If your dental office is experiencing rising costs and staffing frustrations, you are not alone. In January 2023, Dental Economics and The Levin Group conducted a survey on dentists’ challenges in 2022 (Levin, 2023). That survey highlighted dentists’ most significant concerns, as shown here:
The 2023 Dental Economics Fee and Staffing Survey, conducted by Dental Economics and Endeavor Business Intelligence collected data on staffing challenges and fee schedules by region and practice location (Urban, Suburban, Rural). In this survey, Midwest region dentists reported the following:
79% of respondents had difficulty filling hygiene positions, 58% had trouble hiring assistants, and 28% struggled to hire office managers;
87% of respondents stated staffing costs negatively impacted their practices to varying degrees.
According to DeStefano (2023) hygienist shortages impact the timeliness of care and dental assistant shortages slow the practice’s pace resulting in an overall decrease in office production. Additionally, these shortages negatively impact the timeliness of patient care. Offices suffering from inadequate front office coverage may experience lapses in insurance filing and inefficient patient communication, resulting in lost opportunity and weaker profitability. To stress this disadvantage, DeStefano (2023) reveals that the average dental practice collections were 10% lower in 2023.
Roger Levin of the Levin Group argues (as cited in DeStefano, 2023) that productivity is further impacted by failure to align dental fees with price increases to maintain healthy profit margins. Levin supports annual fee updates of approximately 5% to keep up with rising inflation.
Overall, the Dental Economics Fee and Staffing Survey found that 65% of participants had increased fees within the last year. Multilocation practices were the most likely to have updated fees within the last 6 months. Interestingly, fee-for-service model or membership model practices were more likely to update more frequently than practices operating under a PPO model. Dr. David Rice, chief editor of Dentistry IQ states that PPO practices may be hesitant to raise fees since they operate under contract limitations, but reminds that this hesitancy prevents PPOs from updating reimbursement tables resulting in lower reimbursement for the practice itself and for nearby practices (DeStefano, 2023).
Although submitting an updated fee schedule is no guarantee of increased payer reimbursement, Levin remarks that it provides payers the opportunity to re-evaluate their fees (DeStefano, 2023).
If your office has not recently performed a fee update, the 2023 Fee and Staffing Survey provides a fee table by region for many dental CDT codes to help you align your fees more appropriately. You can find the survey results here Dental Economics 2023 Fee and Staffing Survey.
Happy 2024, Whalen dentists. January is a great time to re-evaluate your practice’s insurance plan participation. To assist dentists with this task, the ADA has developed several documents designed to streamline the process. These include the following:
These documents are provided here to help you get started quickly. Performing an insurance audit can help you determine which plans you should keep and which ones to eliminate. Paul Bornstein, writing in Dental Economics, gives these additional tips:
Read your state’s dental practice act to make sure that you understand all of the regulations on dental practice. Ohio’s Dental Practice Act is found here. Current Ohio Dental Practice Act
Read your contracts and provider manuals before you sign and re-evaluate yearly. Less than 10% of dentists read these items before signing their contracts!
Medicaid regulations are state-dependent, so be sure to carefully read the contracts and manuals because what is legal in one state may constitute fraud in another state.
Acquaint yourself with all required documentation under PPO contracts and federal Medicaid laws.
Make sure you sample audit your patient records to ensure that the patient record is complete to the state’s practice act requirements and notes are signed. Medicaid excludes unsigned claims from consideration, as do some private dental payers.
Whalen CPAs is dedicated to helping you improve your practice’s operational efficiency. We are here to help with questions you may have regarding this information. For assistance, reach out to us here.
Please be advised that the ADA has released an updated insurance claim form for 2024, which will go into effect on January 1, 2024. To ensure seamless processing of your insurance claims and avoid any delays, it is crucial to update your practice’s insurance claim software to accommodate the new form.
