Talking with the Toothcop

Have you considered adding a dental membership plan to your practice? Have you looked at the pros and cons but just haven't pulled the trigger? My guest today, Jordon Comstock, has simplified the process by creating BoomCloud—Dental Membership Software. In this episode of Talking with the Toothcop we talk about why a dental membership plan is worth it, having systems in place, and the BoomCloud interface.

Both Jordon's parents were in the dental industry and he started as a lab tech. Most of his immediate and extended family are in dentistry. He grew up surrounded by the struggles of dental offices and sought to create a plan to help simplify their business—but amplify their results. The software he created helps dentists easily manage a membership plan. Listen to this episode for details!

Outline of This Episode

• [1:10] Jordan's history in the dental industry
• [6:18] The benefits of a membership program
• [10:25] Solving the access to care issue
• [12:09] Regulations regarding memberships
• [15:05] Dental practice success stories
• [21:27] What membership programs do for your practice
• [24:07] What to understand from a compliance perspective
• [27:13] The benefits of working with BoomCloud
• [33:41] Jordon's automatic insurance verification app

What are the benefits of a dental membership program?

Dental providers—and patients—often vent about how miserable it is to work with dental insurance. They often deny payment on claims or reduce reimbursements and can make a dent in your revenue stream. Starting a membership program in your practice is a way to offset troublesome insurance issues—and provide care to patients without dental insurance.

Jordon shares that an average membership a practice will offer is $30 a month or $350 a year, but that it varies from practice-to-practice. It would cover things such as exams, cleanings, and x-rays and offer a percentage off procedures. You can look at it as the Amazon Prime of dentistry. Jordon has noticed that patients enrolled in a membership spend 2-3x more than someone using insurance would.

Above all, it provides you a consistent recurring revenue stream for your practice. It can also offset slow months when a practice is billing fewer procedures.

3 case studies that show the membership model works

Jordon shares about 3 practices who adopted a membership program and how they made it work:

1. The first practice had 500 patients sign up throughout one year. They looked up how many patients they treated consistently who were without dental insurance and offered them the membership at their next appointment. They combined this with an email blast to all of their patients. Now, they have $12,000 of recurring revenue month, whether or not any work is done.
2. The second dental practice enrolled 1,000 patients in their program with $25,000 in recurring monthly revenue. On top of talking with their uninsured patient-base, they focused on Facebook ads. One particular year they grew by 370% percent.
3. The 3rd practice had 2,000 people sign up with $40,000 in recurring revenue. They used direct mail marketing and targeted communities ages 55+ who would be looking at retirement and facing the loss of dental insurance.

Every strategy works, you just need to pinpoint what's best for your practice. And with approximately 180 million Americans without insurance, your program can offer dental care to those without access.

Smart business owners don't start from zero

A traditional dental practice starts from scratch every month and must work their way up to the cash flow needed to support their business—and cash flow is a huge problem in the dental industry. A membership program removes the problem. Small business owners need to focus on reducing risk. A membership program removes your reliance on PPOs as a revenue-stream.

It gives your practice stability. Many successful practices adopt a hybrid approach: they stop working with difficult dental insurance plans with while launching their program. They continue working with the policies that afford them a decent profit margin. It's a win-win for your dental practice and your patients.

Launching a program also reduces issues with insurance companies. You still need to keep records for patients and procedures—but your risk of recoupment from insurances due to "record-keeping problems" will be reduced. Keep listening to find out the simple thing you need to do to protect your practice from a compliance standpoint.

Systems help you scale

I asked Jordon to talk about BoomCloud and some of the benefits their platform offers. Here's a snapshot of what you get:

• BoomCloud offers a dashboard that shows monthly and yearly revenue, active patients, cancellations, and more.
• They have tools/systems to remind patients of bills, if a credit card was declined, etc.
• ACH function—patients can connect their bank account and their monthly fee can be automatically withdrawn
• The ability to choose a proven membership template
• You can easily verify that a client's membership is active and that they're paying their fee
• They even offer a patient portal

Anyone can start a membership program for their practice, but it is far easier to manage when you can rely on software—and not a team member trying to track the details on their own. The more members you add, the harder it will become to manage on your own, and that's where BoomCloud simplifies the process.

Listen to the whole episode for complete details on Dental Memberships, BoomCloud, and Jordon's automatic insurance verification app for dentists—JetPack.

Resources & People Mentioned

• The Insurance Extravaganza Conference
• Connect with Jordon Comstock on LinkedIn
• BoomCloud Dental Membership Software
• BoomCloud Free eBook
• BOOK: The Automatic Customer
• JetPack Dental Insurance Verification
• Jordon's podcast: Say No To PPOs
• Jordon(at)BoomCloudApps.com

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

While it's a phrase straight from the mouth of Paul Blart: Mall Cop, it holds true. Safety never takes a holiday, and the safety of your staff and patients should be first and foremost in your mind. Dental professionals need to be educated on proper procedures for cleaning and sterilizing the tools that they're using every day so they're not exposing people to pathogens.

Over the course of this next quarter, I'm dispatching to different dental offices that we work with to conduct a series of experiments. The goal is to find out if the most stringent infection control procedures that we utilize are doing enough. If they aren't, then it's time to make some changes to our checklists and procedures as well as in the dental industry as a whole.

