Dental Office Administration

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Dental Office Administration

GERALDINE IRLBACHER-GIRTEL, BScN, RN, MEd

GUY S. GIRTEL, DDS

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Library of Congress Cataloging-in-Publication Data

Irlbacher-Girtel, Geraldine.Dental office administration / Geraldine Irlbacher-Girtel, Guy S. Girtel.

p. ; cm.ISBN 978-0-7817-9160-1

1. Dental offices—Management. 2. Dental office managers. I. Girtel, Guy S. II. Title. [DNLM: 1. Dental Offices—organization & administration. 2. Accounting—methods.

3. Office Management—organization & administration. 4. Personnel Management—methods. WU 77 I69d 2009]

RK58.I75 2009617.60068—dc22

2009021969

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For Everett and Simon

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Preface

Advancements in the field of dentistry are constant. As clinical advancementsgrow, there is an increasing need for educated professionals in the administra-

tive area of the dental field. The oral health of the public is much too important tobe left up to personnel who are not formally trained in the dental field. Dental of-fice administrators are dental professionals who receive the formal training re-quired. The formally trained dental administrative assistant has become a criticalcomponent in the delivery of quality oral health care. As an administrative memberof the dental profession, you are embarking on an exciting and challenging career.

OBJECTIVE

The primary objective of this text is to make available a comprehensive resource ondental office administration to the dental profession and the administrative and clin-ical staff who affect the success of a dental office. As you progress through the chap-ters, you will find that all the information reflects current information and develop-ments in the dental industry.

ORGANIZATION

This textbook is organized into five parts. Part 1 provides an introduction to the dental administration profession by pro-

viding insight into the dental office from the business perspective. This section ex-plores the characteristics of a successful dental administrator. A thorough definitionof the role of the dental administrator and explanation of the importance of the po-sition give the reader a complete understanding of the qualifications and expecta-tions of the position. A comprehensive review of the components of a successfuldental office, such as office layout, team members and their roles, and the special-ties found in the dental profession, provides students with the knowledge requiredfor success in the profession. This section also covers the ethical and legal knowl-edge necessary for dental administrators and further outlines the responsibilitiesthat they have to patients in the dental practice as mandated by HIPAA in the UnitedStates and PIPEDA in Canada. Section 1 is rounded out with the importance ofasepsis in the clinical and administrative dental environment and the responsibilitiesof the dental administrator in this regard.

Part 2 begins with a dental terminology section as a necessary resource for thereader to ensure correct pronunciation and usage of dental terminology in the

Preface

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industry. The main focus in the section is on communication in the dental office andthe importance of correct and accurate communication. Emphasis is on the devel-opment of successful verbal and nonverbal communication skills and their effect onpatient relationship development. Effective telephone and written communicationskills are brought together in this section to emphasize this very important area ofthe dental administrator role.

Part 3 introduces the critical features of the role of the dental office administra-tor: patient record management, patient development and maintenance, appoint-ment management, office policies and procedures, filing procedures, inventory, andtechnology. For success in the dental practice to occur, the dental office administra-tor must grasp the fundamental skills of establishing and maintaining patient rela-tionships. The reader will become well-versed in methods used in the dental officeto achieve a balanced patient flow such as recall systems, telephone reminders, andwritten reminders.

Appointment management is introduced, and readers are given real-life scenar-ios to challenge them. Providing insight into how to deal with late patients, no-shows, walk-ins, and emergencies will enhance the confidence to effectively dealwith patients for any reader new to the dental industry. An understanding of dentaloffice policies and the role they play in the development of a successful practice out-lines other management responsibilities that dental office administrators must be familiar with. This section ends with a look at dental office filing and inventory pro-cedures, and an in-depth look at computerized practice management. An overviewof a computerized practice management program is given with applications for thereader to get a feel for the real thing.

Part 4 addresses the financial management aspects to dental office administra-tion. Patient billing and payment is a large part of dental administration. One chap-ter is devoted to the collection of funds from patient by various means, with the bulkof the attention being given to insurance companies and the forms required for fil-ing a dental claim, as well as the different types of dental plans available. Accountsreceivable and accounts payable are both given equal time to provide a comprehen-sive lesson in collecting monies and paying expenses in the dental office. Bankingprocedures and payroll functions are outlined in the final two chapters of this sec-tion. In smaller dental clinics, the dental office administrator becomes the one staffmember who is responsible for the financial aspects of the practice. A full overviewof these procedures provides the reader with essential knowledge for managementof a dental office.

Part 5 is devoted to the career considerations of the dental office administrator.As students begin the transition from student to employee, tips for making that tran-sition as smooth and successful as possible are provided.

FINAL NOTE

In all chapters, Web sites and references used are current. These are included to sub-stantiate the content and to encourage self-study by the reader. Self-education is es-sential for professional growth in the dental industry, especially if your career hasjust begun!

It is hoped that this book will facilitate the learning and knowledge necessaryfor success in the role of the dental office administrator. As the program you are inprepares you to be a respected professional of the dental industry, the knowledgethis book provides will stay with you as you enter the world of dentistry and en-hance the face of dental office administration.

Geraldine Irlbacher-Girtel, BScN, RN, MEdGuy S. Girtel, DDS

viii Preface

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Chapter Introductions lay out the topics that willbe covered in each chapter.

