Clinic Clinic Organization andOrganization and
Business Business ProtocolsProtocols
December 5, 2005December 5, 2005
Nader A. Nadershahi, DDS, MBANader A. Nadershahi, DDS, MBA
Second Year Clinic -- A Second Year Clinic -- A System Overview -- The System Overview -- The
ClinicsClinics Main ClinicMain Clinic
Located on Level CLocated on Level C
Clinical Practice BreakdownClinical Practice Breakdown Senior (Third) Year Clinic -Groups I, II, III, Senior (Third) Year Clinic -Groups I, II, III,
IV)IV) Junior (Second Year Clinic)Junior (Second Year Clinic)
Clinic OrganizationClinic Organization
Four Group Practices with their own GPA Four Group Practices with their own GPA and Administrative Assistant (I, II, III, IV)and Administrative Assistant (I, II, III, IV)
Second year faculty are in format that you Second year faculty are in format that you are familiar with in ½ of the alphabetare familiar with in ½ of the alphabet
Third year students will work with mentor Third year students will work with mentor groups and specialty faculty as neededgroups and specialty faculty as needed
All rotations and other programs still All rotations and other programs still applyapply
Patient TransfersPatient Transfers
Patient transfers will be made in Patient transfers will be made in group practices. (Students in 2group practices. (Students in 2ndnd ¼ of senior class will transfer ¼ of senior class will transfer patients to students in 2patients to students in 2ndnd ¼ of ¼ of junior class.)junior class.)
The PeopleThe People
StudentsStudents Senior Students + AEGD, OMFS, Senior Students + AEGD, OMFS,
&& Junior Students Ortho residentsJunior Students Ortho residents
PatientsPatients Senior CasesSenior Cases Junior CasesJunior Cases Sharing -- Referrals within the group Sharing -- Referrals within the group
practices andpractices and between between Seniors and JuniorsSeniors and Juniors
The People (continued)The People (continued)
Faculty: from all clinical departmentsFaculty: from all clinical departments
Staff: receptionists, sterilization, cashier, Staff: receptionists, sterilization, cashier, patient care coordinators (PCC) patient care coordinators (PCC)
Clinic Administration: ADCS, Group Clinic Administration: ADCS, Group PracticePractice Administrators (GPAs) & Administrators (GPAs) & assistantsassistants
Associate Dean for Clinical Services
GPA Group I
GPA Group IV
Restorative Chair
Perio Chair
Removable Chair
Endo Chair
2nd year clinical faculty
GPM Coordinato
r
Group I GPMs and
3rd year faculty
Group II GPMs and
3rd year faculty
Group III GPMs and
3rd year faculty
Group IV GPMs and
3rd year faculty
Admin Asst.
Group I 3rd Years and
Patients
Group II 3rd Years
and Patients
Group III 3rd Years and
Patients
Group IV 3rd Years and
Patients
Clinic Managers
PSL GPA GroupII
GPAGroup III
ReceptionistsPCCsSterilization
Admin Asst.Admin Asst.Admin Asst.
Group I 2nd Years and
Patients
Group II 2nd Years and
Patients
Group III 2nd Years and
Patients
Group IV 2nd Years
and Patients
The ClinicsThe Clinics Oral Surgery (Level C)Oral Surgery (Level C) Radiology (Level C)Radiology (Level C) Emergency (Level C)Emergency (Level C) Pediatric Dentistry Clinic (1st Floor)Pediatric Dentistry Clinic (1st Floor) Orthodontic Clinic (1st Floor)Orthodontic Clinic (1st Floor) Oral Medicine and Facial Pain (6th Floor)Oral Medicine and Facial Pain (6th Floor) Faculty Dental Service Group (1st Floor)Faculty Dental Service Group (1st Floor) Advanced Education in General Dentistry (Level B)Advanced Education in General Dentistry (Level B) Perio Surgery (Level C)Perio Surgery (Level C)
The YearThe Year
QuarterQuarter
Fifth (Mon.-Fifth (Mon.-Thurs.)Thurs.)
Sixth, Seventh Sixth, Seventh and Eighth and Eighth Quarters (Mon.-Quarters (Mon.-Fri.)Fri.)
Time Spent in Time Spent in BlocksBlocks
40 Percent Blocks40 Percent Blocks
40 - 50 Percent 40 - 50 Percent BlocksBlocks
Second Year Clinic GoalSecond Year Clinic Goal
To develop the fundamental clinical To develop the fundamental clinical patient care skills in all dental disciplines patient care skills in all dental disciplines for comprehensive patient care.for comprehensive patient care.
