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How much should you pay for dental consulting?

Posted on by Jen McGuire | Category Practice Management

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What costs more: practice management consulting or a new car? That depends on the consultant and whether your taste in cars is more Tesla or Toyota. Chances are they’re in roughly the same ballpark. While it might seem crazy to spend your new car fund on something as intangible as consulting services, there’s very little chance a new car is going to make you money, unless you’re an Uber driver. On the other hand, a good practice management consultant will design and implement a coaching plan to grow your practice production. The key is finding the consultant that fits the needs of your practice, to maximize your return on investment.

Any major purchase process starts the same way, by establishing what you want the purchase to accomplish. If you’re buying a car, do you want to efficiently commute to work every day? Or do you want to enjoy leisurely drives and envious looks. Selecting a consultant requires the same analysis. Do you want to work more efficiently? Attract more new patients? Prepare your practice for a successful transition? The consultant you choose to work with should have a skill set that closely aligns with your individual practice needs. You don’t want to end up commuting in a Hummer. Read articles (and social media posts) written by consultants, check their references, ask colleagues for referrals, and talk to your local dental professionals.

The next step is the test drive. Schedule calls with each of the consultants who made your short list. Most will provide an initial consultation at no charge. Use this time to outline your current practice status and share your goals. The consultant can share their approach for your situation and you can determine if there’s a fit. Although the selection process rests in the hands of the dentist, remember that this is a decision that will significantly impact your team. Consider including the office manager or key staff members in your process.

Consulting is an investment in the long-term success of your practice, but it does not have to be complicated or expensive to be effective. Schedule a free consultation to learn more about cost-effective coaching from 360 Practice Development.

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OSHA Fines Increase by 78% on August 1st

Posted on by HS We Do That | Category OSHA & HIPAA

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by Karson L. Carpenter, DDS

On November 10th, 2015 the United States Congress passed a budget agreement. Part of this agreement was a provision allowing OSHA to increase fines by approximately 78%, effective August 1, 2016. This dramatic increase in fines was described as a “catch-up” based upon the inflation rate from 1990, when they were last raised, to the present. The new provision also stated that going forward, OSHA fines will be raised each year based on the Consumer Price Index (CPI). Any citations issued by OSHA are subject to the new penalties if the related violations occurred after November 2, 2015.

OSHA Director, David Michaels, stated that “Unscrupulous employers often consider it more cost effective to pay the minimal OSHA penalty and continue to operate an unsafe workplace than to correct the underlying health and safety problem”. OSHA feels that the extreme increase in penalty levels will make more employers “take notice” of the safety violations that may be present in their workplace and move to correct these hazards as soon as possible.

With the new fines now in place, serious citations increase from their current level of $7000 and move up to $12,740. Repeat and willful violations increase from the present range of $5000-$70,000 up to a range of $9,100-$127,400. For those states that operate their own Occupational Safety and Health Plans, all are required to adopt maximum penalty levels that are at least as effective as Federal OSHA’s.

Your Henry Schein representative can conduct an informal OSHA inspection to identify and correct potential violations as part of your annual OSHA compliance training.

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The One Thing Millennial Employees Really Want… and Aren’t Getting

Posted on by Jen McGuire | Category HR, Team Harmony

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Lost in the debate over generational differences is a critical component of successful employee management. While people debate the strengths and weaknesses of Millennials, Baby Boomers, and Gen X’ers, one aspect continues to surface across all generations: Appreciation (and more importantly the lack there of!).

Appreciation is the secret weapon for successful practices. On the surface, production and collections are high, employee turnover is low, employees are happy and engaged, and doctors have low employee-related stress. It all seems so perfect that outsiders conclude it must be plain luck.In these successful practices, a deliberate theme runs through the day-to-day interactions between doctor and staff—a theme of genuine appreciation. The appreciation takes several forms: saying “Thank You” when a job is done well, buying the employees lunch for no particular reason, lending a hand when things are busy, making time to listen patiently to employee concerns, and high-fives or pats on the back.

These forms of appreciation are categorized as: Words of Affirmation, Tangible Gifts, Acts of Service, Quality Time, and Physical Touch. Across all generations, industries, income and education levels, these basic forms of appreciation have incredibly positive effects on employee productivity and longevity. The pioneering research is outlined in the book “The 5 Languages of Appreciation in the Workplace”, by Gary Chapman and Paul White.

More so than salary, benefits, or work hours, appreciation has the greatest impact on employee morale and turnover. Implementing appreciation in your office is easy, intuitive, and fun. Grab a copy of the book (which is a very quick read) and start your practice on the path to success. To learn more about appreciation and other secrets to HR success, request a free consultation.

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Can Your Landlord Relocate Your Dental Practice?