Key Points to Note:
Recommended Update: All offices, regardless of using automated forms or manual processing, must update their systems to the new 2024 claim form to prevent claim processing delays. Software Updates: Offices with automated insurance claim submission software should verify with their respective software vendors to ensure they have subscribed to or purchased the necessary updates to incorporate the new form. Importance of Timely Updates: Neglecting timely software updates could lead to claim processing delays and potential financial implications.
Resources for Assistance:
Sample Form: Access the new 2024 insurance claim form here: Sample Form Form Filling Guide: Refer to the comprehensive PDF guide for detailed instructions on filling out the new form: PDF guide Video Overview: Watch the informative video that provides an overview of the changes and demonstrates proper form completion: Link to Video For more information: Here is the information that the ADA has released. ADA Link
We highly recommend that you prioritize this matter and take the necessary steps to update your insurance claim software well in advance of the January 1, 2024, deadline. By proactively addressing this requirement, you can ensure timely processing of your insurance claims and avoid any disruption to your practice’s cash flow.
Parts 1 and 2 of our embezzlement series discussed who embezzles and why. It also revealed the embezzled owner’s core problem: a lack of appropriate oversight. In this third and final part, we will provide essential tips on developing embezzle-resistant offices through effective revenue cycle management.
Can You Prevent Embezzlement?
In Healers versus Stealers: How to Outsmart the Thief in Your Dental Practice (2023), David Harris, CEO of Prosperident, a dental embezzlement investigation company, says embezzlement is a premeditated crime, not a crime of opportunity. That is, embezzlers don’t decide to steal impulsively; they look for ways to commit the fraud they have determined to commit. Thinking about embezzlement as deliberate frees owners from spending extraneous time on prevention strategies and more time on functional oversight of their companies.
Designing an embezzlement-resistant office starts with clearly understanding that some embezzlers have planned to steal from you even before you hire them. Harris calls this subset “zero-resistance employees.” These employees look for oversight breaches to green-light their intended theft. The best way to avoid these embezzlers is to pre-screen applicants through a rigorous hiring process (Harris, 2023). To evaluate your current employees, Harris suggests that owners look for ethical lapses on the job or for high-risk behaviors off the job. Gambling, alcohol or drug use, unstable personal lives, or frequent moving can signal problems that may make embezzlement attractive to some (Harris, 2023).
Suppose you have previously exercised little (or no) oversight in hiring. In that case, Harris (2023) suggests that, in addition to considering whether the potential hire is competent and fits in with the office’s culture, you consider a fundamental question: Is everything the applicant is telling me really the truth? Dentists often hate hiring and are lax in following a thorough hiring process. Repeat embezzlers take advantage of this laxity as an invitation to present themselves as just what the frazzled dentist needs. Harris (2023) suggests the following tips:
Think of hiring as a part of owning a business: Remember you are a dentist and a business owner. Hiring is part of business, and the new employee will influence the course of the practice. Take the time to hire carefully.
Enter the hiring process with an investigator mindset: Savvy owners try to uncover what the applicant doesn’t want to divulge. A recent survey reported by CNBC.com (2022) found that over 55% of respondents admitted to lying on their resume at least once. Common resume lies include falsehoods about skills, previous work experience, degrees, personal details, salary, and employee references.
Don’t trust your perceptions: 1 in 4 adults have a criminal record. You probably think you don’t even know someone with a criminal record or that you are a good judge of character. Harris (2023) admits that not all criminal records are instant barriers to hiring. Still, owners should take the time to uncover an applicant’s record and determine if the offense has unwanted implications for the safety of the other employees, patients, and office assets. Trusting your impression of an applicant is a sure-fire way to get deceived.
Become a proactive employer: Don’t toss the unsolicited resumes in the trash if you are not actively hiring. Take time to evaluate the resumes and file the ones that seem a good fit for your office. You may need to add to your current employee pool and will have the opportunity to reach out to someone who may be willing to come and work with your team.
Look for hires with good people skills: Most dentists want a quick learning curve for the new hire, so experience in a dental setting gives a candidate the edge. Harris (2023) suggests that offices hiring for public-facing roles may find excellent candidates in other industries. Computer software skills are probably trainable compared to trying to teach someone to be customer service-minded.