To provide close faculty interaction to To provide close faculty interaction to carefully guide student learning carefully guide student learning experiences.experiences.
To provide quality patient care.To provide quality patient care.
How do we do it? -- The How do we do it? -- The Year as a TransitionYear as a Transition
Designed to introduce students to Designed to introduce students to comprehensive patient care with an comprehensive patient care with an emphasis on diagnostic skills.emphasis on diagnostic skills.
Teach students to manage dental cases.Teach students to manage dental cases.
Prepare students for more complex Prepare students for more complex patient care cases.patient care cases.
Fifth Quarter -- The Fifth Quarter -- The BlocksBlocks
22ndnd Year Clinic Year Clinic BlocksBlocksPerio RecallPerio RecallPerio Perio Surgery Surgery AssistingAssisting
Oral SurgeryOral SurgeryRadiologyRadiology
Other BlocksOther BlocksLocal Local AnesthesiaAnesthesia
Endo BlockEndo BlockImplantologImplantologyy
Fifth Quarter -- The Fifth Quarter -- The OperationOperation
StaffStaff Some Patient Some Patient
SchedulingScheduling Financial ContractsFinancial Contracts
PatientsPatients Recall PatientsRecall Patients
“check up & “check up & cleaning”cleaning”
Simple New Patient Simple New Patient CasesCases
FacultyFaculty Manage Patient CareManage Patient Care Same Students with Same Students with
Same FacultySame Faculty StudentsStudents
Patient Exposure (Be Patient Exposure (Be there and be there and be prepared)prepared)
1st Impressions are 1st Impressions are ImportantImportant
Pay AttentionPay Attention Patient SchedulingPatient Scheduling
Sixth Quarter -- The Sixth Quarter -- The BlocksBlocks
40 - 50 Percent 40 - 50 Percent BlockBlock
22ndnd Year Clinic Year Clinic BlocksBlocks Perio RecallPerio Recall Perio Surgery Perio Surgery
AssistingAssisting Others: Same as Others: Same as
Last QuarterLast Quarter
Other Clinic BlocksOther Clinic Blocks Same as Last Same as Last
QuarterQuarter Pedo BlockPedo Block
10-12 students 10-12 students scheduled for scheduled for 10 consecutive 10 consecutive clinic sessionsclinic sessions
Sixth Quarter -- The Sixth Quarter -- The TransitionTransition
StaffStaff Some Patient Some Patient
SchedulingScheduling Financial ContractsFinancial Contracts
PatientsPatients Increased flow of new Increased flow of new
patientspatients Encourage students Encourage students
to bring in their own to bring in their own patientspatients
FacultyFaculty Increase Student/ Increase Student/
Faculty RatioFaculty Ratio Assisting in Assisting in
procedures, less procedures, less patient managementpatient management
StudentsStudents Increased Increased
IndependenceIndependence Comprehensive Comprehensive
Patient CarePatient Care Patient SchedulingPatient Scheduling
Seventh and Eighth Seventh and Eighth Quarters -- Turning It Quarters -- Turning It
OverOver 40 – 50 Percent 40 – 50 Percent
BlocksBlocks Perio BlocksPerio Blocks
50 – 60 Percent 50 – 60 Percent Open Clinic TimeOpen Clinic Time See your own See your own
patientspatients
Other Main Clinic Other Main Clinic BlocksBlocks Same as Last Same as Last
QuarterQuarter
Other BlocksOther Blocks Same as Last Same as Last
QuarterQuarter
Clinical Services in the Clinical Services in the Second Year ClinicSecond Year Clinic
Comprehensive Patient CareComprehensive Patient Care
Relatively Simple Restorative CasesRelatively Simple Restorative Cases
Clinical ExperienceClinical Experience
Clinical Services in the Clinical Services in the Second Year Clinic -- Second Year Clinic --
(continued)(continued) Fifth QuarterFifth Quarter
Mostly ODTP & Mostly ODTP & PerioPerio
Almost Any Almost Any OperativeOperative
Almost Any EndoAlmost Any Endo Almost Any Single Almost Any Single
Crown Crown No RemovableNo Removable
Sixth QuarterSixth Quarter ODTP & PerioODTP & Perio Almost Any Almost Any
OperativeOperative Almost Any EndoAlmost Any Endo Almost Any Single Almost Any Single
Crown Crown Still No RemovableStill No Removable
Clinical Services in the Clinical Services in the Second Year Clinic -- Second Year Clinic --
(continued)(continued) Seventh QuarterSeventh Quarter
