Business Operating Systems - Chapter 62

Role of the Dental Business Assistant

The business assistant, also known as the administrative assistant, is responsible for the following essential functions within the dental practice:

• Greeting patients and answering the telephone.

• Scheduling patients effectively to ensure practice productivity.

• Managing patient records, including clinical and financial data.

• Managing accounts receivable (money owed to the practice) and accounts payable (money the practice owes).

• Managing the recall system (preventive care) and inventory control systems.

• Overseeing and monitoring practice marketing activities.

• Managing payroll for the office staff.

• Presentive and making financial arrangements with patients.

• Overseeing insurance submissions and following up on claims.

Standard Operating Procedure (SOP) Manual

The SOP manual is a comprehensive guide that outlines how the practice operates. Its contents typically include:

• New patient protocol.

• Office communications procedures.

• Staff and employment policies.

• Office records management procedures.

• Health Insurance Portability and Accountability Act (HIPAA) compliance protocols.

• Occupational Safety and Health Administration (OSHA) and infection control policies.

• Clinical procedures.

• Sterilization process protocol.

• Room turnover protocol.

• Lab shipping and receiving protocol.

• Information regarding professional organizations.

HIPAA Compliance and Privacy

The Health Insurance Portability and Accountability Act of 1996 protects patient privacy and regulates how patient information is shared. The dentist must follow a specific format when implementing these policies. Requirements include:

• Staff Training: The dental staff must be informed of specific security and confidentiality issues, and training must be reinforced continuously.

• Compliance List:

  • Know the law thoroughly.

  • Adopt or create required forms (e.g., Notice of Privacy Practices).

  • Educate all dental staff on HIPAA mandates.

  • Notify patients of the new privacy policies.

  • Ensure all policies are current and fully implemented.

• Safeguards: Physical and technical safeguards must be in place to protect electronic and paper records. Electronic files should be backed up daily, with one set kept in the office and a second set stored off-site. Paper files must be stored in correct cabinets and closed properly at the end of each business day.

Personnel Manual

Personnel issues can be part of the main SOP manual or a separate document. Key topics include:

• Detailed job descriptions for every role in the office.

• Working hours and specific pay periods.

• Information regarding employee benefits.

Business Equipment and Computer Applications

Standard business equipment found in a dental office includes telephones, fax machines, computers, and copiers. Computer applications are utilized for broad administrative tasks:

• Appointment scheduling and the recall system.

• Electronic patient records (EHR) and word processing.

• Networking, marketing, and online communication.

• Bookkeeping, spreadsheets, and inventory management.

• Billing, collections, patient ledgers, and processing insurance claims.

Dental Record Management

Records are categorized into three main types:

• Patient Dental Records: Clinical in nature. They include the registration form, medical and dental history, exam findings, diagnosis, treatment plans, record of treatment (progress notes), correspondence, consent forms, and radiographs.

• Patient Financial Records: These are filed separately from the clinical record. They include payments, insurance claims, statements, and reminder letters.

• Practice Business Records: Includes accounts receivable, expenses awaiting payment, expense records, payroll, correspondence, canceled checks, bank statements, income records, financial statements, tax records, and personnel records.

Filing Systems and Methods

Efficient filing is necessary for the rapid retrieval of information. Common methods include:

• Alphabetical Filing: The easiest and most common system. Items are filed in straight A-B-C order following basic indexing rules.

• Color Coding Filing: Uses adhesive tabs combining colors and letters to indicate the first two letters of the patient’s last name, making misfiled charts easy to spot.

• Numerical Filing: Each chart is assigned a number. Items are filed in strict $1-2-3$ order. This is common in large group practices and requires a cross-reference file to find a patient’s number by name.

• Computerized Filing: Records are stored digitally within the practice management software.

Guidelines for Efficient Filing

1. Keep the system simple.

2. Label folders clearly.

3. Leave adequate working space within each file drawer.

4. Label all shelves or drawers.

5. Use outguides (bookmarks for folders) to show where a file was removed.

6. Presort items before moving to the filing cabinets.

Active and Inactive Files

• Active Files: Files for patients seen recently (usually within the past $2 – 3$ years). These are kept in the most accessible areas.

• Inactive Files: Files for patients not seen in over $3$ years. These are kept in less convenient areas but remain accessible.

