 

How to handle families that cannot afford treatment

Occasionally Dr. Mason will recommend IV sedation and major treatment to a family that just cannot afford $3,000 worth of dentistry completed. Sometimes parents will cry or get angry because they are upset at the situation and don’t know what to do.

Your job is not to be the “bad guy” to keep these poor families out of our practice.You do not have to tell them that they cannot have treatment here. Your job is to facilitate these families to get the treatment their child needs AND they can afford. There are several steps to do when this situation arises:

  1. Recognize and acknowledge the financial challenge that the family is facing. It is okay for you to agree with families by saying “I understand this is a large amount of money. I know this is a tough situation for you to figure out. I can help you.”
  2. Review the standard acceptable financial arrangements – Dr. Devany’s deposit must be collected in full with the balance expected the day of the appointment in order to schedule the treatment. We must receive at least 2/3rds of the treatment fee in order to schedule the treatment and we must have a solid arrangement to collect the rest of the money. If the family says they just cannot afford this, then you should ask – How much money can you afford? You should ask what monthly amount they could afford and you should ask if they have any savings or other resources (parents, other relatives, etc.) that they could use as well.
  3. Next, you can give the family a couple of choices:
    1. Give them a list of financial resource ideas and see what they can do to get the money together. Then, you will call them in one week to see how they did and to schedule their appointment.
    2. Offer to work with Dr. Mason to re-evaluate his treatment plan to see if there is any treatment she can delay or do outside of sedation in order to meet the family’s budget. If they choose this option, then go to the next step.
  4. Once you have the family’s budget for dentistry, review this with Dr. Mason to see if he can modify his treatment plan to meet their budget. For example, if the original treatment plan is $800 for Dr. Devany and $3,000 for Dr. Mason and the family says they could put $500 down and then pay $250/month. Leaving the family in the consult room for a moment, you should go back to Dr. Mason and ask him what he thinks he could do with this new budget. Remember, options with treatment include: eliminating sealants, delaying space maintainers, pulling some questionable teeth instead of pulp/crowning them, reconsidering oral sedation instead of IV, etc. Once Dr. Mason has a chance to reconsider his treatment plan, it would be best to have him come back to the consult room with you. Then you can help to write down exactly what the compromise is and how much is due at what time to get what treatment done. If you can work this out, then you can copy your notes from your notepad onto the treatment plan page and have the family sign this.
  5. There will be times we just can’t work it out. Perhaps the family is declined for our patient financing program or the gap is just too wide between what the family can afford and the treatment that is needed. Then, you should say, “You know, we can still help you. Here is a list of several different foundations that may help you to get the money needed to complete treatment here. This list also includes several dentist offices that provide sliding fee schedules for families. What I recommend is that you take the treatment plan we have put together for you today – it shows exactly what treatment we would do. Then, you should call each organization and office on this list. Be sure to write down the name of who you talk to and write notes on your conversation – let each one of these folks know that you have a treatment plan from Dr. Mason, our Pediatric Dentist, and that you are looking for help to get this treatment completed – and ask what they can do to help you. I know that several families have received financial help while others got treatment completed at discounted prices by working through this list of resources. If you talk with every single one of these resources and have detailed notes and information and you cannot find help, then I want you to call me so I can get involved again. Here is my business card with my direct line so you can get in touch with me.” Then the family should leave. You should make a note in your planner to follow up in 2 weeks to see how successful they have been.
  6. Now, let’s assume that the family calls every contact on the list and calls you back (this might happen once in an entire year). Then you would thank them for calling, and confirm that they did in fact call every single resource on our list. Ask them to send you a copy of their list and then once you receive it, you will meet with the office manager to discuss what we can do to help this family.