Outline of This Episode

• [1:30] Infection prevention and control and my upcoming project
• [11:09] The importance of sterilizing your equipment
• [17:59] Learn how to read and follow IFUs
• [26:36] Addressing lack of formal infection control training
• [32:22] Learn how to properly use your ultrasonic
• [41:01] Make sure you're receiving the proper vaccinations
• [42:48] Wear proper protective gear: gloves
• [46:56] The alarming biofilm being found in dental waterlines
• [1:02:49] How does infection control apply to ortho?

Texas—and all states—should require infection prevention and control training

There is no infection control training in Texas and quite honestly, they're behind the times. Admittedly, they aren't as forward-thinking as other states. I believe that very few schools—and not just in Texas—are teaching current standards in their curriculum. It begs the question, are our dental assistants getting the proper training?

What about dentists? I've found that some schools of dentistry have their dental students go through a rotation where they learn how to process and sterilize their instruments. But most instrument processing is done by a paid staff and dentists are never educated on the proper procedure for cleaning their tools.

This has got to change. There is a gross lack of knowledge and a whole lot of misunderstanding in the industry. Many dentists and their assistants are learning techniques and procedures from sales reps who don't know what they're talking about. They're often the only outside contact that dentists have which is a problem in and of itself.

Very few dental offices properly use their ultrasonic

Dental staff often overlook one simple thing that will give them the answers to proper sterilization procedures—Instructions For Use (IFUs). It's a user manual for your instruments that lays out the exact procedure to properly use, clean, and sterilize your tools. It's pretty idiot-proof.

There's an amazing product called SonoCheck—it's a tablet that you drop into your ultrasonic to test if it's working properly. You drop it in green and it should come out yellow. If there are major problems with your Ultrasonic cleaner, it won't change colors at all.

I've seen time and time again that offices just crank the dial on the ultrasonic to whatever time it lands on and expect it to clean their instruments. Most are only doing half the time required in their instruments IFUs. Dental offices NEED to start using them for the correct amount of time. They also should use critical water, the right amount of water at the right temperature, and enough of the right kinds of enzymes.

The bottom line is if the instruments aren't processed long enough and in the proper manner, they won't be clean. You'll be using dirty instruments on your patients.

The often overlooked tactic to protect your staff

It's simple and highly effective: wear the right kind of protective gloves. Most dentists, hygienists, assistants, etc. are required to get a Hepatitis B vaccine. Most do it before they finish school but some don't finish the series. They don't get tested to make sure they have the antibodies if they're exposed. It's currently the only required vaccination.

But if you're not wearing protective gloves and get stuck by an instrument used on a patient, you're exposing yourself to other pathogens as well. It could be hepatitis B, Syphilis, Malaria—anything bloodborne. You must assume that everyone is sick and that every instrument is trying to kill you until proven otherwise.

Gloves are inconvenient, sure. But you CAN learn how to process instruments with gloves. Train until you get comfortable with them, but for heaven's sake wear the dang gloves!

Treat your water lines regularly and monitor them for biofilm

We've talked about this before, but biofilm is a buildup of bacteria (both good and bad) that can adhere to water lines. They're terribly difficult to kill and the longer they go unnoticed the more difficult it becomes. I believe states will start mandating water line testing. My advice? Don't wait until it's mandated.

In 2016, a dental unit water line in Anaheim, CA was contaminated with a mycobacterium. It was discovered when dozens of children showed up complaining of facial swelling and pain. Their faces and jawbones were infected with this bacteria. One child had the bacteria progress so severely that she had to have part of her jaw bone removed—all because of an untested waterline in a dental office.

The hassle it may cost you is not worth the PR nightmare. It's not worth losing your license, your practice, and perhaps your freedom. Test your water lines, treat them with shock treatments, and replace them if necessary. You must know how to monitor and maintain control of your water quality.

Jacque and I discuss in-depth testing and cleaning of water lines, proper use of ultrasonic equipment, how these strategies apply to ortho, and much more. Be sure to listen to the whole episode to learn how to better protect your practice!

Resources & People Mentioned

• OSAP
• OSHA
• AAMI ST79:2017
• Sonocheck
• Brandmax Triple Enzyme Cleaner
• ProEdge Dental Water Labs
• Aquasept

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

In this special Q&A episode of Talking with the Toothcop, Jacque and I will tackle questions we've been receiving from listeners. We want to preface this episode by saying that we never intend to promote our business with this podcast. First and foremost, we want to focus on educating the dental community about compliance. However, we've received so many questions about what we do that we thought we'd address them all in this episode! Listen to hear how I became The Toothcop, what exactly it is that we do, and some specific things to watch out for in your office.

Outline of This Episode

• [0:21] Answering Listener questions
• [1:45] How Duane got started in Dental Compliance
• [5:05] Starting a business that didn't exist
• [8:30] The chief nerd at Dental Compliance Specialists
• [10:00] The business at the beginning
• [12:58] Building relationships with dental offices
• [19:11] Do everything we tell you to do
• [28:54] How to get your staff on board
• [35:59] We help monitor and train
• [40:45] What exactly is it that we do?
• [47:20] Chart and record audits
• [51:40] What happens when you don't heed our advice
• [1:01:07] What you need to know about exclusion checks
• [1:08:50] Corporate Integrity Agreements (CIA)
• [1:10:55] Above all—don't panic!