Appointment Scheduling Goals and Formats

Effective scheduling ensures patients are seen on time, the patient load is balanced, and staff time is maximized.

• Units of Time: Time is divided into "units." Depending on the dentist’s preference, a unit may be $10, 15, \text{ or } 30 \text{ minutes}$. Procedures are scheduled by the number of units required (e.g., a $40\text{-minute}$ procedure in a $15\text{-minute}$ unit office requires a "three-unit" appointment).

• Columns per Day: Each column in an appointment book typically represents one operatory or treatment area. This allows a dentist to use several treatment areas simultaneously (dovetailing).

• The Appointment Book Matrix: This is the framework of the schedule. Before scheduling patients, the matrix must outline:

  1. Office Hours: Opening, closing, and lunch hours.

  2. Buffer Time: Time reserved for emergency patients or short appointments (denture adjustments/suture removal).

  3. Meetings: Morning huddles, team meetings, and professional society meetings.

  4. Holidays and Vacations.

  5. Dovetailing: Scheduling a short appointment (like an injection or a check) during the time the dentist is waiting for another patient’s anesthetic to take effect ($10 – 20 \text{ minutes}$).

Appointment Entries and Codes

All entries must be accurate, complete, and legible. If manual, they must be in pencil. Entries should include:

• Patient's full name (first and last).

• Business and home telephone numbers (especially for new patients).

• Abbreviated code for the treatment.

• Length of appointment (indicated by an arrow).

• Special notations (e.g., new patient, premedication required, or "L" for lab work).

Common Scheduling Codes

• C / e: Appointment needs Confirmation / Confirmed.

• cr: Crown.

• ag: Amalgam.

• comp: Composite.

• ext: Extraction.

• prophy: Prophylaxis (cleaning).

• RP: Root Planing.

• rc / rct: Root Canal Therapy.

• fl: Fluoride treatment.

• p.o.: Post-operative appointment.

• br: Bridge.

• prep: Preparation (for a crown, bridge, inlay, or onlay).

• ins: Insertion (placement of a restoration).

• tp: Told Patient.

• L: Lab work.

• *: Lab work has returned from the lab.

Patient Circumstances in Scheduling

• Late Patients: Consistently running late is disrespectful to patients. If a patient is more than $10 \text{ minutes}$ late, they should be contacted immediately.

• Cancellations and No-Shows: Should be tracked. Confirmation by phone, email, or text the day before helps prevent these.

• Short-Notice Appointments: The office should maintain a list of patients who can come in on short notice to fill gaps caused by cancellations.

• Daily Schedule Form: A copy of the next day's schedule is posted in each treatment area (out of patient view), the lab, and the dentist's office. This is updated throughout the day. A checkmark next to a name indicates confirmation; a circle around the time indicates the appointment is NOT confirmed.

Preventive Recall Programs

Recall systems ensure patients return for regular preventive care. Methods include:

• Continuing Appointment System: The patient is given their next appointment before leaving the office.

• Written Recall Notification: A postcard or reminder is mailed to the patient.

• Recall by Telephone: Staff calls patients from a maintained monthly list.

• Recall Tracking: A system (manual or computerized) tracks first, second, and third notices. Patients are only removed from the system if they request it or move to another practice.

Inventory Management and Ordering

Maintaining adequate supplies is vital. Systems scan bar codes or use manual tags to track quantities.

Ordering Logistics

• Reorder Point: The minimum amount of a product that represents an adequate reserve. It is based on:

  1. Rate of Use (daily/weekly/monthly).

  2. Lead Time (time needed to receive the supply, including potential delays/backorders).

• Reorder Tags: Attached to the minimum quantity; when reached, the tag is removed and used to process the order immediately.

• Backorders: When an item is unavailable and will ship later. If the item is critical, the backorder may be canceled to buy it elsewhere.

Supply Categories

• Consumables and Disposables: Items used up as part of their function (e.g., cotton rolls). Disposables are single-use.

• Expendables: Low-cost materials used up quickly (e.g., gloves, local anesthetic).

• Nonexpendables: Smaller equipment or instruments that eventually need replacement (e.g., handpieces, curing lights).

• Major Equipment: Costly, large items that depreciate over time (e.g., dental chairs, X-ray units).

Equipment Repairs and Service

Accurate records for all equipment must be kept, including the date of purchase, supplier name, warranty expiration, and model/serial numbers.