User’s GuideUser’s Guide

This User’s Guide helps you take full advantage of theDental Office Administrationtal Office Administra-tion text. Each chapter offers helpful features that en-able you to quickly master new concepts and put yournew skills into practice.

A number of features are included in this text tofacilitate learning.

OBJECTIVESAfter completing this chapter, you should be able to do the following:

• Spell and define key terms• Describe the various functions and responsibilities of the dental office administrator

• List personal characteristics of the dental office administrator

• Describe the layout of a dental office • Discuss the concept of professionalism as it relates to the dental office administrator

• Explain the importance of the administrator’s position in the dental office

• Identify team members in the dental office and their role in the office

• Discuss the specialties in dentistry and the differences among them KEY TERMS

Dental OfficeAdministration

• dental office administrator• professional • professionalism • team member • confidential • consultation area • dental operatories • sterilization area • laboratory • dentist • dentistry

• DDS• DMD • dental specialty• dental specialist • RDH

• certified dental assistant• registered dental assistant • dental office manager • CDT • professional association

T oday’s dental offices are different from dental offices of the past, where little em-

phasis was placed on the office environment and where the sterile office smell and

silence were commonplace. The creation of a comfortable atmosphere and removing the

3

Introduction to OUTLINE

What Is a Dental OfficeAdministrator?Functions and ResponsibilitiesCharacteristics of aSuccessful Dental OfficeAdministratorProfessional AppearanceProfessional AttitudePromptness and EffectiveTime ManagementOther CharacteristicsTeamwork

Confidentiality Importance of the PositionEducation and Certification Certification of theDental Assistant National Credentials State CredentialsCertification of theDental OfficeAdministratorDental Office LayoutReception and Business AreasFront Desk Dentist's Office Consultation AreaClinical AreasStaff Areas

Dental Team Dentist Dental SpecialistsDental Hygienist Dental Assistant Dental Office Manager Certified Dental Technician Sterilization Assistant andOffice Assistant Association MembershipsChapter Summary

O U T L I N EWhat Is a Dental OfficeAdministrator?

Functions and ResponsibilitiesCharacteristics of aSuccessful Dental OfficeAdministratorProfessional AppearanceProfessional AttitudePromptness and EffectiveTime ManagementOther CharacteristicsTeamwork Confidentiality Importance of the PositionEducation and Certification Certification of theDental Assistant National Credentials State CredentialsCertification of theDental OfficeAdministratorDental Office LayoutReception and Business AreasFront Desk

Dentist's Office Consultation AreaClinical AreasStaff AreasDental Team

Dentist Dental SpecialistsDental Hygienist Dental Assistant Dental Office Manager Certified Dental Technician Sterilization Assistant andOffice Assistant Association MembershipsChapter Summary

chapter O N Echapter O N E

Learning Objectives provide clear goals toensure mastery of the content presented inthe chapter, and Key Terms are listed at thebeginning of each chapter and are boldfacedat first use within each chapter to introducethe student to the basic vocabulary of dentaloffice administration. These key words arealso listed and defined in the glossary at theback of the book.

30 PART I Introduction to the Profession

As a dental office administrator, you will work on behalf of the patient as well as thedentist to ensure a high level of professional excellence in delivering oral health care.In the process of doing this, you will be faced every day with making decisions that

have serious legal and ethical implications. Such decisions can affect not only the healthand well-being of your patients but also the liability and reputation of your dental officeand colleagues and the very future of your career. For example, if the dental office ad-ministrator received a telephone call from a patient who requested a refill of his or herpain reliever prescription, the dental office administrator would know that there are fed-eral laws that govern prescription writing and medication administration that apply tothe dentist. If the dental office administrator chose to accommodate this patient andprovide him and her with a refill for the prescription by telephoning the pharmacy with-out first getting the permission of the dentist, the dental office administrator would beacting on behalf of the dentist and in violation of the laws in this respect. Thus, it is crit-ical that you understand the state and federal laws that govern the dental office and todevelop a strong, personal code of ethics to guide you as you work as a dental officeadministrator.

The purpose of this chapter is to introduce you to the legal concepts and laws thataffect the dental office, especially the Health Insurance Portability and AccountabilityAct of 1996 (HIPAA), and to discuss how you can help ensure compliance with these lawsin your role as an administrator. Additionally, this chapter presents the codes of ethicsadopted by dental professional associations and covers key ethical issues you will face asa dental office administrator. Finally, this chapter equips you to establish your own ethi-cal framework, to guide you as you make difficult decisions.

• defamation • breach of confidentiality • privacy rule• protected health information (PHI)• individually identifiable health information• privacy practices notice• minimum necessary• personal representative

• privacy officer• mitigation • security rule • administrative safeguards• technical safeguards • physical safeguards• code of professional conduct• code of ethics

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x User’s Guide

Canadian Practice boxes offer unique content related to dental administration in Canada.

74 PART I Introduction to the Profession

CANADIAN PRACTICE : WORKPLACE HAZARDOUS MAT E R I A L SINFORMATION SYST E M

The Workplace Hazardous Materials InformationSystem (WHMIS) is a classification system establishedby the Canadian Center for Occupational Health andSafety (http://www.ccohs.ca/oshanswers/legisl/intro_whmis.html) that groups chemicals that have simi-lar properties. In the dental office, there are many mate-rials you may come across through stocking, disposing,ordering, or using that fall under any one of thecategories outlined by the WHMIS. There are six classesof hazardous materials in this system, some of whichsubdivide to include other classes.

