Now it is time for you to be the office administrator for a specialist. Manage each specialist for 1 month to get a better feel and understanding of the operations of their practice. When you are done you will be assigned a specialist to manage or co-manage. Good luck!
Checklist for starting a new Specialist Coordinator
Steps to train a Specialist Coordinator:
Being a Specialist Administrator
Our specialists are highly trained, creative people who are used to working in solo practices. The challenge for you is to facilitate them to effectively use these talents within the framework of our group to promote the best business results.
As a specialist administrator you have 7 tasks
Task #1: Coordinating the specialist’s energies to fit within our group’s needs
Wow! This is not easy! You’ll need the courage to stand up for yourself, the belief that you are okay, doing the right thing, the flexibility to adjust your approach quickly as needs change, and the tact to help them feel they did it.
Ideas to help you succeed:
Task #2: Understand why your specialist acts the way they do:
Task #3: How can you help them to fit their creative energies and clinical skills into our value system:
Task #4: Insist on Excellence and Results:
Task #5: Support your specialist to manage staff, build the practice and innovate new concepts
Task #6: Communicate your organizational structure in such a way that the specialist doesn’t feel controlled by you or our group
Task #7: Manage effectively while balancing the needs of the specialist and our group
Tips on Managing your First Specialist
Reasons docs don’t act when they should:
Practice crises are not caused by:
Instead, they are caused by the old way that led to success no longer works
Administrator’s task to avoid crisis is to have a clear vision of the future that inspires her team to new actions leading to success
Dr. __________ is a Periodontist. She provides treatment to patients that have major gum recession and tooth mobility in an attempt to solidify the teeth so that a person can keep their teeth. Often, once gum treatment is completed, the person can have restorative dentistry done with a GP.
She generally performs the following periodontal treatments :
Gum surgery– to treat deep pockets and prevent further bone loss.
Grafts – can be int the form of soft tissue or bone. Recession can be treated with the soft tissue graft and the exposed roots can be covered with the graft.
Crown lengthening – to show more tooth and improve appearance by removing some bone and tissue
She also performs some oral surgery treatment like Wisdom teeth extractions and Other extractions
Your responsibilities as the Periodontist Coordinator include :
Managing the Periodontist’s schedule
Day after she works
Review day sheet from last day worked. Make sure implants are added to Implant spreadsheet, and number of periodic exams done entered into end of month spreadsheet. Check daysheet for errors.
Prepare paperwork for biopsies to be sent to the path lab and send through Fed Ex.
Day before she works
Day she works
Keep her schedule full
Dr. works ____________. With this schedule, it is easy to look at her schedule in Dentrix and follow up on each individual patient. She is willing to come in early to accomodate a patient’s needs – check with her and let her assistant know as the schedule changes.
You can use Dentrix to run a report to find code D0180 (Comprehensive perio evaluation) completed in order to generate a list of patients who have been evaluated and use this list to fill her schedule. Another report you can run is unscheduled treatment for Dr. – as long as you change the provider in the family file to her name, then you can run this report to find outstanding treatment. You can also maintain a broken appointment list for Dr. . You need to send PTEs for clients that want to know what insurance will pay. As the PTEs come back, they will be added to the weekly unscheduled list. Call the patients once they are returned in order to schedule.
You will run perio maintenance letters monthly for Dr. Our insurance/billing person has a signature stamp to send these letters. You are responsible to call these patients that do not schedule from the letter. You may want to create a spreadsheet to track these patients and then you can follow up within 2 weeks. The current spreadsheet is __________.
Adding days to her schedule:
When Dr.’s schedule is full (not including the 4 unit block for new patients and extractions) for four weeks out, please check with her about her availability in adding another day to her schedule. Once she okays a day, advise the administrator and and make sure her assistant is available to work with her. If her assistant is working on the GP side, make sure she has coverage for her GP. Frequently, Dr. will opt to increase her hours to stay into the evenin. MAKE SURE THIS IS CLEARED WITH HER ASSISTANT !