ODTP & PerioODTP & Perio Almost Any Almost Any
OperativeOperative Almost Any EndoAlmost Any Endo Almost Any Single Almost Any Single
Crown Crown Maybe Posterior Maybe Posterior
BridgeBridge Full Denture CasesFull Denture Cases
No Partial DenturesNo Partial Dentures
Eighth QuarterEighth Quarter ODTP & PerioODTP & Perio Any OperativeAny Operative Any EndoAny Endo Any Single Crown Any Single Crown
Maybe Posterior or Maybe Posterior or Anterior BridgeAnterior Bridge
Any Removable Any Removable CaseCase
Clinical Services -- Most Clinical Services -- Most Common CDT5 CodesCommon CDT5 Codes
D0150 -- Initial Oral D0150 -- Initial Oral Exam (ODTP)Exam (ODTP)
D0120 -- Periodic D0120 -- Periodic Oral Exam (Recall) Oral Exam (Recall)
D0210 -- Full Mouth D0210 -- Full Mouth Series (FMX)Series (FMX)
D0274 -- Four D0274 -- Four Bitewing FilmsBitewing Films
D1110 -- D1110 -- Prophylaxis, AdultProphylaxis, Adult
D4341 -- Root D4341 -- Root Planing (per Planing (per quadrant)quadrant)
D4910 -- Supportive D4910 -- Supportive Periodontal Therapy Periodontal Therapy (SPT)(SPT)
D2140 -- One D2140 -- One Surface AmalgamSurface Amalgam
D3310 -- Anterior D3310 -- Anterior Root Canal TherapyRoot Canal Therapy
D2790 -- Full Cast D2790 -- Full Cast Crown (FVC)Crown (FVC)
D2750 -- PFM CrownD2750 -- PFM Crown
New Patient Intake New Patient Intake ServiceService
Screenings are done on a first-come, Screenings are done on a first-come, first-served basis. Sign up starting at first-served basis. Sign up starting at 8:30 and 12:30.8:30 and 12:30.
Done by FacultyDone by Faculty Monday-FridayMonday-Friday 9:00 a.m. to 12:30 a.m. and 1:00 9:00 a.m. to 12:30 a.m. and 1:00
p.m. to 4:30 p.m.p.m. to 4:30 p.m.
Patient Intake FlowPatient Intake Flow Patient registers at Patient registers at
Front DeskFront Desk Fills out paperworkFills out paperwork
Demographic FormDemographic Form Preliminary EvaluationPreliminary Evaluation Health HistoryHealth History Patient Rights & Patient Rights &
ResponsibilitiesResponsibilities Dental Materials Fact Dental Materials Fact
SheetSheet HIPPA AcknowledgementHIPPA Acknowledgement
Patient returns forms Patient returns forms to Front Deskto Front Desk
Patient directed to Patient directed to Radiology for Pano Radiology for Pano and 2 Bite-Wings and 2 Bite-Wings ($25)($25)
Radiology technicians Radiology technicians give forms and give forms and radiographs to radiographs to Screening FacultyScreening Faculty
Patient Intake Flow Patient Intake Flow Chart -- (continued)Chart -- (continued)
Faculty member:Faculty member: discusses patient’s chief concern/desire/ discusses patient’s chief concern/desire/
expectationsexpectations explains clinical protocolsexplains clinical protocols briefly reviews patient’s medical statusbriefly reviews patient’s medical status
medical consult form, if neededmedical consult form, if needed determine patient’s dental needsdetermine patient’s dental needs determine teaching case statusdetermine teaching case status provides patient with very rough cost provides patient with very rough cost
estimatesestimates
Patient Intake Flow Patient Intake Flow Chart -- (continued)Chart -- (continued)
If faculty member and patient agree If faculty member and patient agree to make patient a teaching case, then:to make patient a teaching case, then: faculty member suggests Junior or Senior faculty member suggests Junior or Senior
ClinicClinic faculty member prescribes remaining faculty member prescribes remaining
films to have FMX (for an additional $70)films to have FMX (for an additional $70) FMX taken or appointment madeFMX taken or appointment made If patient brings in FMX, Radiology If patient brings in FMX, Radiology
Faculty determine acceptability of filmsFaculty determine acceptability of films
Patient Intake Flow Patient Intake Flow Chart -- (continued)Chart -- (continued)
After FMX:After FMX:
Patient Intake Manager, Mr. Robert Trezia, Patient Intake Manager, Mr. Robert Trezia, brings cases to Group Practices on a rotating brings cases to Group Practices on a rotating basis.basis.
GPA and AA’s assign based on needs list and GPA and AA’s assign based on needs list and procedure tracking.procedure tracking.