The figure shows each of the six classes and the sym-bol associated with each. The symbol for each class isthe symbol that can be found on the container of thematerial. For example, cleaning supplies, dental x-ray de-veloper, mercury amalgam waste containers, and sharpsdisposal containers will all have one of the symbols yousee in the figure on the outside of the container. Thepurpose of the symbol is to aid in the identification ofthe hazardous material.

The six classes are as follows: compressed gas, flamma-ble and combustible material, oxidizing material,poisonous and infectious material, corrosive material, anddangerously reactive material. One of the regulations con-cerning these materials is that they are considered danger-ous goods and, as such, are not able to be transportedwithout an MSDS, discussed later in this chapter.

Although you may not come across every one ofthese hazardous materials in the dental office, it is use-ful to study these symbols so that you will recognizeany hazardous materials that are in the dental office.

Compressed Gas

The compressed gas symbol is a picture of a cylindersurrounded by a circle.

Any material that is normally a gas and contained in acylinder is considered compressed gas. Compressed gasis considered dangerous because it is under pressure. Ifthe cylinder is broken by misuse and handling, it can be-come a projectile, which could cause damage to an ob-ject or a person nearby. Also, if a cylinder ofcompressed gas is heated, it will explode. In the dentaloffice, you may see a cylinder of oxygen or nitrous ox-ide for sedation purposes.

Flammable and Combustible Material

Flammable means that the material will burn or catchfire easily at normal temperatures. Reactive flammablematerials are those that may suddenly start burningwhen they touch air or water or may react with air orwater to make a flammable gas. The material may be asolid, liquid, or gas. Combustible materials usually have

to be heated before they catch fire. In the dental office,you may see butanes or solvents with the symbol of aflame inside a circle, which indicates that the material isflammable or combustible.

Oxidizing Material

The symbol for this class of materials is an “o” withflames on top of it. Oxidizers are materials that assist inthe fire process by providing oxygen. An oxidizer can bea gas, a liquid, or a solid.

Poisonous and Infectious Material

These materials can cause serious harm to a person.There are three subdivisions of materials in this class, allof which are found in the dental office, so they willreceive our attention.

1. Division 1: Materials causing immediate toxic effects,such as poisons, cleaning supplies, or dental x-raydeveloper, make up this division. These materials areidentified by the “skull and cross-bones” symbol.

2. Division 2: Materials causing other toxic effects,such as cancer, allergies, or reproductive changes,are part of this division. The symbol is a “T” with anexclamation point at the bottom. Materials such asmercury and benzene, which are found in thedental office, fall into this category.

3. Division 3: Biohazardous infectious waste refers tothe organisms that can be produced from infectiouswaste and cause diseases. In the dental office,sharps are the most common form of biohazardouswaste. The symbol looks like three “c’s” joinedtogether in a circle.

Corrosive Material

Corrosive material can cause severe burns if it comes incontact with skin or other human tissue and can usuallyburn through clothing and other material as well. Thedamage is permanent. The symbol for this class of mate-rials is two test tubes pouring material, one onto a hand,the other onto a bar, and showing the items beingaffected. This type of material would more likely befound in a dental laboratory than in the dental office.

Dangerously Reactive Material

Most of materials classified as dangerously reactive areextremely hazardous if they are not handled properlybecause they can react quickly and easily. An exampleof this type of material would be aluminum chloride.The symbol for dangerously reactive materials is apicture of a test tube with lines coming out of the tubesurrounded by a letter “R” inside a circle.

CANADIAN PRACTICE : WORKPLACE HAZARDOUS MAT E R I A L SINFORMATION SYST E M

what I FA patient has arrived for anappointment and hasexpressed concern to youabout the dental assistantwearing gloves duringtreatment. The patientfeels that this is offensivesince she does not haveany diseases that the den-tal assistant should be con-cerned with contracting.How do you respond?

It is important toeducate the patient on themeaning of “standard pre-cautions” and what isinvolved with this process,particularly, how these pre-cautions protect the dentalpatient and staff members.The patient needs to beaware that every patient istreated the same; that is,all members of the clinicalstaff wear gloves for eachtreatment performed oneach patient.

What If boxes are hypothetical scenarios in thedental office that require the reader to applyknowledge to resolve a realistic issue or problem.

legal TIPDiscussing patientinformation where otherpatients can overhear cansometimes happenunintentionally in thedental office. Use thefollowing points tominimize this fromhappening:

• Use a private area outof the range of hearingof others to discuss pa-tient information.

• Use a low voice whenspeaking with patientsin public areas.

• Never address a patientby his or her full firstand last name.

• Never discuss patientsoutside of the dentaloffice with otherpeople.

Legal Tips are tips on protecting patients’ privacy while per-forming day-to-day tasks with medical records and on basiclegal responsibilities of dental office administrators.