Posted on by HS We Do That | Category Practice Management

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By Jeremy D. Behar, President & CEO, Cirrus Consulting Group

Picture this. You’ve built or bought your dream dental practice, amassed a loyal patient roster, and are enjoying the fruits of a successful dental practice. Having found a space that works for your business, you feel lulled into a sense of security by what you thought was a good and solid dental office lease.

Suddenly, without warning, you receive notice from your landlord that the dental practice you have worked so hard to build is being relocated to another location to make room for the accountant next door who is expanding. You realize that the office lease you thought was designed to protect your interests, is actually riddled with clauses that the landlord can exploit to their advantage — in this case it’s the “relocation clause”. So, what does this mean for you and your practice?

What is the “relocation clause”?

To start with, the relocation clause gives your landlord the right to relocate your dental practice to another location in the center or building. Landlords generally exercise this right when they have a tenant interested in expanding into the space or are willing to pay higher rental rates.

A more attractive or lucrative offer may give incentive for a landlord to invoke the relocation clause and request that current tenants vacate their space – with typically 30 days’ notice – and move to a new location. As dental practices are expensive to maintain and difficult to relocate, a hidden relocation clause can pose major problems for a tenant. In fact, relocation can easily add up to hundreds of thousands of dollars in unexpected costs.

The most effective way to avoid an unexpected relocation is by identifying this clause in advance, and negotiating it out of your lease before you sign it. If it cannot be removed, often it can often be re-drafted in a way that is more favorable to the tenant.

Can’t remove it? Improve it

The best defense is a good offense, and with a planned, strategic approach, often the terms of your dental office lease can be renegotiated with your landlord. Consider some of these remedies to altering a relocation clause in your favor:

Landlord is Responsible for All Expenses: Negotiate the terms of the clause so that the landlord becomes responsible for all costs associated with the move, including marketing materials and stationary, moving expenses by trained dental movers, demolition, renovation, and the build-out of the new space. Put the onus on the landlord to conform the space to your needs, not the other way around.

Rent Abatement: Ensure you will pay the same or comparable rent in the new location.

Comparable Location: Add language that will ensure the new premises will be comparable with the original space in terms of size, configuration, view, and foot traffic.

Sufficient Notice: Demand a sufficient notice period in order to adequately prepare your staff, patient roster, and build-out of the new space to avoid any practice downtime until the new location is ready.

Limit the Number of Relocations: Because landlords can exercise their right to relocate you indefinitely, negotiate the language so you can only be relocated once during your term.

Lease Termination Rights: Finally, try to negotiate your option to terminate the lease should the landlord relocate you to a less-than-adequate location.

Better yet, avoid the problem altogether

Starting or buying a dental practice is always exciting, but before you break out the bubbly and sign your name on the dotted line, it’s imperative to conduct a thorough review of the details in your dental office lease. A dental office leasing professional can vet out any hard-to-spot risks like the relocation clause in the lease, and devise an appropriate lease negotiation strategy to improve the terms of your lease agreement before it’s too late.

A strong lease can set you up for success by offering security and long-term practice location protection so that you can focus on practicing dentistry without having to worry about packing up your business down the line. To learn more, request a free lease consultation.

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How can dentists compare PPO plans?

Posted on by HS We Do That | Category Coding and Insurance

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For many dentists, more than 50% of their practice revenue is generated through Preferred Provider Organization (PPO) plans. Thus, it is important to compare PPO plans prior to enrollment as well as periodically after enrollment to ensure practice profitability.

As a starting point, compare the in-network reimbursements across your top grossing procedure codes. It can be helpful to use a spreadsheet to compare in-network reimbursements paid by each PPO plan. Use your office fees as a benchmark to calculate the in-network reimbursements as an average of your office fees. Rank each plan from highest to lowest according to the average in-network reimbursements. Factor into your ranking whether the insurance carrier is willing to negotiate in-network reimbursements and how often they are willing to negotiate.

Next compare each PPO plan based upon the number of your current patients covered by each plan. You may be able to obtain a list of your insured patients and their specific PPO plan through your practice management software. It may further be worth comparing the total number of insureds under each plan within your area from a patient growth perspective. A few PPO insurance carriers are able and willing provide to you the total number of their insured members located within a specific geographic region. You may otherwise be able to approximate the number insured members through researching the larger employer groups in your area, their total number of employees and then identifying who they utilize to provide or administer their employees’ dental benefits.

Finally, keep in mind the varying limitations placed on in-network dentists and insurance carrier requirements for claim payment when comparing PPO plans. These limitations and requirements are often overlooked but can impact PPO revenue. For example, one of the largest PPO plans limits reimbursement of periodic exams to exam one per year. Thus, in-network providers may be unable to collect payment for a second exam when completed within the same calendar year. Another major PPO insurance carrier now requires a narrative explaining necessity to obtain reimbursement for a PA film. This requirement makes it more a difficult or, at least, a more time consuming process to obtain reimbursement for this common expense. Insurance carriers will likely continue to implement cost containment measures and it is worth evaluating the associated in-network limitations and the obstacles to obtain reimbursement when comparing PPO plans.