 

 

 

 

 

Other situations

  1. What if this family is a long term patient? No extra discounts apply. Dr.Mason is a specialist and he does not offer a long term discount for IV sedation treatment.
  2. What if our next date for IV sedation is 8 weeks away? (Can Dr. Mason work this child in more quickly?) The family must pay in full for Dr.Devany’s fee in order to schedule the appointment. Dr. Mason’s 2/3rds amount must be collected 2 full weeks in advance of the appointment or you will delete the appointment – you can always reschedule it for the next month.
  3. What if someone says they are not comfortable with paying for something until it is done and they assure you they will pay in full on the day of treatment? You should say, “Boy, I sure understand how you feel. I wish we could do that. Unfortunately, this has not worked in the past and so now we are forced to collect in advance. If it helps, you should know that we provide a refund if you end up with a credit.” If they are adamant that they will not pay in advance, then you can offer for them to get a second opinion in order to find another office that might work more to their liking regarding financial arrangements.
  4. What if someone wants to write you a check and have you hold it until the day of treatment? Nope – we just cannot do that. We could accept a check as long as we can deposit it 2 weeks before the appointment – if it clears, then their appointment is confirmed. If not, then we can always reschedule to the next month once the money works out for them.
  5. What if the family says “I know we won’t be approved for any credit”? Then ask them what their budget is for the dentistry – follow the financial arrangement technique above.
  6. What if the dentist seems to be unconcerned with getting paid for the treatment? Ask the dentist to confirm how they feel about financial arrangements.
  7. What if they cannot pay off their portion within 3 months? Then ask them what their budget is for the dentistry – follow the financial arrangement technique above.

 

Also remember, you are not helping a family if you go ahead and schedule treatment without working out financial arrangements that follow our collection policy in advance. Let’s say the treatment is completed and now the family owes $3,000 to HealthPark and they want to pay us $100/month. That will take this family 30 months (almost 3 years!) to pay this debt off. If they stop paying, then our office policy is to send their account to the collections agency for amounts over $100. If we send a family to the collections agency, this affects their life by receiving negative phone calls and letters and they will be angry at us. They will not appreciate us for putting them into a bad financial situation. Plus, they will lose their warranty – if their child chips off part of their filling or a crown pops off and they haven’t paid us, then they cannot return for more treatment. If families do not return, then most likely the kids will get more decay – and the problem starts all over again.

 

M. Pediatric Collections

Sample Pedo Collection Letter – for IV sedation and other major cases

 

Dear __________________,

 

I have not heard from you since I examined ________________ on ________________ and we discussed needed treatment.  Your child has significant dental health problems that must be corrected.

As we discussed, I could do only the most severe problems at first and save the remaining treatment for later to reduce the cost.  We can also spread out this cost if that would help.

Due to your child’s severe infection, the major treatment should be completed as soon as possible.  Please call me by _________ to schedule your child’s treatment or to let us know which other dentist you have chosen to complete this treatment.

If I don’t hear from you, I will assume that there is something preventing you from protecting your child from this severe infection.  I’ll contact children’s services to help you provide the care your child needs.

 

Sincerely,

 

 

Run report for Ambulatory Case Acceptance

Start by creating new excel worksheet :

Open Excel F:SecretariesSecretarial administrationSpecialistsPediatricsEnd of month2013

Create a new worksheet for the month

*       right click on the last month created, select insert

*       make sure Worksheet is highlighted, click ok

*       will automatically be named Sheet1. click down and drag to after last month created

*       right click on Sheet1 and click rename

*       Now, type current month

*       Go to previous month and copy format to new month, deleting pt info from previous month

*       Click save button

Now, go to Dentrix

Go to Office Manager Screen

Click on Letters

Click on Misc

Select Stats Pedo Case Acceptance

Click Edit

Make sure it’s set up to search A through Z (no ZZ patients)

Make sure all patient status, gender, position & aging have no checkmarks

Under provider – All should be checkmarked

Under billing type – Billing types 1-4 should be selected

Click the button next to Procedures – Checkmark Completed and codes AmbCnslt – AmbCnslt & select dates for the month (03/01/06 – 03/31/06) This will find all ambulatory consults completed during the month. Click okay.

Click the Data Fields tab & make sure Last name, First name, Appointment Date & Reason are checkmarked.

Click okay to take you back to the list of reports in Misc – then click Create/Merge

Click on Create Data File Only

Click on OK

When list is done – click on View List

Click on Edit, Select All

Click on Edit, Copy

Go to excel sheet

Click on Edit, Paste- under Ambulatory Consult section

Insert a column for Accepted & Tx coordinator – these are the columns you will fill in. This shows all the cases presented – you need to look each patient up to find if they accepted or not (and why) as well as fill in who the tx coordinator was.