My journey from street cop to toothcop

People are often curious how I got into dental compliance. It doesn't seem like a natural segue from being a deputy sheriff to a dental compliance specialist. However, it truly was a natural progression. After being a street cop, I had the opportunity to work for the state dental board investigating cases for them. I really was a toothcop—I still wore a gun and carried handcuffs when I walked into a dental office.

As I investigated dental fraud and other concerns that arose, I began to realize that I could do something to help prevent these issues from happening. These dental offices weren't necessarily intending to commit fraud or allow patients to be harmed—they just didn't know what they didn't know. So I quit being a cop. Then I started reaching out to offices that I had investigated, offering to help them learn how to prevent what was wrong.

We started a business in a space that didn't really exist. Even now, there is only a small group of people that do what we do. We were simply armed with an idea and blind faith that we could make it happen. We believe what we do matters and truly makes a difference in people's lives—even if we can't quantify it.

What exactly do we do at Dental Compliance Specialists?

When I dove headfirst into dental compliance I did a lot of traveling. I was in dental offices with my checklist in hand covering state board requirements, observing staff, and answering questions. We were continually adding in more checklists that covered OSHA, HIPAA compliance, infection control, and more. I would find issues, take notes, and train as I went along. I was going into offices every quarter and running into the same issues—no one was retaining what I taught them. Talk about frustrating!

I was on the verge of complete burnout and told Jacque I didn't think I could do this anymore. If they don't remember the training or implement changes, what was the point?

Jacque said "give me a year" and we got to work, brainstorming how we could streamline the process. Now, we have a system in place for everything. We broke our compliance training down into 12 modules. Each month a dental office is given a virtual module to cover. We leverage technology and do inspections in small pieces (i.e. one visit is just for radiology training). Doing this gave them manageable chunks to learn and retain, and we were interacting and answering questions monthly vs. quarterly.

It's about building relationships based on confidentiality

Our entire business is based on confidentiality. We want to work with dental offices to improve their compliance, not penalize them for existing issues. We don't disclose who we work with or what the compliance issues are. Even if clients permit us to share that we've worked with them, we won't share anything we've done. We want to build trust to facilitate dialogue—to make you feel comfortable and not judged.

No one is perfect and no office is perfect. In all of the years we've been doing this, maybe 2-3 offices have come close to passing my initial compliance inspection. I've seen some pretty horrendous things in offices full of pretty great people. I remind them things are fixable and help them figure out how to implement changes and often see significant changes for the better in "before & afters".

We can't tell you how many patients or staff members didn't get sick. We can't tell you how many fines or recoupments we helped you avoid. But we can help give you peace of mind. We can train your staff to reach the highest level of compliance standards. You can rest easy knowing that you've done everything you can to protect your business and your patients.

Most common question: What is required vs. recommended?

This one just makes us shake our heads. We understand that some people are comfortable in gray areas and others prefer black and white. But we would never recommend something if it was just optional. Everything we put in our checklists and training modules help you obtain the highest level of compliance. It protects you, your staff, and your patients.

It's not just about "best practices" anymore. You can get fined. You can go to jail. Even if you don't have malicious intent, you will be held responsible for mistakes made. So we don't skip steps. Our system for nailing down compliance failures and integrating guidelines to implement change is tested, tried, and true. So you need to ask yourself the question, "is it legal, ethical, and does it reflect my values? If the answer is no, it's time to make some changes.

Jacque and I dive deep into specific questions covering chart and record audits, exclusion checks, corporate integrity agreements, and so much more—be sure to listen to this important and educational episode. We don't want you to feel overwhelmed, but equipped. Above all, don't panic. If some of these topics leave you with a sinking feeling in the pit of your stomach reach out to us! We'd love to help.

Resources & People Mentioned

• Blog: 7 Key Elements of a Compliance Plan

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Dental insurance billing is something many dental offices struggle with because it can be so complex. When do you bill? What rates do you bill? What if the patient has two insurance coverages?How do you keep your office organized and implement a system? It's a lot to remember. Colleen Huff joins me in this episode of Talking with the Toothcop to answer some of those questions—and help you simplify the process.

Colleen Huff has been everything from a bookkeeper to a scheduling coordinator, with extensive experience managing practices. In her management role, she saw a severe lack of training—to the point dental offices were engaging in illegal billing practices and didn't know it. So she started educating others on proper practice. Colleen has been a dental insurance coach for the last 17 years.

Outline of This Episode

• [0:20] Colleen Huff's background
• [5:05] Can you simplify the dental billing process?
• [15:45] The biggest mistake dental offices make
• [19:20] Anyone engaging in fraudulent billing is liable
• [22:10] Understanding insurance breakdowns
• [26:20] Dealing with multiple insurance coverages
• [28:05] Common issues offices struggle with
• [30:55] How do you systematize and organize?
• [34:20] Connect with Colleen

How do you simplify the verification process?

We're at the beginning of the year right now, when many clients have switched to new insurance—which typically means a mad scramble to verify coverage. Coleen does everything she can to make sure insurance is verified weeks before a patient's appointment so they can contact them about any problems that arise.

