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Dental Office Procedures for Dental Assisting Exam Study Guide (page 3)

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Updated on Jun 23, 2011

Continuing Care/Recall Management

A continuing care or recall system notifies patients when they are due to return to the dental office for routine dental care. This system helps patients maintain good oral health for a lifetime.

A routine cleaning and examination is the most common reason for the patient’s recall visit. However, the patient may need to return to the office for other reasons, such as a limited exam of the treatment site after surgery, a limited exam of an eruption of a particular tooth, exam of a full or partial, follow-up on an endodontic treatment, or follow-up on an implant. There are three types of continuing care/recall systems:

  • Advanced Appointment Recall System
  • Telephone Recall System
  • Mail Recall System

Advanced Appointment Recall System

The recall visit is scheduled before the patient leaves the office. A continuing care/recall postcard is mailed out as a notice or reminder of the patient’s pre-scheduled appointment. The advantage is that no extra cost or time is involved for the business assistant, and it projects future production in the appointment book.

Telephone Recall System

The business assistant calls patients when they are due for their recall visit and schedules the appointment. The disadvantage is that this system is very time-consuming.

Mail Recall System

A recall postcard is mailed to patients notifying them that they are due for their recall appointment, and they call the office for an appointment. Recall/continuing care postcards are filed in a chronological file and mailed out two weeks prior to the appointment date. These should be issued according to HIPAA guidelines. The disadvantages of this system are that it is costly and time-consuming.

Accounts Receivable Management

Accounts receivable is the total amount of money owed to the dentist for services rendered. The daily charges (fees for dental services) are posted onto the patient’s ledger. The payments received are also posted to the patient’s ledger. The total balance on all the patient’s ledgers is the accounts receivable. The total accounts receivable is either owed to the doctor by the patient or the patient’s dental insurance company.

There are times when patients cannot afford to pay for all services received, in which cases financial arrangements must be discussed with the patient. These arrangements often take the form of a payment schedule. These can be tailored based on the patient’s ability to pay versus the dental office’s need for income. As creditor or lender, the dental office is required to complete a Truth in Lending form, which is a federal document used when a treatment plan is extended to four or more monthly payments.

Bookkeeping is the process of recording financial transactions. Keeping accurate records is essential in account management. It is always best to take your time and double check the entries. For example, at the end of the day, all money, checks, and credit card slips must be deposited with a proper deposit slip. The total amount on that slip should agree with the payments column on the day sheet.

All daily charges are posted to the patient’s account ledger. All payments made are also posted to the patient’s ledger as they are collected. The total amount of the checks, cash, and credit card payments made must agree with the total of monies posted as payments in the computer that will be printed on a daily transaction sheet.

A debit balance is the amount owed to the dentist for services rendered. A credit balance is a total of what the dentist owes a patient. Credit balances usually stem from patients paying for services in advance (before the services are completed).

Statements or bills are mailed to the patients to show them their financial status and amount owed to the dentist. The statement indicates the charges, payments, and adjustments made to their account. Adjustments to the patient’s accounts include professional adjustment, senior citizen discount, family discount, returned check fee, and, in some offices, service charges for balances that are over three months old.

The balance on the statement or ledger is the total amount of money owed to the dentist. The balance is aged into categories showing the patient how long the balance has been owed. The aging categories are current, 30–60 days, 60–90 days, and over 90 days.

An accounts receivable report is generated monthly so that the business assistant can follow up on the money owed by call or sending letters to the patient and/or the insurance company. Legal guidelines must be followed to avoid harassment of patients when collecting overdue amounts. When you have exhausted all other avenues trying to collect a patient’s debt, the final step is to contact a collection agency. When working with accounts receivable, it is important to follow the Fair Debt Collection Practices Act, a federal act passed to protect the patient from unethical collection procedures.

Financial arrangements or payment plans can be arranged with the patient. Credit bureaus can be called for credit reports on patients that are setting up payment plans with the office if the business assistant has obtained the patient’s consent.

Accounts Payable Management

Accounts payable refers to the amount of money owed by the dentist to others to run the dental practice. This is often referred to as overhead. The office overhead is much like running a household. The income is portioned out to cover monthly expenses. The following are some costs that dental businesses must consider.

Office Mortgage or Lease

The cost of the office space, whether it be leased (long term) or purchased through a mortgage, is an office expense. It is the most costly of all of the doctor’s overhead expenses. Some dentists will share office space or building space with other medical/dental professionals in order to cut down on this overhead expense.

Utilities

The utilities are the same as your water and electric bill at home. The dentist must pay for the electricity, water, and sewage for the dental practice.