 

To find Ambulatory cases completed this month :

Go to Office Manager Screen

Click on Letters

Click on Misc

Select Stats Pedo Case Acceptance

Click Edit

Make sure it’s set up to search A through Z (no ZZ patients)

Make sure all patient status, gender, position & aging have no checkmarks

Under provider – All should be checkmarked

Under billing type – Billing types 1-4 should be selected

Click the button next to Procedures – Checkmark Completed and codes D9996 – D9998 (Treatment coordination fee & Hospital sedation fee) & select dates for the month (03/01/06 – 03/31/06)  Click okay.

Click the Data Fields tab & make sure Last name, First name, Appointment Date & Reason are checkmarked.

Click okay to take you back to the list of reports in Misc – then click Create/Merge

Click on Create Data File Only

Click on OK

When list is done – click on View List

Click on Edit, Select All

Click on Edit, Copy

Go back to excel sheet, Paste underIV Sedations & Hospital Cases Completed this month

Insert a column for Tx coordinator – these are the columns you will fill in. This shows all the cases completed – you need to look each patient up to find who the tx coordinator was and who earns a bonus for this case.

Copy the calculations & descriptions of case acceptance from last month & fill in the numbers.

 

Ortho Cases by a Pediatric Dentist

Dr. Mason does some orthodontics for children. He will do certain appliances that help with growth and development as well as Phase 1 ortho.

 

Here are some instructions for handling ortho for Dr. Mason:

  • Create a new patient with last name including zzma – example: zzma Nesbitt, Dave and billing type 3
  • Give the client the correct ortho handout
  • Review the schedule 2 days in advance looking for ortho clients – check to make sure they are on time with payments & if not, add a note to the appointment to ask for payment – if they fall more than 1 month behind on payments, then do not schedule the next ortho appointment.
  • Call clients that had an ortho consult and did not schedule – these are on the Case acceptance spreadsheet
  • Call clients that are due for ortho re-evaluations – these folks were seen for an ortho consult and were not ready to start ortho at that time. The clinical staff will enter their continuing care into the family file and then Jamie will print the recall postcards and mail them. Your job is to call anyone who has not scheduled.
  • Track cancellations and no shows along with your regular pediatric clients.
  • If you send letters to ortho clients – be sure to delete the ZZMA from the client name
  • Clinical staff should treatment plan D8000 Ortho consult (found in the initial box)

 

Ortho Checklist (Dr.Mason)                            Patient Name: _______________________

Dr. Mason Tax ID #274509034NPI Number 1588646798                                

 

Initial Exam (2U)

q  If child has ortho coverage, let the parent know that this would be taken out of their lifetime amount of _______________.  Ask if they want us to submit to insurance or to just pay out.   ____ Yes  _____ No

q  Insurance coverage $________________

q  Insurance name _____________________

 

 

Date of Records Appointment (4U) ____________________

Prepare for first visit:

□    Initial exam Date: _______________

  1. Set up zzma acct
  2. Billing type 7
  3. Fee schedule set for Managed Care
  4. Call ins. for ortho benefits (delete ins. from their acct if no ortho coverage)
  5. Make G notes

Ins. Co. Name _______________________________________

Phone Number ______________________________________

Contact Name  ______________________________________

Parent Name /SS #___________________________________

Lifetime Max _______________________________________

Deductible    ________________________________________

Paid at What % ______________________________________

Do they pay automatically or want statements?_____________

Any ortho ins used? __________________________________

        If dual ins. ask secondary if they have a non-duplication clause

_____________________________________________

 

Due at records appointment $___________

  • D0330 Pano
  • D0470 Impressions
  • D0340 Ceph
  • D0350 Images

 

q  If insurance – ask again about using ortho benefits  ____ yes  _____ no

q  If treatment length is less than one year, 6 month coupon

q  If treatment length is more than one year, 12 month coupon

q  Consent form for pedo ortho treatment

q  Diagnosis and treatment planning consult page personalized

q  Edit the FA’s to match patient, tx fee and tx plan then print

q  Introduce yourself, see if anyone has questions

q  Financial Arrangement form signed

q  Secretary discuss insurance and make financial arrangements

 