If a client has a Medicaid policy—which can terminate at a moment's notice—you must be sure to verify it the day of the appointment. She also recommends doing this for commercial insurance plans because they no longer run on just a calendar year. Many are contract year, benefit year, or even a rolling year based on employee hire date.

It is preferable to know ahead of time whether or not there will be a financial challenge for you and your patient. You can notify the client upfront, instead of billing them later and dealing with an angry client. With the real-time eligibility systems in place, the process has become much easier. Listen as Colleen and I chat about how she documents the process and communicates problems with patients.

The biggest mistake dental offices make

The #1 problem Colleen sees in dental offices is not submitting claims on the proper completion date. Many offices send claims before the work isn't completed, citing that "everyone does it" or "no one ever gets caught". Doing so is dangerous for your practice. You need to submit the claim for the proper date the procedure(s) was completed or face the consequences when you're caught. It will be jail time.

It's not just the Dentists that can be prosecuted. A billing staff who knowingly submits fraudulent claims can be found at fault. Whining that "The Dentist told me to!" will not protect you. If you are part of the billing staff you must be reviewing claims before you send them.

It comes down to integrity. The more you allow and the more "little" discrepancies that you let slide will make an impact. Make sure your morals and beliefs align with how you are operating your practice. We talk about an incident where a provider did end up in prison and the reason behind it—keep listening.

Why insurance breakdowns are important

Colleen and I agree: you must know how much a procedure will cost a patient. Run the verification, make whatever calls necessary, and print out a breakdown of what a client will owe. Then, collect whatever copay is necessary. Your billing will be more accurate. This also removes the chance of most—if not all—surprises and helps you avoid a patient getting an unexpected bill.

Some offices struggle with moving into the 21st century and claim that "Patients should understand their insurance and what they charge". Colleen is more familiar with insurance than most people, but even she doesn't know everything—and you can't expect your patients to either. Gathering information on the front end is important.

Is it time-consuming? It can be. But most insurance companies have a way for you to check verification and coding online. Sometimes it may take a phone call. But it saves you future hassle and makes your patients feel relieved and secure in your ability. Referrals come from happy customers, and the more you simplify the process for them, the happier they'll be.

Your dental insurance billing questions answered

Colleen took some time to answer common questions and issues that dental offices struggle with:

1. If a client has two insurance policies, which is primary and which is secondary? There are a few simple rules. First, a Medicaid policy is always secondary (except for a few rare circumstances). Your plan is always primary to your spouses. For a minor child, unless court-ordered differently, the parent with the earliest birth date in the year is the primary insurance.
2. Should you bill your full fee or the contracted rate? Always bill your full fee. The insurance company will pay the contracted rate and you adjust off the rest based on the contracted fee schedule.
3. How do I negotiate fee schedules? Colleen notes that you must be billing your full rate. If you don't, an insurance company will see that they're already paying you what you're asking, and you have no leverage for negotiation. It takes time, but if you go through the proper channels you can see a fee schedule increase.
4. What is the difference between a write-off and an adjustment? A write-off is when you bill the insurance for something that's not covered according to your contracted agreement or the patient's policy. If the service was carried out, you may NOT bill the client for the cost and must write it off. An adjustment is an amount that is adjusted off the bill sent to the insurance company. They pay you the rate your contracted for and nothing more.

Listen to the whole episode as Colleen shares her background in the industry, strategies for staying organized, things to keep an eye out for, and much more!

Resources & People Mentioned

• Colleen Huff's Facebook page
• NADP Conference
• Colleen's Website
• Colleen's email: DentalInsuranceCoach(at)gmail.com

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

How to Utilize Instructions for Use in Infection ControlInstructions for Use (IFUs) should be included with any and every medical device that you use in your practice. Learning how to properly use and follow IFUs will aid in proper infection control. As we are rolling into 2020, improvement in infection control in dentistry is at the forefront of my mind. So in this episode of Talking with the Toothcop we're going to cover how to properly clean and disinfect medical devices (and how to reference the IFUs). Check it out!

Outline of This Episode

• [0:20] Welcome to 2020!
• [4:55] Infection control and room for improvement
• [6:30] Policy to practice book from OSAP takeaways
• [7:45] Properly use IFU's (Instruction for Use)
• [13:30] You need written policies and procedures for infection control
• [17:45] Enzyme solution and critical water
• [22:55] Proper care of hinged instruments
• [24:45] Spot-testing in dental offices
• [26:30] Infection control testing coming in 2020!
• [31:00] Move in one direction and never backward

Why Instructions for Use are SO important

Instructions for Use teach you how to properly use any and all medical devices that you use in your practices. Everything is regulated by the FDA—each product HAS to provide an IFU to remain compliant. They'll tell you how to use it, care for it, clean and sterilize it, and how to store it. They are comprehensive guidelines for the proper care of your devices to increase longevity and protect your patients.

