Did You Commit a Felony Today?
As High Impact Leadership digs into our dental roots (pardon the pun), I am happy to highlight Theresa Sheppard, an expert in the dental field of risk assessment. Enjoy her article and think about what risk you may have put your practice in....
Practicing Can Be Risky Business: Assess, Identify & Correct
When we think of a felony, we think of armed bank robbery or something equally as sinister. Yet, dental practices commit felonies every day, they just don’t know it. Most felonies committed in a dental practice have to do with fraud. That is why it is critical that the Dr. and team understand proper coding and billing. 99.9% of practices that find themselves in trouble have no malicious or fraudulent intent… so why are they in trouble? LACK OF TRAINING!
When I perform a risk assessment on a practice the following three concerns are always at the forefront:
This can include failure to diagnose & treat, allowing the patient or dental benefit plan to dictate treatment, (such as performing a “bloody prophy” on a perio patient because they refuse SRP) or delaying needed treatment (Let’s “watch” that old MODL leaking amalgam). Do we allow patients to refuse x-rays for an extended period of time, yet perform procedures? Can we perform a procedure that we know does not address the diagnosis or clinical need of the patient just because the patient signs a refusal? The answer is a NO! We obviously cannot force a patient to follow our diagnosed treatment plan, but to do something less than that can be supervised neglect and well below the standard of care. (Let’s think about that “bloody prophy” again) .
We want to help our patients get the care they need; however, you are not responsible for what your patient presents with. Many times, patients simply don’t want to pay a co-pay. Oral health is an investment, dentistry is not expensive, neglect is.
The Standard of Care:
There is no actual regulation for “Standard of Care” rather, there is a definition and expectation that a reasonable provider with the same level of education would make the same decision. Here we are with the prophy vs. perio dilemma again. We know that oral pathogens cause and contribute to many serious health conditions such as CV Disease, Diabetes, Alzheimer’s, Pre-mature birth, many different cancers and more. Continuing to allow a patient refuse perio treatments, especially those with these co-morbidities, not only put the practice at risk, but it can also seriously jeopardize the patient’s health. Performing a “bloody prophy” is below the Standard of Care, as it does not address the patient’s disease process. Are we forgoing a complete oral cancer screening and head & neck exam?
Just as under-treating can be beneath the Standard of Care, excessive treatment such as taking X-rays because the patient is “Due” rather than based on clinical need can also raise a red flag. X-rays must be prescribed by the Dr. per individual need.
Documentation is what will determine if you are “defensible” or not, and where I consistently see the biggest risk. Some examples are:
Seeing a patient for a perio maintenance and bill out a prophy because “it’s covered by their insurance.”
Making a stayplate & billing as an acrylic partial
Placing a base during a crown prep & billing out a crown build up
Diagnosing treatment but no supporting documentation about x-rays, perio charting, or how arrived at that diagnosis.
Not only is accurate documentation critical to correct coding errors, but it can also often reveal hundreds or thousands of dollars a month in lost, legitimate revenue because there was something left out.
Other areas of risk can involve writing off co-pays, changing dates, and failure to prove clinical necessity.
Did Dr. view those x-rays? Were treatment options discussed with the patient? Were written & verbal post op instructions given? You bet they did! However, I can sum up documentation in two words: Prove It!
If it is not in your patient records, you didn’t see it, you didn’t say it, you didn’t do it, it didn’t need to be done & it doesn’t exist! We should not get too comfortable or assume that we know all the current codes & regulations. A practice risk assessment and team training in the area of risk management is essential to keep your & your practice protected & profitable.
Theresa Sheppard, RDA