Date of Actual Banding (3U) –__________________

q  Enter tx into dentrix (confirm correct fee with Dr. Mason)

q  Make copy of signed Financial Arrangements form (scan)

q  Make copy of signed Treatment plan (scan)

q  Print coupons, put in chart to give to patient at next visit

q  Insert payment arrangement note in appt. – how much to collect

q  Make note in planner for next appt. just so you can say hello.

q  Secretary/Jamie update ortho spreadsheet

 

For Phase 1 clients:

  • Sign the financial arrangements form – this is saved in the document center and copy to the parent.
  • Call the insurance company to find out if ortho benefits exist & how much they are
  • If phase 1 clients have ortho insurance, then let Jamie know (you can email her) so she can process the claim & make sure the ortho insurance pays on time.
  • Print FA coupons for the client
  • Have the parent sign the informed consent form for orthodontic treatment. Give a copy to the parent & keep a copy in the document center.

 

Ortho scheduling:

  • You can use the Multi-code for Child Phase I Early Tx to treatment plan for Phase 1 ortho
  • Codes – he will use D8010, 8020, 8030, 8050 or 8060 for phase 1 treatment and he will use D8210 or D8220 for the fixed appliance therapy.  When dealing with Managed Care patients, Dr. Mason will often use the code for Phase I treatment since expansion can have substantial discount of the regular fee.
  • Dr. Mason must tell you the type of ortho he plans to do (usually with the code) and how long the treatment will last. You need this information to treatment plan and set up the financial arrangements.
  • Dr. Mason will let you know that she wants an ortho consult by communicating that to the assistant that will bring the family up for checkout. You should schedule D8000 for 2u. You need to call that client’s dental insurance to determine ortho coverage before the day of their consult.
  • Expect to spend time with the client reviewing the ortho financial arrangements on the day of the consult.
  • Once the parent has agreed to ortho treatment and signed the paperwork at the consult appointment, then next you will schedule the records appointment. At the records appointment, collect the records fee.
  • After the records appointment, print the coupons to give to the family at the banding appointment.

 

Prepare the Coupons for the Banding Appointment:

A)    Click on patient’s Ledger

B)    Click on Handshake icon

C)    Type in dollars for coupons in Bal. For PA box (about middle of the screen).  The dollars are from the contract, page 6, “Deferred payment price”

D)    Type date in First payment due box.  This is always the 15th of  the next month following the banding appointment

E)     Type in dollar due each time in Payment Amt. box.  The dollars are from the F.A. sheet, “Monthly installment payments”

F)     Set the Contract/Coupons:

  • click on Terms
  • click on Select Type
  • Click on OK
  • Click on OK
  • Click on Print
  • Click off Truth in Lending Disclosure and
  • Click on Coupon Book
  • Click on Print
  • Click on OK

G)    The coupons will print three (3) on a page.  There is a paper cutter for you to use.

H)    Arrange the coupons in payment order and staple

I)      Place the coupon booklet in the patient’s folder

 

For each banding appointment, be sure that you have all the financial arrangements and informed consent paperwork signed and that you have the coupons printed and ready. You should also check to see that the entire ortho treatment has been entered and that the correct code will be charged out at the banding. At the banding appointment, collect the total treatment fee. Give the parent the coupons. Afterward, give the chart to Jamie to process the ortho insurance claim. Both, appliance therapy clients and phase 1 clients will have several ortho visits. These are usually scheduled 4-6 weeks apart and the charge for these visits is included in the fee charged out at banding.

 

To keep ortho kids on track for cleanings:

Print schedule & highlight each patient that is overdue for their cleaning. Look up each patient’s regular account to see if they are overdue for their cleaning. If they are, then highlight their name on the schedule and ask them to schedule when they check in. Also, mention these patients in huddle so that Dr. Mason will also tell them that it is important to schedule their cleaning w/ their regular dentist.

 

You should check 2 days in advance for anyone having their braces or appliance removed. You want to make sure their balance is zero.

 

Financial Arrangement form

To prepare the payment arrangement document:

Open Excel

Open the file:

F:SecretariesSecretarial administrationSpecialistsOrthoFinancial ArrangementsPayment Calculation Dr Mason.xls

 

Fill in all yellow cells – some info from calling the insurance, some info from the treatment plan Dr. Mason creates (number months in tx, total fee for treatment, etc.). This will auto calculate the info you need in the rest of the spreadsheet and auto fill in the numbers in the contract.