For more information on comparing PPO plans, request a free insurance management consultation.

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Will I lose patients if I drop a PPO plan?

Posted on by HS We Do That | Category Coding and Insurance

Waiting Room 2While many dentists are extremely frustrated with the low reimbursements they receive from Preferred Provider Organizations (PPOs), they are reluctant to drop a PPO plan for fear of losing current patients who are covered by the plan. While there is a risk of patient loss associated with terminating in-network participation, there are ways to potentially avoid, mitigate or off-set patient loss.

First, determine whether there is a possibility for in-network participation through a direct contract with another PPO insurance carrier. There may be an opportunity to participate in-network with a specific PPO plan even after you terminate your direct contract with the PPO insurance carrier. Many PPO insurance carriers enter into shared network agreements, whereby a dental provider may participate in-network with multiple PPO plans through another PPO contract. For example, a dental provider may be directly contracted only with Principal and participate in-network with Ameritas insured patients. It is important to keep in mind this may only be an option in limited circumstances. A PPO carrier with whom you terminate your direct contract may not allow you to participate in-network via a shared network agreement.

Second, PPO plans often provide out-of-network benefits. It is important to understand the limitations of any out-of-network benefits; especially if a portion of your current patients work for the same employer group with limited out-of-network benefit coverage. This information can help prevent loss of patients who are covered by the PPO plan by explaining to them the extent they can still utilize their dental benefits at your practice. Identify the current patients insured by the plan you intend to drop and develop a plan to communicate with them after you terminate in-network participation with their plan.

Third, evaluate options to participate with a few other PPO plans you do not currently participate in-network with. There may be PPO carriers that offer a competitive rate of reimbursement and are seeking dental providers for their insured patients in your area. This new or additional PPO participation may allow you to off-set patient loss by adding new patients to your practice and at higher rates of reimbursement.

It is important to evaluate your PPO participation on regular basis. Your cost of doing business increases each year and it may not make financial sense to continue participating with a specific plan that will not sufficiently increase reimbursements. The potential negative impact of dropping a specific PPO plan may be much less than you initially feared after you carefully evaluate the insurance plan and develop a strategy to mitigate and off-set patient loss.

To learn more, schedule a free insurance consultation.

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3 Questions to Check Your Dental Coding Skills

Posted on by Jen McGuire | Category Coding and Insurance

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Coding correctly is critical for maximizing reimbursement, increasing cash flow, and minimizing any coding errors that could result in fines or worse. We consistently find $20,000 to $30,000 in coding errors during our practice analysis process. Test your coding knowledge with these 3 questions.

1. What code should be used for fluoride treatments?

2. When can you use code D0180?

3. What code should be used for an emergency visit to treat a patient in pain?

Answers

1. D1208 and D1206 (varnish) should be used for child and adult fluoride; previous restrictions to patients with moderate to high caries risk have been eliminated. Fluoride codes D1203 and D1204 were discontinued in 2013.

2. D0180 may be reported for established periodontal patients, patients showing signs or symptoms of periodontal disease, and for patients with risk factors such as smoking and diabetes. D0180 usually pays a slightly higher UCR than D0150.

3. D9110 can be used to report minor non-definitive procedures to reduce discomfort, sensitivity, or pain at an emergency visit. D9110 is a procedure code, not an exam code, so it does not use one of the patients’ limited exams for the year.

Perfect the process of coding and insurance administration in your practice. Request a coding review from your Henry Schein representative today.

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5 Things Every Dentist Should Do BEFORE Renewing an Office Lease

Posted on by HS We Do That | Category Practice Management

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By: Jeremy Behar, President and CEO, Cirrus Consulting Group

Smart dental office lease negotiations require long-term strategic planning, and a proactive approach. Like a poker player who analyzes their hand and anticipates the dealer’s cards, dentists who prepare for lease renewals and begin negotiations ahead of time are more likely to come out winners.

Here’s what you need to know to get ahead of the game and start planning for your upcoming office lease renewal.

1. Save the date

The first thing to do is review your current office lease. Note your lease expiry date and your lease renewal date (often called an “option to extend”), and mark these in your calendar, with several reminders as the dates draw nearer. It is recommended that dentists start preparing for negotiations at least 18 to 24 months before their lease expiry date. This typically provides enough time to assess your short and long-term practice goals, prepare a negotiation strategy, and bring the landlord to the table.