Students check patient lists regularly for new Students check patient lists regularly for new pts.pts.
Student makes first phone call and appoints Student makes first phone call and appoints ODTP.ODTP.
Screening GoalsScreening Goals
To Determine:To Determine:
Chief ConcernChief Concern
ExpectationsExpectations
NeedsNeeds
Medical StatusMedical Status
To Discuss:To Discuss:
Introduce ClinicIntroduce Clinic
Comprehensive Comprehensive Care!Care!
FinanceFinance FeesFees Payment PlansPayment Plans
Screening Goals -- Screening Goals -- (continued)(continued)
Is this patient a teaching case?Is this patient a teaching case? Based on patient needs and expectationsBased on patient needs and expectations Based on faculty assessmentBased on faculty assessment
If patient is a teaching case, then:If patient is a teaching case, then: Order FMX ($70)Order FMX ($70) GPA assigns to appropriate studentGPA assigns to appropriate student
If patient is not a teaching case, then If patient is not a teaching case, then give patient referral advice and filmsgive patient referral advice and films
How to bring in your own How to bring in your own patientpatient
Patient must fill out patient Patient must fill out patient information form.information form.
Chart must be made for patientChart must be made for patient Information DeskInformation Desk
Complete ODTP steps 1 & 2 on Complete ODTP steps 1 & 2 on clinic floorclinic floor
Faculty determines Faculty determines appropriateness of case for 2appropriateness of case for 2ndnd year year studentstudent
Radiograph Rx from facultyRadiograph Rx from faculty
Main Clinic Main Clinic Business Business ProtocolsProtocols
Clinic Business Protocol Clinic Business Protocol – Prelude – Prelude
ODTP -- Step 7ODTP -- Step 7 Prioritize Treatment PlanPrioritize Treatment Plan Entered into Computer in Proper Entered into Computer in Proper
SequenceSequence Clinical ApprovalClinical Approval
ODTP – Step 8ODTP – Step 8 Signed Treatment Printout in ChartSigned Treatment Printout in Chart All Charting in ComputerAll Charting in Computer All Forms Signed and Organized in ChartAll Forms Signed and Organized in Chart
Discussing Treatment Discussing Treatment AlternativesAlternatives
Explain clinical importance of Explain clinical importance of preferred procedurepreferred procedure
Respect patient’s ability to pay Respect patient’s ability to pay for servicesfor services
Patient Autonomy and Standard Patient Autonomy and Standard of Care Practicesof Care Practices
CARE and Denti-CalCARE and Denti-Cal
CARE officeCARE office Luis RodriguezLuis Rodriguez
Denti-Cal Approval from GPAs or Denti-Cal Approval from GPAs or Department ChairsDepartment Chairs
After approval, chart taken to PCC After approval, chart taken to PCC for final for final financial approvalfinancial approval
Clinical and Financial Clinical and Financial ApprovalApproval
Type accepted Type accepted treatment plan into treatment plan into computercomputer
Get instructor to Get instructor to give clinical give clinical approvalapproval
Print out treatment Print out treatment planplan
Have patient sign Have patient sign treatment plantreatment plan
Patient fills out Patient fills out Patient Patient Credit Information Credit Information FormForm
Preauthorization donePreauthorization done Sign up to see Patient Sign up to see Patient
Care Coordinator Care Coordinator (PCC)(PCC)
Wait for PCC to page Wait for PCC to page See PCC for financial See PCC for financial
arrangements and arrangements and approvalapproval
Road to Clinical ApprovalRoad to Clinical Approval
Discuss Treatment Options & Costs with Discuss Treatment Options & Costs with PatientPatient
Treatment Plan Acceptance Treatment Plan Acceptance Enter Accepted Treatment Plan into Enter Accepted Treatment Plan into
Computer in Planned Delivery SequenceComputer in Planned Delivery Sequence Have Faculty Member give Clinical Have Faculty Member give Clinical
ApprovalApprovalHint: Ask for clinical approval from the faculty member you worked with during the ODTP process.
Ways to Lose Clinical Ways to Lose Clinical ApprovalApproval
Change the sequence of the Change the sequence of the clinically approved treatment planclinically approved treatment plan
Add Add anythinganything to the clinically to the clinically approved treatment planapproved treatment plan
Delete Delete anythinganything from the clinically from the clinically approved treatment planapproved treatment plan
First Steps to Financial First Steps to Financial ApprovalApproval
Patient signs clinically approved Patient signs clinically approved treatment plan printouttreatment plan printout
Patient fills out Patient fills out Patient Credit Patient Credit Information FormInformation Form
Complete pre-authorizations as Complete pre-authorizations as neededneeded
Go to Patient Services Go to Patient Services Student signs up to see Patient Care Student signs up to see Patient Care
Coordinator (PCC)Coordinator (PCC)
Patient Services (PCCs)Patient Services (PCCs)
Located directly behind the Front Located directly behind the Front (Information) Desk on Level C(Information) Desk on Level C
Patient Care CoordinatorsPatient Care Coordinators Irene VargasIrene Vargas Maria BranMaria Bran Jerilyn ThompsonJerilyn Thompson
Patient Care Patient Care CoordinatorsCoordinators
Answer patient account questions.Answer patient account questions.