Save this spreadsheet. Do not close it.

Open Word

Open the file: F:/Secretaries/Sec. Admin./Handouts/K- Ortho/7 – Ortho. Treatment Financial Arrangement

Check this document to make sure that all the blanks have been automatically filled in.

Print this contract to review with the patient & have them sign.

Give a copy to the parent to keep and keep the original in the chart.

To treatment plan for ortho in Dentrix

  1. There are multi-codes set up in the tooth chart that have all the codes needed to treatment plan for ortho treatment.
  2. There are 2 types of ortho treatment for braces for children: Child full braces – choose the multi code for this and Child partial braces (also known as Phase I or Early treatment) – choose the multi code for this
  3. There are 2 types of ortho appliances – no multi-code for these:  D8210 Removable ortho appliance  and D8220 Fixed ortho appliance
  4. Go to the tooth chart for the patient, select multi codes and look for the ortho multi codes.
  5. Select the code, click okay then click tx, this will auto enter the codes you need, including:
  1. D8660 Records
  2. D8050 or D8060 – Braces (depending on the multi code you select)
  3. D8700 Remove braces
  4. D8680 Retainer
  5. D8800 Seat Retainer

 

We run several reports monthly to keep track of ortho appointments

  • Continuing care report to see who is due for any sort of next appt – must pull charts from this list to make calls and schedule next appt.
  •  List of patients who had braces removed – verify that retainers seated.  List of patients with retainers – verify that retainers seated
  • List of patients who had NP eval or re-eval – pull charts to see next step and call them
  • Ortho Recall Follow up – never scheduled from recall card.  We called and scheduled them or sent them a letter similar to our letter
  • Ortho Dropouts – no showed or cancelled an appointment for treatment (records/banding).  We called and scheduled them or sent them the letter

 

Ortho no-show F/U system – Follow the same system as used for regular pediatric clients

 

Orthodontic Scheduling Test

 

  1. Set up a new patient with an orthodontic account
  2. Schedule a records appointment for an orthodontic patient.
  3. Schedule a banding appointment for an orthodontic patient.
  4. Explain what orthodontic recall is and why we do it.
  5. Pull an orthodontic chart and explain the financial arrangements.
  6. A patient calls and says, they saw Dr. Dajani one month ago and would like to schedule their next appointment, what should you do?
  7. A patient calls and tells you that their bracket has come off, what should you do?

 

Run report for Ortho Case Acceptance

 

Open Excel :

F:SecretariesSecretarial administrationSpecialistsPediatricsEnd of month2013

Create a new worksheet for the month

*       right click on the last month created, select insert

*       make sure Worksheet is hightlighted, click ok

*       will automatically be named Sheet1. click down and drag to after last month created

*       right click on Sheet1 and click rename

*       Now, type current month

*       Go to previous month and copy format to new month, deleting pt info from previous month

*       Click save button

 

Now, go to Dentrix

Go to Office Manager Screen

Click on Letters

Click on Misc

Select Stats Dr. Mason Ortho Cases

Click Edit

Make sure it’s set up to search A through Z (no ZZ patients)

Make sure all patient status, gender, position & aging have no checkmarks

Under provider – All should be checkmarked

Under billing type – Billing types 1-4 should be selected

Click the button next to Procedures – Checkmark Completed and codes D8000-D8002 & select dates for the month (03/01/06 – 03/31/06) This will find all ortho consults completed during the month. Click okay.

Click the Data Fields tab & make sure Last name, First name, Appointment Date & Reason and Balance are checkmarked.

Click okay to take you back to the list of reports in Misc – then click Create/Merge

Click on Create Data File Only

Click on OK

When list is done – click on View List

Click on Edit, Select All

Click on Edit, Copy

Go to excel sheet

Click on Edit, Paste- under Ortho Cases for Regular Account section

 

Run report for Ortho Cases Started

Go to Dentrix

Go to Office Manager Screen

Click on Letters

Click on Misc

Select Stats Dr. Mason Ortho Cases

Click Edit

Make sure it’s set up to search zzma A through zzma (no ZZ only accounts)

Make sure all patient status, gender, position & aging have no checkmarks

Under provider – All should be checkmarked

Under billing type – Billing types 1-4 should be selected

Click the button next to Procedures – Checkmark Completed and codes D8010-D8220 & select dates for the month (03/01/06 – 03/31/06) This will find all ortho consults completed during the month. Click okay.