 2. Read the fine print

Next, review and analyze the language in your office lease to identify any clauses that may impact your flexibility for a renewal or, hinder your long-term plans. Often, risky language in the lease is buried under dense legal jargon that may take some digging to find.

3. Look for these important leasing considerations:

Option to Renew: Does the lease provide sufficient options to renew the lease? When the time comes to transition/sell the practice, will these options be transferable to a future tenant? Without flexibility in a lease, your practice value goes down immensely in the eyes of a future buyer.

Surprise Relocations: Can your landlord relocate your practice multiple times throughout your tenancy, at your expense?

Death and Disability Protection: In the event of death or an accident that prevents you from working, are you and your family protected? Can you terminate the lease, or will your landlord continue to charge you rent until the end of your lease term?

Assignment Language: Can your landlord deny your request to sell the practice and retire? Can they terminate your lease and kick you out of the premises just for inquiring?

When it comes to deciphering the complex language in your office lease and understanding how to structure your new one, it is recommended that you engage the help of dental office leasing professionals as there is little room for making mistakes.

4. Know the stakes

So, now that you are fully aware of the risks buried in your lease, and its expiration and renewal deadlines, what’s next? Track them! When you pass your office lease expiry date, you turn into a month-to-month or “overholding” tenant, which means that you are no longer protected by the security of your lease. This is a risky arrangement because your landlord now has the right to terminate your lease with 30 days’ written notice, giving you very little time to find a new location and relocate your practice.

5. Make your move

In the long run, a dentist who sits back and does nothing about their lease renewal deadline will spend a lot of time, effort and money repairing unnecessary damage. A dentist who prepares early, avoids the financial pitfalls and inconvenience brought on by poor planning. All it takes is a careful review of your dental office lease agreement, anticipating – and not simply waiting for – the expiry of your current lease, and knowing what terms to negotiate so your business is protected.

When it comes to planning for an office lease renewal, a dentist should approach their lease negotiation with a full understanding of what it is they want to achieve for their practice in the long-run. Don’t be a passive tenant, and don’t allow your landlord to command the terms of your tenancy.

Educate yourself and take action, so that when it’s time to negotiate the terms of your new lease, you’re the one coming out on top with a winning hand. Request a free consultation to discuss any areas of concern in your lease.

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Need for Gingivitis Treatment Recognized with New CDT Code

Posted on by Jen McGuire | Category Total Health

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Over the last few years, new research has broadened our understanding of the implications of gum disease. As the connection between oral bacteria and inflammation, and overall health has become clear, there has been an increased emphasis on treating gingivitis to help patients avoid a further decline into periodontal disease. Unfortunately coding has failed to reflect this new understanding and the coding gap that exists between healthy patients and those diagnosed with periodontal disease has made gingivitis intervention difficult.

Consider how you address gingivitis in your practice. Typically these patients are treated with a prophy and education on improving homecare. For many this will not be sufficient to reduce gum inflammation, and gingivitis will eventually progress to periodontal disease.

“Current codes document treatment procedures for patients with a healthy periodontium or patients with periodontal disease that has accompanying loss of attachment — such as periodontal pockets and bone loss,” said Dr. Ronald Riggins, committee chair. “However, there is no CDT code available to record therapeutic treatment of patients with gingival disease and no attachment loss.”

In March, the Code Maintenance Committee approved a new scaling code designed to address this coding gap and represent care for patients with gingival disease, without attachment loss.  The new code, which will appear in the periodontics category of the 2017 CDT manual, is defined as “scaling in the generalized presence of moderate or severe gingival inflammation — full mouth, after oral evaluation.”

This new code allows the dental team to properly document the treatment needed, both for the patient and a third-party payer. While there is no guarantee that insurance companies/employers will provide coverage for this treatment, proper documentation for the necessary care is a step in the right direction! For help explaining the importance of gum health to your patients, request a free copy of the Total Health patient brochure from your Henry Schein representative.

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Answer 3 Questions to Avoid a $25,000 Lawsuit

Posted on by Jen McGuire | Category HR

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Did you know that dental practices are subject to 95% of the same labor regulations as large corporations like Henry Schein?

Minimize your risk of HR violations by completing a short compliance audit. You can assess 4 key areas of employment compliance in less than 5 minutes.

1. Do you have an up-to-date HR policy manual?
Only 51% of respondents have answered “YES.”

2. Do you have a job description/expectation manual?
Only 53% of those with policy manuals stated theirs contained job descriptions.

3. Do you have a written hiring/firing process?
Average respondent has hired 1 person within the last 12 months.

4. Answer the rest of these critical questions. The experts at Bent Ericksen will review your responses, evaluate any potential red flags in your practice, and schedule a free advisory call to help you address any areas of employment liability risk.

For more information on employment compliance contact your local Henry Schein representative or review our HR and Behavioral Styles information.

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