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User’s Guide xi

Administrative TIPWhen a new patient telephones the dental office to sched-ule an appointment, there is specific information that isnecessary to obtain from the patient to establish a patientrecord before setting an appointment. Some dental officesmay require only name and contact phone number as theinformation necessary for scheduling the appointment.Other offices may require more information to establish apatient record. A new patient telephone call informationsheet is a very useful tool in establishing a patient record.This is a form that is kept in an accessible place to collectthe necessary patient information, such as name, address,phone number, date of birth, and insurance information.Having this information prior to the patient appointment al-lows you to mail the proper forms to the patient for com-pletion prior to the appointment and verify insurance infor-mation. The form can also be used to collect informationsuch as the referral source of the patient. If a currentpatient has referred a new patient, this is an opportunity tosend a thank you card or other acknowledgment to the re-ferring patient. Finally, documenting when the new patientdemographic and health history forms were sent can alsobe verified on this form. When the patient arrives for thescheduled appointment, the form can then be filed in thepatient chart, as it is written documentation of the initialcontact with the patient. Figure 8-7 is an example of whatthe new patient telephone call information sheet may looklike. This form can be modified to fit the requirements ofthe dental office.

Administrative Tips are tips on how to perform some ad-ministrative task in the dental office.

Tip F ROM THE DENTISTOne of the most distressing things that I see when I am lead-ing my team to provide a caring, safe, and stressfree environ-ment for our patients is when members of the team don’tunderstand or appreciate their role in maintaining the flowin the dental office. For instance, if the dental office admin-istrator fails to be ready and able to work at the opening ofthe office, someone must take the place of that individualto answer the phone and greet patients as they arrive. If theperson filling in is the dental assistant, then he or she is nolonger available to help the dentist or attend to patients’needs in the operatory. The responsibility of every employeein the dental office is not to the dentist or patient alone butto every member of the dental team.

Each member of the team must understand and appreci-ate the role of all team members and how each person isintegral in maintaining an efficiently run office. Just as im-portant, team members must be aware of how theiractions affect the team.

Team members may appear disorganized and incompe-tent when they are trying to fill in where they don’t feelcomfortable; this creates a pressure-filled environment thatpatients can sense.

Tips From the Dentist are tips from the perspec-tive of the dentist regarding optimal practices fordental administrators.

PROCEDURE 3- 1 Hand Washing

4. Rinse thoroughly under the running water, startingfrom the forearms to the fingertips.

5. Repeat the process. 6. Use a paper towel to dry your hands and

forearms. 7. Use a paper towel to turn off the tap. Do not use

hands to turn off the tap as the risk ofrecontamination to hands is greater.

The following steps outline a correct hand-washing pro-cedure.

1. Remove all jewelry (rings, watches, bracelets). 2. Turn on the tap and run cool water at a medium

stream. Use antimicrobial soap. 3. Lather hands, wrists, and forearms. Rub all surfaces

using light pressure. Fingers should interlace.Wash each finger individually, rubbing with a back-and-forth motion with light pressure.

Procedure boxes provide step-by-step directions on performing common office manage-ment tasks.

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xii User’s Guide

POINTcheckPOINT2. Describe five personal

characteristics of thedental officeadministrator.

3. Why is it importantfor the dental officeadministrator to thinkand act calmly inemergency situations?

Checkpoint Questions are re-view questions interspersedthroughout each chapter thatallow students to check theirrecall of the content presentedin the section just read.

Chapter Summary

Dentistry is constantly evolving. The formally trained dental office administratorwill be a part of one of the most exciting times in dentistry, as new advances in den-tistry appear everyday. The dental team members can make a dental practice verysuccessful when they work together to deliver high-quality dentistry. As a dental of-fice assistant, the value you add to the dental office by embracing the responsibili-ties and challenges that present themselves every day is an important resource to thedental office. The dental office needs a dental office administrator to create asmoothly run environment. As you grow professionally, your career as a dental of-fice assistant will prove to be as exciting and steadfast as the advancements you’llencounter in the dental profession.

Chapter Summaries offer a brief review ofthe content covered in the chapter.

CHAPTER 1 Introduction to Dental Office Administration 27

Review Questions1. In addition to the qualities touched on in this chapter,

discuss some personal qualities that you think a den-tal office administrator should possess and why theywould be important in the dental office.

2. Describe some of your personal experiences as apatient in the dental office and think about whatcould have been done to make the experiencedifferent or better. If your experience was a positiveone, what were the things that made it so? If yourexperience was negative, what could have beendone differently to prevent it?

3. Review the list of dental specialists and think aboutwhich of them you would like to work for. Arethere any specialists in the geographic area in whichyou live? If they have a Web site, can you get anymore information on their office? Prepare a writtenresponse to these questions.

Multiple Choice 1. Time management is

a. the utilization of processes that increase a per-son’s time efficiency.

b. a process that occurs naturally over time. c. the biggest challenge faced by administrators in

dental offices today. d. an evolving method of scheduling proficiency.

2. A common time waster in the dental office isa. a patient who consistently arrives late. b. staff who discuss personal issues during lunch

hour. c. lengthy important telephone calls to patients. d. reading personal e-mails during office hours.

3. Which of the following does not contribute to pro-fessional appearance?a. Long curly hair tied back b. Finger nails cut to a short, active lengthc. Shoes that are scuffed from overwear d. Clean, pressed uniform

4. A main concern for the dental office administratorshould bea. building relationships with all employees. b. caring for patients and their welfare. c. being available for weekend work. d. ensuring that all employees receive their paychecks.