Click the Data Fields tab & make sure Last name, First name, Appointment Date & Reason and Balance are checkmarked.

Click okay to take you back to the list of reports in Misc – then click Create/Merge

Click on Create Data File Only

Click on OK

When list is done – click on View List

Click on Edit, Select All

Click on Edit, Copy

Go to excel sheet

Click on Edit, Paste- under Ortho Cases for zzdj Account section

 

 

To Schedule:

D8660 Preliminary Records Fee $250 for 4u

At this appointment, Dr. Mason will take a panoramic xray and impressions.

 

D8210 Thumbsucking appliance $950

 

D8220 Fixed Appliance Therapy $728

D8680 Retainer – Change the fee to zero (included in the appliance fee)

 

At the comprehensive exam, you can give patients a ballpark estimate for total cost of $1,000 if they are considering coming in for the records appointment.

 

At the records appointment, Dr. Mason will work out his treatment plan for the child. He will determine the exact treatment and total fee. Generally, patients will wear an appliance (like an expander) for 10-12 months and Dr. Mason will see them for 2u ortho visits every month. After the appliance is removed, then the patient will wear a retainer. Dr. Mason is responsible for getting the Consent for Orthodontic Treatment form signed and you should keep a copy in the document center and give the patient a copy. You are responsible for working out financial arrangements with the parents as well – pay in full discount or can pay monthly over 10 months.

 

Marketing:

 

Checklist for Dental Prevention Month.  This event is yearly in February.  You want to start preparing for this as early as November/December the year before.

 

Goal: to add new patient children into the practice

We can send staff into the school to run the “Quiz Show” game with a classroom of children, teach them a little something about taking care of their teeth – and then give them a postcard to mail back to our office with a chance to win a new bicycle – that way we gather their name & contact information so we can market to these families.

Also great opportunity to leave a packet with the teacher for the other teachers/administrators – let them know we have the only Pediatric Dentist in Miami County, we have an Ortho here also, we have three GPs on staff, and they can call us anytime to help with kids that have dental problems. Could also eval the dental insurance/benefits for teachers – run a contest for teachers to win a whitening – again, to gather their contact info & we could create an online newsletter just for the teachers??

 

Schools:

7 Troy elementary schools

10 preschools in Tipp/Troy

3 Tipp/Bethel elementary schools

= 20 total

 

Would be great to get into at least one classroom in each school just so we have a way to get a package to the teachers/administration of each school. However, we may be limited by staff hours.

Assume 1 hour per class – including some travel time may be more like 1.5 hours for a staff person to be out.

 

Finances

HealthPark to pay staff salary for secretary/assistants (not EFDAs or RDH)

If estimate average pay rate for staff is $15/hour x 20 hours = $300 in staff costs.

Other costs:

Kids toothbrush for each child – $1/tbrush (Estimate 25 kids per class x 20 classes = $500, but $0 this year due to Betty from Schein donating child brushes) **Betty donating 350 tbrushes!**

Package for teachers/administration – tbrush/person – estimate 40 people/school or 15 people/preschool so for 10 elementaries x 40 people = $400 in tbrushes and 10 preschools x 15 people = $150 in tbrushes – altogether is $550

Total $850

 

Could offer to Dr. Mason & Dr. Khan – will they together cover 2/3rds of this cost ($567) and Smith pay for $283? The benefit is that the NPs that come benefit pedo/ortho primarily. Hopefully we gain some NP parents as well.