Dental Supplies

Dental supplies are an ongoing overhead expense. These are usually divided into two categories: expendables and capital expenses. Capital expenses include big ticket items such as equipment, computers, etc. Expendables are those consumable supplies that are used daily and must be replenished.

Staff Salaries/Payroll

Staff salaries are a major portion of accounts payable. To attract the best employees, you have to pay the best salaries. Employee benefits range from medical coverage to retirement plans, and this is often a large part of payroll expenses. A benefit plan summary is a description of the benefits that the employer offers to the employee.

Additional payroll expenses include preparing paychecks, making deductions, and completing the necessary forms, all of which are time-consuming. The Federal Insurance Contributions Act (FICA) is the federal law that requires employers to withhold taxes for Social Security and Medicare programs.

Payroll Taxes

A yearly wage and tax statement for each employee is made on the W-2 form, showing the income, taxes, and other deductions.

Insurance

The dentist may pay all or a portion of medical insurance premiums for the staff.

Petty Cash

A small amount of money is kept in the office for incidental expenses or making change for cash-paying patients.

Dental Insurance Management

Many patients have dental insurance and, as a courtesy, the dental office will often bill the insurance company directly for the dental services rendered using a claim form. A claim form is generated for every date of service. The claims are either printed on paper and faxed, or mailed to the insurance company, or created digitally and sent electronically to the insurance company using the computer. Electronic claims are either sent to a clearing house or directly to the insurance company. A clearing house pre-screens the dental insurance claim to ensure that all pertinent information is complete and correct.

Under the HIPAA, all healthcare providers, health plans, and healthcare clearing houses that transmit data electronically must use a universal language and a standard format. The universal language is the American Dental Association (ADA) Current Dental Terminology (CDT) Code on Dental Procedures and Nomenclature. Each specific dental procedure is identified by a code.

The codes start with a D, are followed by four numerals, and are categorized according to the type of procedure. The CDT has a complete list of the current dental procedure codes, along with a description of the procedure.

Dental insurance policies can be quite complex, and there is a wide variation in procedures covered from one insurance company to the next. Dental insurance plans outline payments based on a set fee allowance for each dental procedure, known as a fee schedule. Benefit plans often have certain restrictions or limitations that may include age limits for particular procedures, waiting periods, and frequency of certain services.

The percentage of the insurance claim the company will pay depends on the type of procedure and the insurance contract. Because of the complicated nature of insurance policies, it is difficult to predict which procedure and what percentage a particular policy will cover. That is why dentists submit treatment plans to the insurance companies before starting work to get an estimate of how much of the treatment will be covered. This is known as predetermination of benefits.

The highest total amount an insurance carrier will pay toward the cost of dental treatment in a given benefit period is known as the annual maximum allowable amount. Dental procedures must be properly categorized for insurance purposes. For example, adult prophylaxis and study models are considered preventative/diagnostic services.

If a patient has two insurance policies, this is termed dual insurance. The two insurance companies coordinate their benefits. The first company billed is the primary carrier and the other is the secondary carrier. When more than one carrier is involved, benefits are coordinated in two possible ways:

  • Standard coordination of benefits
  • Non-duplication of benefits

The subscriber is the person who owns the insurance policy, and a dependent is a spouse or child of the subscriber. The subscriber signs the assignment of benefits line on the dental insurance claim form. The assignment of benefits is the authorization by the subscriber for the dental carrier to issue benefits directly to the provider, who is the treating dentist. When the assignment of benefits line is signed by the patient, the payment on the claim is paid directly to the dental office.

The insured person must pay the deductible portion of the total dental treatment costs before the benefits go into effect.

Generally, dental insurance plans cover minor children, but adult children may be covered by the parent’s policy if they are full-time students. When both parents have dental plans, the primary carrier is determined by the parents’ birth dates. The one with the birthday closest to January is the primary carrier. This is known as the birthday rule. Children of divorced parents, each with a dental plan, are generally covered by the plan of the parent with whom the child lives. This is known as the primary carrier. The plan of the other parent is known as the secondary carrier.

There are many abbreviations used in dentistry and dental insurance. For example, UCR stands for usual, customary, reasonable. For more about commonly used abbreviations, consult the appendix at the back of this book. Every dental procedure has an ADA code that is required on each dental claim form for each procedure billed to the insurance carrier. Each procedure description and procedure code is listed on a single line on the claim form.

“Signature on file” is written on all claims instead of the subscriber’s signature so that the claim forms can be billed electronically. A “signature on file” card is signed by the patient on the first visit and kept inside the record.

The provider is the attending dentist who performs the dental treatment. The provider’s name, address, license number, tax ID number, and phone number are all listed on every claim form.

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