5. Which of the following credentials applies to den-tists?a. RDHb. CDT c. DMDd. RDA

6. The reception area of the dental officea. should be updated regularly. b. is the main “hub” of the office. c. should accommodate the patient.d. is maintained by the office assistant.

7. Procedures a dental assistant may performa. vary depending on the state in which the dental

assistant works.b. are based on the requirements of the dentist and

office needs. c. vary depending on the number of dental assis-

tants in the office. d. are all the same, regardless of certification and

training.

8. The duties of an office manager include all of thefollowing excepta. interviewing job applicants.b. performing dental procedures. c. maintaining accurate financial records. d. managing payroll.

9. The purpose of dental professional associations istoa. produce CE courses for ongoing learning.b. keep all members in contact with one another. c. provide support, recruitment, and retention for

dental professionals.d. none of the above.

10. Which of the following is not a responsibility ofdental office administrators?a. Greeting patients as they enter the office b. Ensuring correct treatment performedc. Scheduling appointments for patients d. Collecting payment on accounts

Web Sites American Dental Associationhttp://www.ada.org/

American Dental Hygienists Association http://www.adha.org/

American Dental Assistants Association http://www.dentalassistant.org/

Chapter Review Questions are mul-tiple-choice questions appearing atthe end of the chapter that help thestudent review the chapter material.

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User’s Guide xiii

76 PART I Introduction to the Profession

Review QuestionsMultiple Choice Select the best response for each question.

1. The spread of disease through contact with con-taminated surfaces such as instruments, counter-tops, and handles is referred to asa. cross-contamination. b. parenteral. c. airborne transmission.d. infectious waste.

2. A pathogen isa. a disease caused by a biological agent such as a

parasite or bacterium.b. waste capable of causing or transmitting an in-

fectious disease.c. a virus or microorganism that causes disease.d. the contact with infectious material as a result of

an employee’s duties.

3. Sharps are infectious materials to be disposed ofin aa. dental material garbage can. b. sharps container. c. sterilized waste container. d. regulated waste container.

4. The transmission of infectious diseases from bodyfluids contaminated with blood is calleda. airborne transmission. b. bloodborne transmission. c. cross-contamination. d. occupational exposure.

5. Biohazardous waste refers to waste such as a. items contaminated with saliva only. b. items contaminated with blood only. c. items contaminated with blood and saliva. d. all items used in the dental office.

6. The following are all examples of personal protec-tive equipment, except a. glasses. b. masks.c. shoes. d. lab coat.

Critical Thinking1. One of the team members in the dental office con-

tinually brings patients’ charts to the front deskwhile still wearing gloves worn during treatmentand has on occasion used pens and left them on thedesk when finished. Is there anything wrong withthis, and, if so, how would you deal with it?

2. As a dental office administrator, you will spendmost of your time in the administrative areas of thedental office, so why do you need to understandasepsis procedures and controls?

3. How do you think a malpractice lawsuit might oc-cur as a result of improper infection control tech-niques?

4. Why do you think it would be beneficial to patientsif you were to educate them regarding infectioncontrol procedures in the dental office?

5. How is learning about hazardous materials usefulto your role as a dental office administrator?

Critical Thinking Questions help thestudent process and apply the chaptermaterial through a number of thought-provoking questions.

3. Prepare a letter for an insurance company of yourchoice, asking it to send payment for a claim thatyou are attaching. Prepare the letter for foldinginto an envelope by showing marks on the letter toindicate the folds, and address the proper sizeenvelopes for mailing.

HANDS-ON ACTIVITY

1. Design a fax cover page for the officeyou are working in.

2. Write a letter to a new patient, thanking him orher for the referral to the practice. Use the semi-block format.

Hands-On Activities require the stu-dent to practice a common task, suchas dental charting, writing a memo, orconducting a mock telephone call withanother student.

ADDITIONAL RESOURCES

Additional resources for both instructors and students are available on the book’scompanion Web site at thePoint.lww.com/Girtel1e and on a disk at the back of thisbook. These resources include the following:

For faculty (on Web site)

• test generator• image bank• PowerPoint lecture slides

For students (on disk at the back of book and on Web site [note: DENTRIX G4practice management software available on the CD only])

• Educational version of DENTRIX G4 practice management software(DENTRIX G4 software courtesy of Henry Schein Practice Solutions, AmericanFork, UT)

• DENTRIX G4 learning activities• DENTRIX G4 practice management User’s Guide• DENTRIX G4 practice management Installation Guide• Quiz bank

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This book was born out of a passion to teach and assist in the evolution of thedental health profession. Many people have offered encouragement, support,

and ideas throughout the development of this book and contributed to it by show-ing their commitment to and concern for its realization. We wish to thank, in par-ticular, those who have made exceptional contributions.

First and foremost, we would like to thank David Payne, the managing editorof this project, who provided invaluable insight and patience when necessary for thedevelopment of this textbook. His expertise and dedication were a contributingforce to the completion of this book. In addition, the staff at LWW who were in-volved in the book development provided the support and resources necessary togenerate the textbook: John Goucher, Executive Acquisitions Editor, for his enthu-siasm for the book and assistance with proposal development, and Eric Branger,Managing Editor, for his assistance in the development process.