The process of cleaning your medical devices

I want to just walk through the general steps (and everything you need to consider) as you clean and sterilize your medical devices:

1. Transporting the instrument(s): When you are transporting devices from the operatory to the sterilization room you must consult the IFU. For example, If it's a sharps device, you must transport it in a closed container that cannot be permeated and label it as a biohazard.
2. Rinsing the instrument(s): Does your devices IFU specify that it needs to be rinsed in a certain type of water? Many now require that they are rinsed in critical water.
3. The Ultrasonic bath: Are you sterilizing hand instruments? Drills? Cavitron tips? For each item, you have to consult their specific IFU to properly clean and sterilize them.
4. Enzyme solution: What type of enzyme solution to you need? Protease, amylase, or lipase? All three? How many squirts or tablets per amount of water being used? Guess what—your IFU will tell you everything you need to know. You also need to de-gas your ultrasonic by running it for 10 minutes before putting your instruments in.
5. Second Rinse: You NEED to use critical water again! Most people are using tap water, and it's probably not doing the job.

Instruments are expensive. You want to properly care for them and the best way to do that is by following their instructions for use. Andrea and I talk about considerations for hinged instruments, so keep listening!

Written policies and procedures

Most offices don't have written policies and procedures in place for infection control. Or, they're so generic that they're useless as a guideline. But you need one for your practice. I've found that the best infection control guidelines that you can find online come from dental schools. But you can't just grab their manual and call it good.

You need to take their baseline and edit it. Structure it for the proper verbiage for your practice. Make sure it addresses policies for stages of the instrument process, sterilization, transport, storage, to reuse or not reuse, surgical milk—the list goes on.

This is its own training manual. You can't tuck into an OSHA manual. You need to have systems in place to properly update it and make sure all staff are reviewing it consistently. Keep listening as Andrea and I chat about the specifics.

Infection Control in 2020: Where are we headed?

Good enough isn't good enough. I've spent hours researching infection control and am investing in some tests that I will use this year. I'll be able to see in-the-moment if a dentist's office is properly cleaning and sterilizing their instruments.

My goal is to track my testing and make the data consistent, measurable, and reliable. We don't want to see what we think are water spots or rust on instruments and find out that they are biological. We need to set a higher standard for ourselves and our patients. That begins with proper infection control.

The CDC doesn't spend time studying dentistry, so we need to make sure that our standards go above and beyond what is in place. Listen to the whole episode as Andrea and I chat about our plan for 2020.

Resources & People Mentioned

• Ole and Lena Jokes
• OSAP
• FDA format guidelines for IFUs
• Supercritical Water Oxidation

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Airborne diseases in dentistry are unfortunately prevalent but preventable. Protecting yourself, your staff, and your patients from aerosols should be a priority in your practice. We are all up-in-arms about bloodborne pathogens and do everything in our power to prevent them, but we neglect airborne diseases. That needs to change! Michelle Strange joins me in this episode of Talking with the Toothcop to start the conversation.

Michelle has been in the dental industry since 2000, and a licensed hygienist since 2005. At one point, she was an OSHA Compliance Manager and Director of Clinical Education at O2 Nose Filters. She left private practice 5 years ago and is now an Educational Consultant for TePe Oral Hygiene Products. Michelle also co-hosts a podcast, "A Tale of Two Hygienists".

Outline of This Episode

• [0:20] I introduce my guest, Michelle Strange.
• [3:05] Research on dental aerosols
• [4:05] The conversation about airborne diseases
• [6:40] Personal Protective Equipment
• [10:25] Protect your patients and staff
• [16:00] The psychology of bias
• [19:30] Transparent conversations with your patients
• [24:15] The dangers of chemical aerosols
• [27:55] How different personalities deal with change
• [32:35] Wrap your head around the why

The lowdown on airborne diseases

There are many safety protocols in place to prevent the transmission of bloodborne pathogens. A standard has been set that professionals must follow to protect themselves. But when it comes to airborne diseases, most providers aren't even using the correct protective mask.

Chickenpox, Measles, Mumps, Tuberculosis, Herpes, and the common cold are all respiratory diseases transferred in aerosols.

Bloodborne diseases can only be transferred if you are cut, and you are exposed to contaminated blood. Airborne diseases can be spread if someone simply breathes or coughs! The dental industry doesn't address this as well as they should—that needs to change.

The importance of Personal Protective Equipment (PPE)

Because of the ease of transmission, it is imperative that you're utilizing the proper PPE. Michelle has always had a proclivity for proper infection control. She made sure to use the Ultrasonic and air polishers for every single patient.

But when she was working as a hygienist, she was always sick with a sinus infection or bronchitis. It got so bad that her patients would comment it was odd when she wasn't sick! Michelle is convinced it's because she never knew the proper level of mask she should be wearing.

When you are working with high levels of aerosols, you need to be using a level three mask. Not only for your protection but your patients as well. Michelle and I cover the topic in detail—keep listening!

The Dunning–Kruger effect: overcome cognitive bias in dentistry

The Dunning-Kruger effect, simply paraphrased, implies that we as professionals believe we are more qualified than we actually are. Michelle contends that we need to consistently work to overcome our cognitive bias that we 'know it all'. It's important to remember that what you were taught in the '80s is going to be outdated.

Science is constantly evolving in the world of dentistry. We are constantly learning about new ways to treat and prevent disease. Keep an open mind and allow yourself to be challenged and always question the status quo. Your mindset must always come back to the proper protection of staff and patients.