Making sure patients are scheduled correctly
It is important to make sure there is time in her schedule for new patients and extractions to be seen quickly. Make sure there is a one hour block in her schedule every week for these appointments. This block can be deleted and the time made available to other patients two weeks before that date.
Two days in advance, you need to review Dr.’s schedule. Pull the charts and make sure there is a referral form for Dr. in each one. If they are missing, you need to have the dentist fill one out before her treatment day.
You also need to type info into Dr.’s appointments. She has remote access, so she will check her schedule throughout the week..
Be sure to schedule from top down. For treatment, Dr. and her assistant can tell you how much time is needed.
Periodontal Huddle: 15 minutes before first patient scheduled
Did everyone clock in?
Review today’s schedule
a) Any past client problems?- upset, long wait, etc.
b) Care to share cards to give out?
c) How many periodic exams will Dr need to do today, and for whom?
d) Do we have lab cases that we are seating?
e) Anyone to ask for a video testimonial?
f) Anyone that will make a good blog story?
g) Do you have all your pamphlets in the charts for today’s treatment?
h) New patients not referred by the GP side: review who referred, what the concern is, X-rays needed?
i) Any perio maint patients that should meet a hygienist to have future recall out of Dr’s schedule?
Secretary: holes in upcoming two weeks of appointments that need to fill?
Insurance narratives needed?
Other projects that Dr. needs to complete today (videos, photos, etc)?
Charts in Dr’s bin that need follow-up or consultation with other doctors?
Checking in and out patients
Be sure to get a copy of their dental insurance card for the chart & confirm the information in the computer is correct. For biopsys or treatment resulting from an accident also get a copy of the medical insurance. Collect payments, set Financial arrangements, and manage contracts same as the GP side financial policy for appointments today and future appointments.
To manage the perio maintenance system for our Periodontist:
On a monthly basis, print the perio maintenance letters for our Periodontist and GP side hygienists. When patients call to schedule their “cleaning” (as written in the letter), the secretary must check the family file in the computer to make sure they are following the continuing care. These patients should be scheduled for 3 units with our Peridontist with code D4910.1 (Perio maintenance by specialist) or 4 units with a hygienist when our Periodontist is here with code D4910 (perio maintenance). There should be a periodic exam scheduled, as well. If the exam is not needed, the assistant or hygienist will remove it before setting the appointment complete. Dr.’s assistant will add an alert to all of Dr.’s STM’s and certain surgeries that need to be seen for perio maintenance and she will change their continuing care to Dr.’s perio maintenance code and write perio maintenance on the blue treatment sheet.
To run the perio maintenance letters:
Scheduling for our Periodontist
To schedule a new perio patient:
To schedule a new oral surgery patient:
To schedule exam only:
If not seen by an internal GP, you must ask the following questions: “Let me get some health information from you so the doctor can know what to expect”
Our Periodontist is a member of the following insurance plans:
Make sure you have a referral form for all new patients.
To schedule surgery rechecks :
Dr. requires a 1unit no charge After Surgery Recheck (Code D7900) one to two weeks following either gum or oral surgery. These appointments should be scheduled in Dr. RCHK column at the start or end of an appointment in her column. Do not schedule these in the middle of a surgery as she is not able to break from surgery.
Perio maintenance Specialist: Time 3 units and Code : D4910.1
Perio scaling and root planing :
For 1-3 teeth, code D4342 Time : 2u
For a quadrant, code 4341 Time : 3u
Gingivectomy : (Remove excess gum tissue, no hard tissue is involved. Can be just one tooth or multiple teeth.)
Per tooth, code D4211 Time : 2u
Per quadrant, code 4210 Time : 3u
Gingival flap : (Resecting the gums and getting access to the roots of the teeth.)
For 1-3 teeth, code 4241 Time : 3u
For a quadrant, code 4240 Time 5-6u
Crown lengthening – Code 4249 Time – usually 4u per tooth
Surgical procedure where more of the tooth is exposed – there are 2 types of crown lengthening :
Bone graft – Time : 4u
Code 4263 and 4264 (additional sites)
She usually uses synthetic bone graft material, but occasionally will be autogenous (taken from other parts of the mouth from the same patient) or bovine.