Send out and monitor insurance pre-Send out and monitor insurance pre-authorizations.authorizations.
Send out and monitor insurance claims.Send out and monitor insurance claims.
Give financial approval to Give financial approval to ALLALL patients. patients.
Patient Care Patient Care Coordinators -- Coordinators --
(continued)(continued) See a PCC if you need information or See a PCC if you need information or
assistance with:assistance with: Financial ApprovalFinancial Approval Private InsurancePrivate Insurance Denti-Cal (Public Insurance)Denti-Cal (Public Insurance) Contracts (Financial Arrangements)Contracts (Financial Arrangements) Patient AccountsPatient Accounts
Payment OptionsPayment Options
Full Payment in AdvanceFull Payment in Advance
Contracts (Under $500 or Over $500)Contracts (Under $500 or Over $500)
Pay for Treatment As They Go Pay for Treatment As They Go
(Depending on amount. Can bill under (Depending on amount. Can bill under $300)$300)
Full Payment In AdvanceFull Payment In Advance
Advantages:Advantages:
To Patient: 5 To Patient: 5 percent discountpercent discount
To Student: To Student: Financial approval Financial approval every visit (as long every visit (as long as treatment plan as treatment plan does not change)does not change)
Disadvantages:Disadvantages:
To Patient: May To Patient: May not have all the not have all the funds at that time.funds at that time.
To Student: NoneTo Student: None
Contracts -- Contracts -- QualificationsQualifications
Employment or Income InformationEmployment or Income Information Major Credit CardMajor Credit Card Bank Account (Savings or Checking)Bank Account (Savings or Checking) Down payment equal to one month’s Down payment equal to one month’s
payment (Procedures requiring payment (Procedures requiring laboratory fabrication need 25% laboratory fabrication need 25% down paymentdown paymentContracts run no more than 20 months with
a $40 per month minimum payment. (Total amountDivided by 20)
ContractsContracts
Contract Under $500Contract Under $500
If patient or co-signer If patient or co-signer has employment has employment verification plus either verification plus either a major Credit Card or a major Credit Card or Bank AccountBank Account
Treatment plan can be Treatment plan can be broken down into broken down into ~$500 increments.~$500 increments.
Contract Over Contract Over $500$500
Patient or co-signer Patient or co-signer has all has all qualifications.qualifications.
InsuranceInsurance
Private InsurancePrivate Insurance
We accept any We accept any dental insurance dental insurance plan that will plan that will accept us.accept us.
Every plan has Every plan has different rules different rules (see your PCC)(see your PCC)
Public InsurancePublic Insurance
Denti-Cal or Medi-Denti-Cal or Medi-CalCal
Pre-authorizations Pre-authorizations a a MUSTMUST
Eligibility needs Eligibility needs to be checked to be checked EACHEACH month. month.
Denti-Cal Procedures Denti-Cal Procedures Requiring Pre-Requiring Pre-AuthorizationAuthorization
Root PlaningRoot Planing
Root Canal Root Canal TherapyTherapy
DenturesDentures
RelinesRelines
Crowns (No Crowns (No posteriors unless posteriors unless abutments for abutments for RPD)RPD)
StayplatesStayplates Partial DenturesPartial Dentures
They are only a They are only a benefit if opposing benefit if opposing a full denture.a full denture.
Failure to wait for pre-authorizations will resultin your not receiving credit for the procedure.
Ways to Lose Financial Ways to Lose Financial ApprovalApproval
Add or subtract anything to or from Add or subtract anything to or from the treatment plan.the treatment plan.
Patient becomes more than 60 days Patient becomes more than 60 days past due (delinquent account).past due (delinquent account). See your PCCSee your PCC
Financial ApprovalFinancial Approval
Be prepared!Be prepared!
Always accompany your patient Always accompany your patient when making financial when making financial arrangements.arrangements.
Only a PCC can give financial Only a PCC can give financial approvalapprovalALL PATIENTS NEED FINANCIAL APPROVAL
Thank You…Thank You…