Finally, we wish to acknowledge our immediate and extended family memberswho all played a role with their encouragement and love during challenging timesthat arose during the book writing process. We wish to thank Ryan Girtel for thepatience and youthful enthusiasm he displayed as the book unfolded as well as Lili,our constant writing companion. We consider our family to include the staff mem-bers of the dental office who have grown with us as we developed this book and ourdental practice and evolved along with the dental profession. Most notably, wewould like to thank Mrs. Nicole Paranica, who has been an unwavering friend andwho believed in us and the necessity of this textbook for the dental profession.

Geraldine Irlbacher-Girtel, BScN, RN, MEdGuy S. Girtel, DDS

AcknowledgmentsAcknowledgments

xv

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TAMARA J. ERICKSON, BADirector of Dental AssistingHerzing College, Lakeland Academy DivisionCrystal, MN

MARI FROHN, AS, BSProfessor Tri-County Regional Vocational Technical High SchoolFranklin, MA

KRISTYN HAWKINS, LDH, BGSClinical InstructorIndiana University, South BendSouth Bend, IN

TONI HOFFA, BSInstructorLakeland Academy Division of Herzing CollegeCrystal, MN

STELLA LOVATO, CDA, MSHP, MAChair of Allied HealthSan Antonio CollegeSan Antonio, TX

MARTHA MCCASLIN, BSBMDental Assisting Program DirectorDona Ana Branch Community CollegeLas Cruces, NM

RITA OHRDORF, MAInstructorUniversity of Northern ColoradoPueblo, CO

SUE RAFFEE, RDH, EFDA, MSASinclair Community CollegeDayton, OH

SHEILA SEMLER, PhdInstructorLansing Community CollegeLansing, MI

DIANA SULLIVAN, MEDental Department ChairDakota County Technical CollegeRosemount, MN

JO SZABO, CDA, CDR, BEDCoordinatorNiagara CollegeWelland, ON

MARY CLARE SZABO, CDA, CDRProfessorGeorge Brown CollegeToronto, Ontario, Canada

MARK THORESON, DDSThe Academy of Dental AssistingRedmond, OR

ReviewersReviewers

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ContentsContents

Preface viiUser’s Guide ixAcknowledgments xvReviewers xvii

part O N E Introduction to the Profession 1

C H A P T E R O N E Introduction to Dental Office Administration 3What Is a Dental Office Administrator? 4

Functions and Responsibilities 4Characteristics of a Successful Dental Office Administrator 6

Professional Appearance 6Professional Attitude 6Promptness and Effective Time Management 6Other Characteristics 8

Teamwork 9Confidentiality 9Importance of the Position 9Education and Certification 10

Certification of the Dental Assistant 10National Credentials 10State Credentials 10Certification of the Dental Office Administrator 11

Dental Office Layout 13Reception and Business Areas 13Front Desk 16Dentist’s Office 18Consultation Area 18Clinical Areas 18Staff Areas 20

Dental Team 20Dentist 21Dental Specialists 21Dental Hygienist 21Dental Assistant 23Dental Office Manager 25

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Certified Dental Technician 25Sterilization Assistant and Office Assistant 25Association Memberships 26

C H A P T E R T W O Legal Responsibilities and Ethics 29Legal Concepts 30

Contracts 31Expressed Contracts 32Implied Contracts 32Termination of Contracts 32

Consent 33Laws That Apply to Dental Professionals 36

Dental Practice Act 36Good Samaritan Act 36Americans With Disabilities Act 36Negligence and Malpractice 37Fraud 38

Health Insurance Portability and Accountability Act of 1996 38Confidentiality and the Privacy Rule 39

Notice of Privacy Practice 41Minimum Necessary Standard 43Personal Representatives and Minors 43Preemption and Exception Determinations 43Administrative Requirements 44

Security Regulations 46Administrative Safeguards 47Technical Safeguards 48Physical Safeguards 48

Identifiers 49Transaction and Code Sets 49

Ethics in Dental Office Administration 49Code of Professional Conduct 49Principles of Ethics 52Patient Rights and Responsibilities 52

C H A P T E R T H R E E Infection Control 59Disease Transmission and Occupational Exposure 60

Methods of Disease Transmission 60Disease Transmission in and out of the Dental Office 62

Patient to Dental Staff 62Dental Staff to Patient 62Patient to Patient 62Dental Staff to Family and Community 62

Infection Control Agencies and Regulations 63Centers for Disease Control and Prevention 63Occupational Health and Safety Administration 63Implementing Office Policies and Maintaining Records 65

Infection Control Techniques 65Immunization 66Personal Protective Equipment 67

Masks and Eyewear 68Gloves 68Uniforms 69

Hand Washing 70Fingernails 70Jewelry 71

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Hand Abrasions 71Waste Management 72

Classification of Waste 72Material Safety Data Sheet 73

Infection Control and the Dental Patient 75

part T W O Communication 79

C H A P T E R F O U R Dental Terminology 81Purposes of Teeth 82

Speech 82Mastication 82Esthetics 83

Parts of a Tooth 83Dentition 84

Primary Dentition 85Mixed Dentition 85Permanent Dentition 85

Arches 85Quadrants 86Anterior and Posterior Teeth 87Types of Teeth 88

Incisors 88Canines 88Premolars 88Molars 89

Tooth Numbering Systems 89Universal Numbering System 89Palmer Notation System 89International Numbering System 91