Bone grafts are done when a patient has bone loss or a bone defect around the root.
Bone grafts are generally charged out at the same time as a gingival flap surgery.
Soft Tissue graft – Time : 3u
There are 3 types :
Distal wedge Code 4274 Time 4u
This is the surgical elimination of pocket or bony defect on the distal of the last standing tooth.
Biopsy Time 2u
Dr. only does soft tissue biopsy (not hard tissue). This is removal of an oral lesion for pathological examination.
Extractions – Single tooth, simple 2u
All wisdom teeth 4u. If any impacted, then 4-5u
Frenectomy Code 7960 Time 2u
Surgical exposure of impacted tooth for orthodontic purposes – Code 7281 Time 3-4u
Other Codes Used :
Periodic Exam : D0120 – used when a patient is in for a cleaning and gets an evaluation by a dentist
Look see D4900 – a 1 minute intro to our Periodontist. She does a quick look and decides if she wants the patient to return for a comprehensive perio evaluation. Next step is either a D0180 (Comp Perio Eval) or D0150 (implant exam)
Comprehensive Perio Eval : D0180 – takes 30 minutes
Dr. will prescribe Halcion as an oral sedative. We have a form Dr. will fill out with the prescription information (at end of this section). The prescription is to be called in two days prior to the appointment. The patient will need someone to drive them to and from the appointment.
Ask patient if they would like to have
If patient has any of these medical problems, they will require a consultation with Dr. Hamal and a medical clearance from their physician.
Aspirin or Blood Thinners – cause bleeding during surgery
If they are taking Aspirin or a blood thinner (Coumadin), the patient needs to consult their physician to see if they can be taken off their medication for a period of time. Their doctor must advise them. NOT US. The first sign should be – any heart problems. We will always do a medical clearance for this type of medical concern.
Insulin (for Diabetes)
If patient is diabetic and is taking insulin, we need to consult their physician for them to adjust their insulin. We will do a medical clearance. Diet controlled diabetic – usually okay.
Inhalers (for Asthma)
If patient has inhaler, must bring it to their appointment.
If patient calls complaining of having a cold, make sure they can breathe through their nose.
If patient has Bronchitis, their appointment will need to be rescheduled.
To schedule for our Periodontist in Dentrix:
When scheduling, please advise patients the comp perio or specialty exam may not be covered by insurance. Most insurance plans will only allow 2 exams per year. They may want to confirm coverage with their carrier should this be an issue.
No Shows / Cancellation Procedures
If a patient no shows you will need to no show in the computer and make a note in patients chart.When you call them, please follow the GP side no show policy. When rescheduling patients to whom you have given the no show/cancel speech, make a note in the chart that you gave them a no show speech and add procedure D9923 (discussed missed appts personally) to their ledger, same as with GP patients.
If someone cancels an appointment more than 24 hours in advance, you can reschedule at this time.
If appointment is canceled less than 24 hours, they will go on broken appointment list, same as GP patients.
Once on the broken appointment list, you can call the client to reschedule 3 times. After 3 attempts, note in clinical notes that we attempted to call and take them off the list.
Insurance Estimates and claims
Periodontal – Need perio charting, pictures, X-rays and narratives for insurance and estimates.
We estimate 50% coverage on all treatment – be sure to check the family file, insurance box, payment table to see if we have any experience with this insurance company for the codes you are planning to use. If we do, then you can feel more confident that insurance will pay accordingly. If we do not, then make sure to change the insurance coverage to 50% in Dentrix. If the patient is very concerned that they know exactly what insurance will pay, we can send a PTE. This usually takes 3-5 weeks to get back from the insurance company.