 

Next steps:

  1. Design a postcard for the children – needs to be self-addressed/stamped to HealthPark and fill in the blank for parent name, email, snail mail address, do they have a regular dentist, when was last dental visit?
  2. Find out if Mason & Khan & Smith are willing to fund this program – could be much less expensive depending on how many classrooms we can get into.
  3. Talk with Smith & Pierson about losing staff in February to do these visits – could pull up Mallory to assist so other assistants could go; perhaps offer Bonny to do some of these & be paid by us?
  4. How many children’s toothbrushes do we have already? I think we had some saved for other events that we could use.  We have 229 children’s toothbrushes from other past events which we will save for another time.
  5. Contact schools to schedule our staff – need a script on why they would want to schedule with us instead of whoever they’ve had in the past. (We have the only pedo/ortho, we’d like to bring tbrushes for teachers/admin, we’re offering $50 in free dentistry for new patients.)
  6. Prepare inventory – do we have enough toothbrushes, floss, etc. for both Teachers and Students?

 

 

  • Choose schools (sticking with Troy, Tipp City)
    • Troy Schools (332-6730)
    • Tipp Schools
    • Pre-Schools in Troy/Tipp
    • See table below
  • Choose dates to visit schools.  Assume each group of children will take about an hour.
  • Choose assistants to attend (Mallory, Erica, Bonny, Monica, Cass)
  • Send out letter to schools as soon as we have possible dates to visit
  • Call schools to schedule – 1 week after letter?
  • Schedule presentation
    • Number of children? _________
    • DVD Player? yes / no
    • Name of Teacher: ___________________________
    • Room number:____________
    • Any special formalities to have school access?
  • Make sure supplies available (plus a couple of extra) for all children
  • Prepare for visit:
    • PC Books
    • Goody Bags:
      • Toothbrush
      • Toothpaste
      • Floss
      • Stickers
      • Activity Paper
      • Flyer for contest (bike?)
      • CTS Pedo
      • Sign-up sheet for parents to enter children in contest
  • Prepare Presentation:
    • Gloves
    • Mask
    • Mirror, Explorer
    • Goggles
    • Jacket
    • Spike and Toothbrush
    • Toothbrush, Floss, Flossman
    • DVD
    • 2 BWX
    • Pano
    • Sugar Demonstration (bottles of soda)
    • Candy to Avoid (Swedish Fish, lollipops)
    • Models of Teeth
    • Flash cards of healthy foods
    • *****Basically do a PC******
  • Make sure presentation date/time is confirmed:
    • School confirmed? yes / no
    • Doctor confirmed? yes / no
    • Assistant confirmed? yes / no
  • Arrive early to set up for presentation
  • Follow up with school to thank them for letting us visit
  • Keep track of e-mails responding to contest – f/u with Secretary in hot seat (going there???)
  • Have “School Visit” added to referred by

 

School Location Phone Number Contact Information Number of Children Calls Made Presentation Date
Concord Elementary Troy 332-6730

 

This is the script for 2 people to visit a children’s classroom for February Dental Health month. They will alternate asking questions to the class. Usually, we select one child to be our assistant b/c they will know the names of their classmates.

 

To bring:

  • Enough sugar free candy so that every child gets at least one piece
  • The stuffed animal sugarbug
  • Bring toothbrushes for all the kids & flossmen – or just a few to make an example of one of the kids
  • Also need a chalkboard to draw a picture of a tooth then write + germs (bugs) + sugar = draw picture of cavity on tooth.  Then draw 2nd picture of toothbrush + floss + toothpaste + good food = draw picture of healthy tooth.

 

 

 

Thanks to ____________ for inviting Mrs. Nesbitt and I to visit with you today.  I am a dentist.  What do dentists do?     Pretty smile, eat well

 

            I brought Mrs. Nesbitt with me; she is the Office Manager in my dentist office.  What does a manager do?  She is the coach of our team who makes sure everybody works together nicely and is happy.

 

Mrs. ___________ invited Mrs. Nesbitt and I to talk to you about what you can do to have these pretty smiles and enjoy eating.  But we are going to need some help, because I only know one of you.  Who do you think I might know?  Why?

 

Okay, Maya, Maya’s mom and I am going to ask lots of questions today and Maya will chose who gets to answer these questions.  If you think you know the answer, hold your hand up so Maya can see it.  Maya, you make sure that everyone gets chance to answer some questions.  There is a prize for every right answer.  Okay let’s start the dentists’ game!