Tooth Surfaces 91Dental Charting 94

C H A P T E R F I V E Communication in the Dental Office 99Maslow’s Hierarchy of Needs 100Elements of Communication 102Verbal and Nonverbal Communications 104

Verbal Communication 104Nonverbal Communication 105Listening 108Attitude 109Empathy 111

Techniques for Successful Communication 111Reflecting 112Paraphrasing 112Open-Ended Questions 112Summarizing 113Clarification 113

Barriers to Communication 113Sender Barriers 113Environmental Barriers 115

Noise 115Desk Organization 115Interruptions 116

Receiver Barriers 116

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Role of Culture, Stereotypes, and Language in Communication 117Culture 117Stereotypes 117Language 117

Communication With the Dissatisfied Patient 118Communication With Team Members 119

Colleagues 119Dentists 120Other Dental and Healthcare Facilities 120

C H A P T E R S I X Telephone Skills 123Office Telephone 124

Placing a Call 124Transferring 125Conference 125Call Forward 125Message Waiting Indicator 126Last Number Redial 126Hold Button 126Speed Dial 126Call Display 126Cordless Telephones 126Voice Mail 127

Create a Detailed Message for Callers 127Keep the Voice Mailbox Empty 128Refer to the Manual 129Multiple Recorded Greetings 129

Speaking on the Telephone 129Showing Respect for Patients 130Speaking Clearly 131Pronunciation and Word Choice 131Confidence and Voice Tone 132Undivided Attention 133

Managing Multiple Patient Interactions 133Taking Messages 135Personal Phone Calls 136Barriers to Phone Communication 136Types of Incoming Calls 137

Appointment Scheduling 138Account Inquiries 138Dental Emergencies 138Treatment Inquiries 138Challenging Calls 139

Upset Patients 139Telemarketers, Solicitors, and Unidentified Callers 139

Types of Outgoing Calls 140Referrals 140Prescriptions Called in/Renewed 140Patient Confirmation 140

C H A P T E R S E V E N Written Communication 145Writing Basics 146

Effective Sentences 146Avoiding Common Errors 148

Word Choice 150Level of Formality 150Slang Terms and Expressions 150

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Stereotypical Language 150Contractions 151

Punctuation Review 151Period 151Comma 152Semicolon 152Colon 153Quotation Marks 153Exclamation Point 153Apostrophe 153Dash 154

Capitalization 154Abbreviations 154Numbers 154

The Business Letter 155Components 155Letter Formats 158Writing an Effective Letter 159

Identify the Purpose 159Organize the Facts 160Know Your Audience 161Choose an Appropriate Template 161Proof a Sample Copy for Spelling and Accuracy 161

Other Types of Written Documents 163Patient Correspondence 163Letters Between Dentists 163Mail Promotions 163Employee Memos 163

Methods of Sending Written Communication 164Preparing for Postal Delivery 164Postage 166Courier 166Facsimile 166Electronic Mail 167

Personalize the Letter 168Use a Relevant Subject Line 168Never Use All Capital Letters 168Spell Check 168Provide Your Information in the E-mail 168Phone Whenever You Can 168

Managing Incoming Mail 168

part T H R E E Dental Office Management 173

C H A P T E R E I G H T Patient Record Management 175Patient Chart Contents and Forms 176

Patient Demographic Forms 178Health and Dental History Forms 184Clinical Chart Forms 186Progress Notes Forms 187Treatment Plan Forms 188

Recording Patient Communication 190Incident Reports 193

When to Complete an Incident Report? 195What to Include in the Incident Report? 195Follow-Up to an Incident Report 196

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Preparing a Patient Chart 197New Patient 197Emergency Patient 198Returning Patient 199

C H A P T E R N I N E Patient Development and Maintenance 203Developing Patient Loyalty 204

Make a Good First Impression 204Focus on the Patient First 205Keep Information Up-to-Date 206Follow Up and Follow Through 206Inform Patients of All Treatment Details and Costs 207

Recall/Recare Systems 207Prescheduling Recare Appointments 208Written Correspondence and Telephone Recare Systems 209Patient Reminders 210

Telephone Reminders 210Mailed Reminder Cards 211Appointment Reminder Cards 213

Marketing 213Patient Retention Marketing 213Marketing to Attract New Patients 215

C H A P T E R T E N Appointment Management 217Appointment Schedule 218

Manual Appointment Scheduling 218Computerized Practice Management Programs and 219

Appointment Scheduling Advantages 220Features 222

Dentists’ Schedule 224Hygienists’ Schedule 225Dental Assistants’ Schedule 225

Maintaining the Schedule 226Units of Time 227Scheduling Abbreviations 228Buffers 230Double Booking 230Dovetailing 230

Scheduling Considerations 230Patient’s Scheduling Needs 231Staff Members’ Scheduling Preferences 231

How to Schedule Appointments? 232New Patients 232Returning Patients 232Emergency Patients 233Walk-In Patients 234

Schedule Interruptions 234Patient Cancellations 234Late Patients 235Missed Appointments 235Dental Office Cancellations 235

Referrals to Dental Specialists or Other Providers 236

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C H A P T E R E L E V E N Staff Management 239Office Policy and Procedure Manual 240