Do proper employment checks: A background check for all potential employees is a must, says Harris (2023); however, how that is accomplished varies by state. To avoid HR violations, check with an employment attorney or an HR specialist to determine the appropriate guidelines for your state. A credit check is advised if the employee will work with any portion of the revenue cycle. Consult an HR advisor or employment attorney to learn more about how credit checking is handled in your state. Low credit ratings should not necessarily disqualify an employee if the circumstances are understandable; however, owners can arm themselves with information and use discernment to determine if they will proceed with hiring.
Scrutinize and call references: The study reported by CNBC.com (2022) identified 21% of people falsifying references. This may take the form of providing phone numbers of friends or relatives who give glowing recommendations or pretending the former employer cannot provide references because they are not in business or deceased, says Harris (2023). Instead of using the provided numbers to speak with former employers, Harris (2023) suggests looking up the number for the business and calling. This strategy will end-run any deception for checking references.
Verify credentials. The study reported by CNBC.com (2022) found that 41% of applicants lied about their college degrees or equivalent. It may be cumbersome, but owners should verify the applicant’s degrees, licenses, and permits. It is important to remember that, should the employee perform procedures outside their scope of licensure, it could cause problems for the owner.
Look for inaccuracies: Attention to detail is the crown jewel in most offices. The resume is an applicant’s first point of contact, so most people want to make a good impression. Resumes with jarring grammar or misspelled words signal the applicant is not attentive to details even when trying to put their best foot forward.
Scan social networking sites: Social sites are great for identifying a candidate’s interests, lifestyle, and behavior outside of the interview.
Oversight
Daily Oversight
Once hiring processes are in order, owners can reconfigure their office oversight procedures. We recommend starting your oversight makeover by dictating the treatment to the assistant for entry into the practice management software while still in the operatory. Hygienists can also employ the same data entry method for their treatment. This is the most accurate way to ensure the patient’s file records the correct treatment for that visit. At the end of the day, Harris (2023) recommends that providers print their own day sheets to verify the treatment entry. Once providers approve the data, the owner should review the day sheet report, initial it, and store it securely. This first step prevents an embezzler from only reporting a “clean” subset of transactions.
Next, scan the day sheet to ensure each patient has a fee charged for the visit unless it is for no-charge visits, such as surgery follow-ups. Be sure to review any fee adjustments. Harris (2023) warns that substituting an adjustment code for a payment code is a common theft-concealment tactic. Harris (2023, p. 138, Kindle edition) says, “Whatever the cause of the adjustment, it represents money out of your pocket, and for that reason, it requires scrutiny comparable to if you were writing a check for the same amount.”
Monthly Oversight
At the end of the month, dentists should print a monthly summary report from their practice management software and compare it to the sum of the day sheets. Whalen can provide a simple spreadsheet for owners should they need extra help. The sum of the individual day sheets should exactly match the month-end report. After verifying the month’s totals, owners should compare these to the bank statements. Whalen has developed standard operating procedures for dental practices to help you complete your monthly oversight duties. If you’d like to learn more about implementation and how oversight can help you, click here for your free copy.
If You Think You Have Been Embezzled
If you believe you are a victim of embezzlement, it is crucial to remain calm. Harris (2023) offers these suggestions for appropriate action:
Summary
Embezzlement in dental offices is rampant. Besides the monetary toll on the practice, owners and staff members must deal with feelings of betrayal and grapple with extending trust to new team members. While owners cannot prevent embezzlement from happening, developing and utilizing oversight strategies can speed up the detection of the crime and help the office move forward successfully.
Resources
Harris, D. (2023). Healers versus stealers: How to outsmart the thief in your dental practice. Tellwell Talent. Kindle Edition.
In the first part of our embezzlement series, we discussed the who, what, and why of embezzlement. This second part will focus on lowering your chances of becoming an embezzlement victim.