 

(Dave and I alternate)

 

  1. Why do we have teeth?

Smile, chew

 

  1. What bad thing can happen to our teeth?

Holes in our teeth

 

  1. What causes decay?

Germs & food

 

  1. What are germs?

Super tiny little bugs

 

  1. How do bugs  → decay ?

Bugs eat food  → acid

 

  1. What is acid?

Hard to explain – Like a candle it’s hard, but fire melts the candle.  Acid looks  like water, but acid is very strong.  And if it touches your tooth it can very slowly melt part of the tooth away, making a hole in your tooth!

 

  1. What do dentists call a hole in your teeth?

Cavity

 

  1. Your bugs like to eat some foods and make lots of acid.  What is the name of         this food?

Sugar

 

 

  1. What do you think dentists call the bugs that eat sugar and make acid?

Sugar bugs

 

  1. What do you eat that has lots of sugar in it?

Wow!

 

  1. What can you do to get sugar bugs off your teeth?

Brush/Floss

 

  1. How many of you brush your teeth?

 

  1. Who wants to show me how to brush your teeth?

 

  1. (While kid brushes) What’s most important for you to do when you brush?

Get all the sugar bugs off

Right!  And here is something to help you – brush your teeth like they were a racetrack.  Start on the outside upper right and slowly, back and forth, go around the outside of all your upper teeth, then inside, then outside bottoms, then inside bottoms.

 

  1. Then we’re done.  Wait a minute!  I think I forgot something.  What was it?

Tops

 

  1. You know, we brushed really well, but where did we miss?

Touching sides

 

  1. How do we get the sugar bugs out from between our teeth?

Floss

 

  1. How many of you floss your teeth?

 

  1. Why does everybody brush, but not many floss?

Hard

 

  1. Maya, would you show everybody how you floss?

 

  1. Right, flossing is hard.  That’s why moms and dads sometimes help.  When you go home, be sure to show Mom and Dad how you brush and ask them to help you floss.

 

  1. Mrs. Nesbitt, would you help Maya floss?

 

  1. Okay, well, here’s another question.  What do we put on a toothbrush to help clean our teeth?

Toothpaste

 

  1. What is toothpaste?

Soap

 

Soap?  How many of you like to eat soap?  Not me!  But toothpaste is a special kind of soap that tastes good when it’s in our mouths.

 

  1. But soap has 2 things in it that help us.  Do you know what makes soap clean teeth?

Tiny, sand-like pieces that help scrub the teeth

 

  1. The other thing is fluoride.  Who knows what fluoride is?

Makes teeth strong so it’s harder for the sugar bugs to make holes

 

Wow!  You kids sure know a lot!  Mrs. _______ is sure a good teacher.  Well, let’s learn a little more together.

 

  1. If bugs eat sugar and make acid that eats holes in your teeth, what’s the best way to stop the sugar bugs from making the acid?

Don’t eat sugar

 

  1. Do all foods have sugar?

No

 

  1. How do you know if a food has sugar in it?

Sweet

 

  1. How many of you brought a snack to school?

 

  1. Who has a snack with sugar in it?

 

  1. Who brought good snacks that sugar bugs don’t like?

 

That’s great!  So the less sugar you eat, the less sugar there is for the sugar bugs to eat and the harder it is for them to make holes in your teeth!

 

  1. Wait a minute!  Maya’s been giving out awards all morning.  What has she been giving you?

Candy, gum

 

  1. I’m a dentist.  Do you think I’d give you something to eat that would hurt your teeth?

No

 

  1. Then everything that’s sweet doesn’t hurt your teeth!  What do you call candy that tastes good but doesn’t have sugar?

Sugarless candy

 

  1. You folks are so sweet!  Mrs. Nesbitt and I have had so much fun today!  Have you had fun, too?

Yay, roar, screaming, jumping, dancing, etc.

 

  1. Before we go, let’s look at what we’ve all learned today – review board.

 

And since you’ve been so great today, Mrs. Nesbitt and I have another snack and presents for each of you.  Can you guess what’s in them?

 

Thank you, Maya, for helping us.  Thank you, again, Mrs. _________, for inviting Mrs. Nesbitt and I to visit with you.

 

Goodbye, Everyone!

 

 

_____________________________                                __________________

Gretchen                                                                      Date