Contents of a Policy and Procedure Manual 240Practice Description and Organization 241Office Procedures 242Personnel Policies 243Task Descriptions 243Emergency Procedures 243

Development of the Policy and Procedure Manual 246Staff Meetings and Communication 246

Monthly Staff Meetings 247Morning Staff Meetings 248Open Door Policy 249

Hiring, Evaluating, and Terminating Staff 249Hiring 249Evaluating 258

Preparation 258Agenda 260Feedback 262

Taking Disciplinary Action and Terminating 262Continuing Education 264

C H A P T E R T W E LV E Filing Procedures 267Basic Filing Guidelines 268Common Filing Systems 268

Alphabetical Filing System 269Numerical Filing System 270Other Filing Systems 272

Filing Equipment 273Open-Shelf 273Lateral File Shelves 273Vertical Filing System 273Closed File System 273

Storing Files 273Transferring Patient Records 274Electronic Filing 275

C H A P T E R T H I RT E E N Inventory 279Supplies in the Dental Office 280

Clinical Supplies 280Administrative Supplies 280Capital Supplies 280

Ordering 281Expiration Dates 282Storage Space Availability 282Frequency of Use 282Product Promotions 283

Working With Suppliers 283Invoices 284

Invoice Head 284Invoice Body 284Invoice Bottom 286

Backorders 286Shipping Methods 286Statements 286

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Inventory Systems 286Manual Inventory System 288Computerized Inventory System 290

C H A P T E R F O U RT E E N Technology in the Dental Office 295The Computer 296

Hardware 296Core Components: Processor and Internal Drives 296Essential Peripherals 298Optional Peripherals 300

Applications 302Administrative Applications 303Clinical Applications 304

Internet Basics 306Security 306Internet Searches 307

Computer Ethics 307Ergonomics 308

Other Office Equipment 308Fax Machine 309Copier 309Postage Machine 309Shredder 309Calculators 310Point of Sale Terminals 310

part F O U R Financial Management 313

C H A P T E R F I F T E E N Dental Insurance 315The Funding of Dental Care: Who Pays? 317

Group Dental Plans 317Individual Dental Plans 318Medicare and Medicaid 318Uninsured Patients 320

Types of Insurance Plans 321Fee-for-Service (Dental Indemnity Insurance) 321

Usual, Customary, and Reasonable Fee 322Schedule of Benefits and Fixed Fee 323

Managed Care Plans 323Dental Health Maintenance Organizations 323Dental Preferred Provider Organizations 324Direct Reimbursement Plans 324Individual Practice Associations 324

Filing Insurance Claims 324Coordination of Benefits 325Electronic Claims Submission 326Predeterminations 326Explanation of Benefits 327

Procedure Codes 329

C H A P T E R S I X T E E N Accounts Receivable 333Bookkeeping Basics 334

Double- and Single-Entry Systems 334Charges 335

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Payments 335Account Adjustments 335Fiscal Year and Month-End Procedures 336

Bookkeeping Systems 336Computer Bookkeeping Systems 336Manual Bookkeeping: One-Write System 337

Journal Sheet 338Charge and Receipt Slip 340Ledger Card 340

Extending Credit and Collecting Payment 341Collecting Payment 341Extending Credit 342Collecting Overdue Payments 343Collection Policies and Procedures 345

Mailing a Statement 345Telephone Call 345In Person at the Appointment 346

CHAPTER SEVENTEEN Accounts Payable 349Types of Office Expenses 350

Overhead 350Controlling Expenses 350Paying Invoices 351Forms of Payment 351

Check Writing 352Parts of a Check 352Types of Checks 353

Petty Cash 353Accounts Payable Systems 355

Computer System 355Pegboard System 355

C H A P T E R E I G H T E E N Banking 359Business Bank Account 360

Types of Accounts 360Bank Fees 360

Monthly Fee 360Transaction Fee 361Overdraft Protection 361Nonsufficient Funds Fee 361

Bank Deposits 361Preparing Checks for Deposit 362Making a Bank Deposit 362

Bank Statements and Account Reconciliation 364Electronic Banking 366

C H A P T E R N I N E T E E N Payroll 369Time Sheets/Cards 370Types of Payroll Systems 370

Computerized Payroll System 370Manual Payroll System 371

Legalities Involved With Payroll 371Tax Withholdings 371Calculating Payroll and Remittances 373

Employee Earnings Record 374W-2 Form 374

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part F I V E Career Considerations 377

C H A P T E R T W E N T Y Employment Strategies 379Practicum 380Finding the Right Job 381

Setting Goals for Employment 382Type of Office 382Size of Office 383Ideal Hours 383Atmosphere of Office 383Opportunity for Advancement 383

Assessing Your Strengths and Weaknesses 383Job Search Resources 384

Networking 384Advertisements 384Yellow Pages 384Internet 384Employment Agency 385

Applying for the Job 385Preparing Your Resume 385

Career Objective 386Work Experience 386Education 386

Preparing the Cover Letter 386Completing the Application 387

The Interview 388Interview Preparation 388Interview Etiquette 389Working Interviews 389Follow Up 390

Beyond the Interview 390Employment Laws 391

Appendix: Answers to Checkpoint and Review Questions 395Glossary 409Index 423

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