• Service Contracts: Provide emergency repairs and routine maintenance on a fixed-fee basis.

• Service Calls: These are expensive, involving costs for mileage, time, and parts. Staff should check basic functions (e.g., is it plugged in?) before calling for a technician. Always have full information ready when requesting service.

Classification of Dental Procedure Categories

• Dental procedures are organized into a standardized coding system, where each category is assigned a specific alphanumeric range of codes beginning with the letter "D".

• These ranges help identify the primary nature of the dental service provided, ranging from basic diagnostic evaluations to complex surgical and orthodontic interventions.

Diagnostic Services (D0100 – D0999)

• Category Definition: Diagnostic procedures are used to evaluate a patient's current oral health status and identify potential issues.

• Code Range: $D0100 - D0999$

• Inclusions: This range typically includes clinical oral evaluations, diagnostic imaging (such as X-rays), and tests/laboratory examinations.

Preventive Services (D1000 – D1999)

• Category Definition: Preventive services focus on maintaining oral health and preventing the onset or progression of dental diseases.

• Code Range: $D1000 - D1999$

• Inclusions: Common procedures in this category include dental prophylaxes (cleanings), topical fluoride treatments, sealants, and space maintenance.

Restorative Services (D2000 – D2999)

• Category Definition: Restorative dentistry involves procedures to repair or restore the structure and function of damaged teeth.

• Code Range: $D2000 - D2999$

• Inclusions: This includes amalgam and resin-based composite restorations (fillings), inlays, onlays, and crowns.

Endodontic Services (D3000 – D3999)

• Category Definition: Endodontics deals with the treatment of the dental pulp and tissues surrounding the root of a tooth.

• Code Range: $D3000 - D3999$

• Inclusions: Major procedures include pulp capping, pulpotomies, endodontic therapy (root canals), and endodontic retreatment.

Periodontic Services (D4000 – D4999)

• Category Definition: Periodontics focuses on the structures that support the teeth, such as the gums (gingiva), periodontal ligament, and alveolar bone.

• Code Range: $D4000 - D4999$

• Inclusions: Services range from surgical periodontics to non-surgical services like scaling and root planing.

Removable Prosthodontics (D5000 – D5899)

• Category Definition: This field involves the replacement of missing teeth and contiguous tissues with appliances that can be removed by the patient.

• Code Range: $D5000 - D5899$

• Inclusions: These codes cover complete dentures, partial dentures, and their respective adjustments or repairs.

Maxillofacial Prosthetics (D5900 – D5999)

• Category Definition: Specialized prosthetic restoration of the face and jaw following trauma, disease, or congenital defects.

• Code Range: $D5900 - D5999$

• Inclusions: This limited range specifically targets facial reconstructions and related complex prostheses.

Implant Services (D6000 – D6199)

• Category Definition: Codes specifically dedicated to the placement and maintenance of dental implants used to support dental prosthetics.

• Code Range: $D6000 - D6199$

• Inclusions: Includes surgical implant placement, abutments, and implant-supported restorations.

Fixed Prosthodontics (D6200 – D6999)

• Category Definition: Also known as "fixed bridges," these comprise the replacement of missing teeth with permanent, non-removable dental appliances.

• Code Range: $D6200 - D6999$

• Inclusions: This range includes fixed partial denture retainers (crowns) and fixed partial denture pontics (the replacement teeth).

Oral Surgery (D7000 – D7999)

• Category Definition: Formally known as Oral and Maxillofacial Surgery, this includes the diagnosis and surgical treatment of diseases, injuries, and defects involving both the functional and aesthetic aspects of the hard and soft tissues of the head and mouth.

• Code Range: $D7000 - D7999$

• Inclusions: Includes extractions, surgical exposures, and reconstructive surgeries.

Orthodontics (D8000 – D8999)

• Category Definition: Orthodontics involves the correction of misaligned teeth and jaws (malocclusions).

• Code Range: $D8000 - D8999$

• Inclusions: This covers different stages of treatment including interceptive, limited, and comprehensive orthodontic therapy, as well as appliances.

Adjunctive General Services (D9000 – D9999)

• Category Definition: This section covers supplemental dental services that do not fit into the other specific clinical categories.

• Code Range: $D9000 - D9999$

• Inclusions: Examples include emergency/palliative treatment, anesthesia (sedation), professional consultations, and professional visits.