Michelle and I believe there needs to be more transparent conversations with patients in the dental industry. It's okay to admit that you're not always the expert. Inform them that you're staying on top of new research and new procedures and will always keep them in the loop on their treatment.

It's not just biological—be aware of chemical aerosols as well

While airborne diseases are the aerosol that can be the most concerning, Michelle and I felt the need to caution you about chemical aerosols as well. When you're working in the lab carving dentures or trimming models those particulates are quite fine.

So are you wearing the proper mask? Are you breathing in those particles? Do office staff enter the work areas without proper PPE? People aren't just getting sick, they're getting really sick. You need to cultivate an awareness of these concerns and educate your staff and patients.

Dentistry is the highest producer of aerosols, but dental masks are based on medical standards. Michelle and I discuss the need for dental standards as well as some other concerns that impact change in the dental office. Listen to the whole episode for more important information.

Resources & People Mentioned

• O2 Nose Filters
• The Dunning-Kruger effect

Connect with Michelle Strange

• Michelle on LinkedIn
• Michelle's podcast
• TePe USA Educator

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Dental billing is an ever-changing process. As a dental provider, how do you stay on top of changing regulations and coding? Do you outsource your billing? Leslie Icenogle joins me today to talk about medical billing for dentistry and where it overlaps with dental billing. We also chat about outsourcing your billing and continuing education for your staff.

Leslie got her start in pediatric dentistry over 30 years ago and has worked in oral surgery for 32 years. She has extensive experience dealing with medical billing and started teaching dental practices how to integrate medical billing. After a couple of years of being asked to take on the work herself, Insurance Billing Outsourcing was born.

Outline of This Episode

• [0:30] Leslie Icenogle's background in dentistry
• [3:05] ICD-10 Diagnosis in Dentistry
• [8:00] SOAP notes: subjective, objective, assessment, and plan
• [10:45] How do you make the process easier?
• [13:50] Compliance and cash flow go hand-in-hand
• [16:15] Outsourcing is sharing liability
• [22:20] Cleaning up your billing practices
• [26:05] High turnover in billing positions
• [27:55] Connect with Leslie

Understanding medical billing in dentistry

Dental and medical billing is at a crossroads, where many things will now be required to be billed to medical insurance primary to dental insurance. Many states already require claims to be submitted with the proper ICD10 coding in place. You'll begin to see (or continue to see) dental insurance denying claims because they were looking for denial or payment from the medical insurance first.

A lot of treatment that dentists could be billing is not being billed—which is a win for the medical insurance and a loss for you.

It will be a learning curve to understand how to begin coding these claims properly. This is where Leslie would step in and offer proper training to your staff. You must learn how to correctly file with the proper attachments, write letters of medical necessity, and learn how to properly read Explanation of Benefits (EOB's). If this is something you're not ready to implement completely, consider outsourcing to a company such as Leslie's.

SOAP Notes: The importance of documentation

The 'SOAP' acronym stands for subjective, objective, assessment, and plan. It is a note-taking system that your practice will need to begin implementing. Medical insurance is all about documenting the details. If you're doing anything other than a simple cleaning, they want to know why the patient is being seen.

What is the chief complaint? How did it happen? What is the history of the illness/issue and was it properly treated? Document their HPI (History of Present Illness) extensively.

Your notes must be clear and detailed. Leslie and I both recommend creating a template where you can input the proper patient information. It helps simplify the process and keeps you consistent.

Clean up and simplify your dental billing

As Leslie has worked in the field, she's found that most dentists are receptive to her feedback or criticisms. After all, the entire goal of cleaning up your billing and learning new processes is to increase cash flow! There are a few ways you can clean up your process as you're learning the new coding:

• Create a template that allows you to easily input a patient's information and history.
• Verify benefits for the medical and dental insurance on the front end, and do so correctly.
• Assign someone—perhaps your office manager—to conduct an audit of patient files. They can assess if the notes are detailed enough, if the insurance was verified correctly, and that the claim was filed properly.

Is the person handling the billing truly able to dedicate all of their time to it? Or are they being pulled in different directions? Another option you can consider to reduce the burden on your staff is to outsource billing.

Invest in education for your billing team

If your practice has designated billing staff—take good care of them. Leslie and I see high turnover rates in billing positions. Often, it's due to improper training (or lack of training). You must invest in continued education for your billing staff and not let them fall to the wayside. We recommend implementing training annually.

This allows your staff to stay up-to-date on the changing rules and regulations in medical and dental billing. It also properly equips them for their job. Ignorance is NOT bliss and your practice could be hemorrhaging money. Spend a little money on the front end on training to amplify the cash flow coming in from proper billing.

Leslie and I talk about the benefits of utilizing ICD-10 coding and why you shouldn't resist it. Don't miss this engaging episode of Talking with the Toothcop!

Connect With Leslie

• Leslie on LinkedIn
• Insurance Billing Outsourcing Website
• Call IBO at 317-565-4988
• Leslie(at)USEIBO.com

Resources & People Mentioned

• ADA Lawsuit against Delta Dental
• ICD Coding in Dental Claims

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

What are some of the security measures you need to have in place to protect your practice? In today's day and age, security breaches can come from many different directions. In this episode of Talking with the Toothcop, Andrea and I will lay out some ways you can protect your business. From security breaches to controlled substance regulations—we've got you covered.