Once treatment is completed and the e-claim has been sent to insurance, Dr. may need to write a narrative for quicker processing by the insurance. Our insurance person will let you know when narratives are needed for claims or estimates. Dental insurance companies do not play nicely with periodontics ; they require x-rays and narratives to prove treatment was necessary – same applies for PTEs.
If you have coding questions refer to secretary level 4 – Maximum benefits for clients
Get a copy of the medical insurance card for patients having their wisdom teeth extracted and for biopsies.
Create your estimate for the patient based on the dental insurance coverage only. The patient has to pay any amount not covered by their dental insurance (even if they think medical insurance might help pay for some of their personal amount). Explain to the client that we will submit to their medical insurance only as a courtesy and their medical insurance will send reimbursment to the patient if they will cover any of the treatment costs.
PERIODONTAL – BONE GRAFTS
There are basically 3 reasons to perform a bone graft that dental insurance may cover:
There are 42 implant codes available through the ADA for submitting to dental insurance companies. We do not use that many! The ones we use (or could use) have been grouped into categories for better understanding:
1. D5820 – interim (temp) partial denture – upper
2. D5821 – interim (temp) partial denture – lower
3. This code is used when a front tooth (smile area) has been extracted and the area needs healing time.
Medical Insurance Billing – Implants and Bone Grafts
Typically, medical insurance companies will cover implants and bone grafts in case of trauma; however, the documentation must clearly show the medical necessity. Some of the medical insurance companies are beginning to cover implants not due to trauma but due to atrophy, congenital tooth lose, etc.
When medically necessary, replacement of teeth by dental implants is covered by the medical insurance company; however, the only procedure covered is the surgical placement of the dental implant body (replacement of the missing root) – our code D6010 for the root form implant. The restorative procedure (replacement of the missing crown) is considered a dental expense and is our codes D6056 for the abutment and D6059 for the implant crown.
There are situations that will allow the medical insurance to be billed for an implant when a bone graft is necessary. These are atrophy, congenital or traumatic loss of teeth, nerve pain due to denture pressure, and chronic mouth sores (stomatitis).
The Medical Cross-Coding Binder will list the ICD-9 diagnostic codes such as:
525.21 minimal atrophy of the mandible
525.25 moderate atrophy of the maxilla
and the CPT codes such as : 21248 reconstruction of mandible or maxilla, endosteal implant, partial
These medical codes (and similar ones) would be used when the medical necessity is indicated on the treatment sheet by the dentist.
Medical claims are not sent electronically. They must be completed on paper (blank forms are located in Jamie’s office).
Preparing Biopsy Forms and Sending to path lab.
Dr. performs soft tissue biopsies only. She will place the specimen in a specimen jar, which is then placed in a plastic biohazard bag.
Dr. will fill out the clinical section of the biopsy form that comes with the specimen jars. You need to fill out the patient information on this form, including a copy of the medical insurance card for the path lab to use for their billing, The copy of the medical insurance card can be cut out and glued to the form, to save copying it over.
Scan the completed biospy form (as all other documents are scanned – if you need a reminder, the instructions for the scanner are in secretary level one) to the patient’s document center. Roll the completed biopy form along with a blank sheet of paper around the specimen jar, place everything in the plastic biohazard bag, and place the bag inside a FedEx envelope. The University Path Lab provides pre-labeled Fed Ex shipping labels to be attached to the outside of the envelope. Please call Fed Ex at 1-800-GOFEDEX and follow the prompts to arrange for pick-up of the package. Our account number withFed Ex is ______.
Shipping materials are kept __________. The pre-labeled FedEx shipping labels are kept ___________. When you are running low on these supplies, please call the path lab at the number on the Fed Ex labels, or include a note with a sample being sent.
The path lab will generally fax results to our office within 5-7 days. A hard copy of the results will follow within a couple days. Read through the results and, if any mention of malignancy is included in the write-up, please forward the faxed copy to Dr. immediately. She may wish to follow-up with the patient before their scheduled re-check, or provide additional instructions to you or her assistant.
Dr. has a consent form for all her treatment. These consent forms are given to the client by the assistant at the beginning of their treatment appointment for them to review and sign.