The Perfect Target
David Harris, CEO of Prosperident, a company of experts investigating dental embezzlement, believes that no one can prevent the crime but that dentists are often easy targets because of their single-minded focus on producing dentistry, with little concern over the practice’s revenue cycle (D. Harris, personal communication, May 23, 2024). Harris says that the embezzler enters the practice looking for the strength of the owner’s oversight. Specific owner characteristics embolden the embezzler to act:
Is the owner comfortable with viewing pre-printed day sheets?
Who enters treatment?
Does the doctor track the top-line revenue?
Does the accountant receive pre-printed day sheets and other reports?
Does the doctor have account access to third-party payers, vendors, etc?
Does the office staff have too much control?
Does the doctor allow office staff uninterrupted access to all parts or consecutive parts of the revenue cycle?
Are doctors tracking month-end revenue numbers?
Owners who exhibit a lackadaisical attitude about the business of dentistry are prime targets for embezzlers because they fit the embezzler’s profile for a successful scam.
How do they do it?
According to Harris, embezzlement is a crime of adjustment, not cash theft, in our technologically dependent environment. Doctors seldom do more than glance at a manager-printed day sheet. Inattention to the account adjustments leaves owners vulnerable to continuously losing revenue. Since the average embezzlement is detected after two years of theft, doctors can lose a significant chunk of their assets before discovering the scheme. Additionally, Harris cites that accountants often only receive documents produced and delivered by the office staff, which allows the falsification to go undetected.
Delegation vs. Abdication
Fraud prevention plans start with a commitment by practice owners to manage their practices. Too often, owners divest control to the office manager so they do not have to wade into tiresome financial details. Preferring to practice clinical skills, many dentists unwittingly open the door to embezzlement because they abdicate their responsibilities under the guise of delegation (Prosperident, 2020). Dentists are unprepared in their business, management, and oversight training. They often rejoice when a competent office manager arrives and condones the hands-off management style. However, few office managers have formal training either. This creates a “perfect storm” scenario for would-be embezzlers. A dentist with no desire to exercise accountability and who extends trust to them allows embezzlers to thrive. Harris (2023) has this to say about practice ownership:
“If you want to own a dental practice and enjoy the numerous financial and lifestyle advantages of practice ownership, you must concurrently accept the responsibilities of being an owner. And one of the biggest responsibilities is oversight (p.134).”
Prosperident (2020) offers these helpful insights on owner accountability:
Accountability is not abstract but actionable: Owners should design office operations around a culture infused with trust and verification.
Accountability requires knowledge and time investment: Prosperident (2020) quips, “Administration is not a cruel joke that the world has played on the dental profession; it is a vital link in the chain between the treatment of patients and your financial well-being.”
Accountability means operational decisions rest with you: In some cases, office managers begin to feel ownership of the office, often acting as a surrogate who knows what the owner wants. Lack of oversight allows those managers greedy for illicit gain to foil any initiatives owners pursue. Dental offices thrive in the team mentality, but remember who owns the team!
Accountability thrives in an oversight environment: Owners must set up policies and stick to them. Set up job expectations and make sure they are performed as prescribed. Cross-train other team members so that no one holds the keys to all information and access. Allow only legitimate and infrequent unsupervised work opportunities. Ask managers to print reports while you stand by for them instead of letting the employees do it within their own timeframe. Print reports yourself and study them carefully for any discrepancies.
Dentists who have never required accountability may fear that employees will feel discredited. When introducing accountability measures, owners must ensure that employees understand the intent of the new oversight policies and procedures. Assure the staff that these positive changes will facilitate best business practices and assist operations when employees transition out of the office. Let the team know that you better understand your owner’s duties, including proper oversight, and that you will intentionally protect the office’s future, which helps preserve their jobs. Listen to their concerns but remain firm that the new operational tactics will be enforced.
In our next blog post, we will look at some tips on making operational changes to your office protocols to assist you in exercising appropriate accountability planning and oversight.
References
Harris, D. (2023). Healers versus stealers: How to outsmart the thief in your dental practice. Tellwell Talent. Kindle Edition.
