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…