Brochures for perio treatment, extractions, implants, and any other treatment Dr. recommends to the patient during her exams should be given to the patient by Dr’s assistant during the exam appointment. This gives the patient the information regarding their treatment,so they can make an informed decision, and can explain to family members what they are having done. The referral sheets are reviewed during huddles for all exams, so her assistant can make sure the correct brochures are already in place in the chart. Dr.’s assistant will make sure she has a stock of commonly used brochures in Dr.’s bin. Please pop-quiz patients as they are leaving to assure they are getting their brochures. For periodic exams, the hygienist is responsible for getting the brochure to their patients.
Our periodontist follows the GP side guidelines for collections.
At end of day – print a day sheet for Dr. review it for accuracy and give it to her (Office manager, Day sheet icon, Select provider , today’s date and ok then print from the office manager list).
Small cases $250 and under – to be paid in full
Large cases $250 and over – ½ down to schedule, balance due the day of appointment, or offer CareCredit
We need a copy of both the medical and dental insurance card for biopsy patients.
You will need to change the provider of record (in the family file) to Dr. before you send insurance claims or PTEs. This should be checked a day or two before Dr is in to make sure the correct provider and fee schedules have been selected. After the insurance claim is printed (or sent as an Eclaim), you can change the provider back to the original.
Medical insurance –These claims need to be printed to paper upon creating the claim. Our insurance person will take care of sending these claims for you. She will copy to the medical HCFA form.
Must pay their estimated portion their insurance will not cover, and their deductible.
Upon checking the patient out, give the chart back to Dr to review. She does clinical notes, although will occasionally makes notes in chart as well. Make sure you have scanned the consent forms to the patient’s document center. For treatment done for GP side patients, notate what was done (Example: Patient saw Dr Hamal on June 1 for gingival flap LL and UL quads. Next visit: Recheck on June 14)
Before Dr. leaves, print her day sheet. Have her review her charts for accuracy and sign letters being sent to referring doctors. Make sure she has signed any letters, signed refund checks and completed any narratives for insurance.
To prepare a letter for a referring doctor outside of our office, you can use the template ________. Locate the correct information for the patient’s GP. The patient may know this information, or you may have to look it up through Google or whitepages.com.
Generally, you can use Dr.’s notes in the chart or clinical notes, as well as the perio charting in the patient’s tooth chart to write the letter. Make note in the letter as to probing depths, whether there is keratinized gingival, recession, bleeding, oral hygiene, recommended treatment, accepted treatment, next visit, and recommended follow-up.
Dr. will review the information you have provided, and make any corrections for you to type before signing. If the corrections or additions are lengthy enough to have to be finished the next day you work, there is a signature stamp that you can use. Send the letter, as well as additional referral brochures, to the referring dentist.
Save the letter. Additional letters sent for each patient through-out the year can saved the same with the month added to the path.
For GP side patients, you do not need to prepare a formal letter. Write up the visit with Dr. in the clinical notes:
End of month reporting
Dr. Hamal’s production goal is $______/year which is $_____/month and $______/week.
Dr. has a production goal and bonus system set up for her coordinator and assistant.
You are responsible for filling out an end of month report – give one copy to Dr. and one to the administrator – using the following End of Month instructions.
Specialists End of Month
Start by creating new excel worksheet for case acceptance that month
To find patients, run the following report for code D0180 (perio consult) :
Patient Name: ______________________ Age___________ Weight _____________
Dosage: c 0.125 mg
c 0.25 mg
Dispense: 3 tablets
Direction: Take 1 tablet ½ hour before bedtime the night before the appointment.
Bring the other two tablets to your appointment.
Pre surgical check list
|Signed Consent||Fully responsive and Conscious|
|Took any premedication||Post op instruction given to escort|
Hypersensitivity to triazolam or Benzodiazepam
Patient on Ketoconazole/itraconazole, nefazodone and ritonavir
Dental specialist Date
Team leader Date