Outline of This Episode

• [0:20] Cyber Ransom Attacks
• [4:55] What does a breach mean for you?
• [8:30] Prepare for potential breaches.
• [13:20] HIPAA security and privacy officer
• [14:40] Bootcamp will cover liability and compliance
• [17:50] How to prepare for and handle "Never Events"
• [23:10] Controlled substance rules and regulations
• [27:15] Change in DEA regulations
• [28:10] Controlled substance storage
• [30:30] Stop over-prescribing antibiotics

Cyber attacks are the real deal

It's a new era, and cyberattacks are becoming more prevalent. A hacker will infect your system with an encryption virus, and to regain access you have to pay a ransom. This isn't just a thing happening on TV shows anymore. It's something that has to be investigated by the FBI, reported to the Office for Civil Rights (OCR), and potentially even media outlets.

Is there anything you can do to prepare? What do you are attacked?

1. Invest in a great IT company that will answer any questions you may have.
2. Obtain adequate cyber-insurance coverage.
3. Have legal counsel in place that you can call if it's ever necessary.
4. Prepare as well as you can—make sure you have more than adequate website security.

Don't let your practice be compromised and watch your reputation take a nose-dive. Do everything you possibly can to protect your practice and your clients. We give you a few options in this episode!

HIPAA breaches and how to prevent them

If you do indeed experience a breach of protected health information, you must have systems in place to handle the situation. You need a designated privacy officer and security officer. If you've done your due diligence and have systems in place, it can be taken into consideration if there is an investigation. A forensic investigation is recommended (especially in the case of a cyber-attack) to determine the scope of the breach and what information was affected.

Assess where your vulnerabilities may be and take preventative action. Was there a change in technology? Where are your gaps? Don't simply rely on your IT company telling you that you're safe—ask questions so that you understand and know you've done everything possible.

How to prevent "Never Events"

"Never Events", usually referred to as "Sentinel Events" are unanticipated extraordinary events that incur serious injury, illness, or the death of a patient. Unfortunately, events like these can and do happen (we talk about prevention and preparedness in depth in this episode).

Even if you do everything right and are a great clinician, the litigation and stress involved in the process can be debilitating. You can't turn back time—but you can be proactive. Have checklists in place to make sure life-saving medical devices are checked regularly. Practice life-saving procedures with your staff. Be prepared for the unexpected.

Controlled substance rules, regulations, and safety measures

A state board rule was enacted in Texas eff. September 1st requiring providers to check a patient's substance history before prescribing controlled substances. There are also whispers that a law will be enacted in 2020 that will only allow prescriptions for controlled substances to be done electronically. Do your research now to find a compatible software to have in place by the time this is state law!

It's an added safety measure that will protect you from some liability as well as protect your patient's life. In the meantime, if you prescribe or utilize controlled substances they must be securely locked up (behind TWO locks and TWO keys). You must have a log to track dispensing that is stored safely with the drugs.

Andrea and I talk in detail about security measures, HIPAA breaches, drug regulations and much more so be sure to listen to the whole episode for details!

Resources & People Mentioned

• Allscripts
• Office for Civil Rights (OCR)

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Everyone lives by the mantra that medical emergencies in the dental office will "never happen to us". Patients certainly don't think about that when they schedule a dentist appointment. But it is your job as a provider to be prepared for the unthinkable. Failure to plan is a plan to fail. There is risk in what you do whether you think about it or not. We cover medical emergencies in detail in this episode of Talking with the Toothcop—be sure to listen!

Outline of This Episode

• [1:30] Preparing for Medical Emergencies
• [6:00] Do scenario training until you don't fail
• [7:55] Combating opiate abuse in the dental office
• [13:50] Use your intuition and don't make stupid decisions
• [17:15] Sedation Rules: Pre Anesthesia Checklist
• [21:20] Opioid addiction resources for Texas
• [24:10] Tracking claim denials and implementing systems
• [26:00] Learn proper administration of emergency medications
• [35:50] Why do we do what we do?
• [39:00] DEA Registration and resources
• [40:10] 'Trust but Monitor' in practice
• [46:40] People can't afford for us to get it wrong
• [48:30] Details about the annual Dental Compliance Bootcamp!

Do scenario training to prepare for medical emergencies in the dental office

Run through scenarios with your team. What do you do if a patient goes into cardiac arrest? What do you do if they have an allergic reaction or don't handle sedation well? Strategize what you would do in these scenarios and talk about how emotions will play a factor in your ability to carry out what your plan.

Run through your weaknesses extensively—because a patient can't afford the luxury of you only playing to your strengths.

The only way to truly prepare for an emergency is to make a plan and test your plan extensively. You cannot run a one-and-done test. You must practice until you don't get it wrong. Practice doesn't make perfect. Practice until you reach perfection. Remember that it could very well be someone's life that is at stake and plan accordingly.

Combating opioid addiction in the dental office

Dentists and dental staff deal with the same problems everyone else does. Unfortunately, due to the nature of their professions, they have easy access to addictive substances. If you're a dental provider struggling with a problem but claim to have it "managed"—it will catch up with you. Don't risk your license, your practice, your family, or your life. Get help now. Check out the resources in our show notes.

On the flip-side, you must carefully monitor the controlled substances that you are prescribing. You must check your patient's consumption history and make sure they are not abusing the system. You have an obligation—both morally and ethically—to treat your patient's pain, while not jeopardizing your license. Bottom line? Use your intuition and don't make stupid choices.

Listen as Andrea and I discuss in detail specific stories of opioid abuse and the consequences suffered by those involved. We also talk about DEA registration and why it's needed for every location you practice at.

Know how to properly use life-saving medications

You must have an emergency drug kit on hand to deal with whatever medical emergency you feel could arise—and know how to properly administer them. You NEED to be proficient in Basic Life Support (BLS) and Pediatric Advanced Life Support (PALS). But don't just stay up-to-date on your certifications, be sure you consistently practice the procedures.

It does you and your patients no good if you have a certification, but when the time comes that you need it, you fall short. You must provide the highest standard of care and prepare for the worst-case scenario.

If you offer sedation at your practice, you must have the medications on hand to reverse the sedation. Typically you'll also need to know how to set up an IV and administer medications that way. So practice practice practice.

Why do we do what we do?

Our Mission: build authentic relationships we build our legacy of making dental practices safer for patients, dentists, and staff by holding quality-focused professionals accountable to their standards.

Our Vision: is not merely to exist but to be better, do better, and live better so that no one is harmed by a dental practice.

Our goal is to equip you to think for yourself and practice the "trust but monitor" mantra. Always be sure to locate the source of the information—even when it's coming from me. Remember, our patients can't afford for us to make mistakes!

Resources & People Mentioned

• Professional Recovery Network Website
• PRN's phone number: 800-727-5152
• DEA's Practitioner's Manual
• Check out our Dental Compliance Bootcamp!

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Today's episode of Talking with the Toothcop is all about the fascinating topic of staying up-to-date with your equipment evaluations and dental policies and procedures. Yes, I think compliance IS fascinating! Andrea and I cover everything from blood-borne pathogens to X-Ray equipment—don't miss this important episode.

Outline of This Episode

• [0:23] What Andrea and I are going to cover
• [3:20] X-Ray law updates in Texas
• [7:05] Written policies and procedures
• [15:50] HIPAA and monitoring PHI
• [35:25] Hepatitis B Prevention and vaccination
• [37:05] Minimizing exposure & safety protocols
• [41:20] 75 Hard update
• [45:00] PPE provided at no cost
• [50:00] You can't always see your enemy
• [53:50] Provide proper post-exposure care
• [56:45] Sterilization of single-use items

Dental policies, procedures, and prevention!

The whole reason you have written policies and procedures is to protect yourself, your staff, and your patients. In theory—really though, in practice—you should have a written policy to address every risk area you may encounter in your dental office. These are a few of my favorite things:

• HIPAA manual
• Infection control handbook
• OSHA policy
• Proper billing procedures
• Clinical policies
• Medical emergency policies

The list goes on! It can be in multiple manuals or one large handbook, but it's important that you know what's in it and that your staff knows where to find it. As a general rule of thumb, you need to review your policies and procedures annually and update them as needed.

Make sure that your manual is legal, ethical, and reflects the values of your organization.

I always feel like somebody's watching me…

...and I got no privacy! Seriously though—you NEED to make sure you are monitoring your office's server access logs. Is a login being used outside of business hours on a normal basis? Did you notice the login of a former employee is being accessed? It is important to monitor for irregularities and anomalies so you know when and if you've been hacked.

It's all about protecting your patient's protected health information (PHI).

This is why it is the law that everyone in your practice has different usernames and passwords for the systems in place that are not shared. This allows you to monitor access, as well as only allow access to certain roles that fit an employee's role. You must keep audit logs of your servers for 6 years in case of an audit.

Down to the nitty-gritty: Blood-born pathogens and prevention

You must offer Hepatitis B vaccinations to your staff at no cost to them. You want your employees to get the vaccination within 10 days of being hired and have them sign a document stating: they've had the vaccination, they've previously been vaccinated, or they acknowledge it's been offered and decline the vaccination.

So what can you do to prevent the spread of a blood-born pathogen? You can minimize exposure by:

• Using High-Volume Evacuators
• Use needle-capping devices
• Use puncture-resistant sharps containers
• Provide hand washing/hand sanitizer stations
• Provide Personal Protective Equipment (PPE) at no cost

Follow the policies and procedures you've set forth and you're 99% of the way towards protecting your staff. Andrea and I cover a whole lot more—keep listening.

What do you do when the unthinkable happens?

Protecting your staff isn't just about prevention. Sometimes, mistakes happen and you or a staff member may have been exposed to a blood-borne pathogen. What you do next matters. First, take care of your staff! Document the incident. Document the route of exposure. Make sure the staff is immediately tested for blood-borne pathogens.

Secondly, get consent to test the patient's blood as well. Unless, of course, you already know if they have Hepatitis B or HIV. Be sure that the proper channels are in place to take care of your employees. This includes medical evaluations and treatment, and counseling if they test positive. Listen to the whole episode for more valuable policies and procedures!

Resources & People Mentioned

• Dental Cone-beam
• OSHA
• HIPAA

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube