Clinic Organization and Business Protocols

1. Clinic Organization andBusiness Protocols December 5, 2005 Nader A. Nadershahi, DDS, MBA

2. Second Year Clinic -- A System Overview -- The Clinics • Main Clinic • Located on Level C • Clinical Practice Breakdown • Senior (Third) Year Clinic -Groups I, II, III, IV) • Junior (Second Year Clinic)

3. Clinic Organization • Four Group Practices with their own GPA and Administrative Assistant (I, II, III, IV) • Second year faculty are in format that you are familiar with in ½ of the alphabet • Third year students will work with mentor groups and specialty faculty as needed • All rotations and other programs still apply

4. Patient Transfers • Patient transfers will be made in group practices. (Students in 2nd ¼ of senior class will transfer patients to students in 2nd ¼ of junior class.)

5. The People • Students • Senior Students + AEGD, OMFS, & • Junior Students Ortho residents • Patients • Senior Cases • Junior Cases • Sharing -- Referrals within the group practices and between Seniors and Juniors

6. The People (continued) • Faculty: from all clinical departments • Staff: receptionists, sterilization, cashier, patient care coordinators (PCC) • Clinic Administration: ADCS, Group Practice Administrators (GPAs) & assistants

7. Associate Dean for Clinical Services PSL Clinic Managers GPA Group I GPA GroupII GPA Group III GPA Group IV Restorative Chair Perio Chair Removable Chair Endo Chair Receptionists PCCs Sterilization Admin Asst. Admin Asst. Admin Asst. Admin Asst. GPM Coordinator Group I 2nd Years and Patients Group II 2nd Years and Patients Group III 2nd Years and Patients Group IV 2nd Years and Patients 2nd year clinical faculty 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 Group I 3rd Years and Patients Group II 3rd Years and Patients Group III 3rd Years and Patients Group IV 3rd Years and Patients

8. The Clinics • Oral Surgery (Level C) • Radiology (Level C) • Emergency (Level C) • Pediatric Dentistry Clinic (1st Floor) • Orthodontic Clinic (1st Floor) • Oral Medicine and Facial Pain (6th Floor) • Faculty Dental Service Group (1st Floor) • Advanced Education in General Dentistry (Level B) • Perio Surgery (Level C)

9. Quarter Fifth (Mon.-Thurs.) Sixth, Seventh and Eighth Quarters (Mon.-Fri.) Time Spent in Blocks 40 Percent Blocks 40 - 50 Percent Blocks The Year

10. Second Year Clinic Goal • To develop the fundamental clinical patient care skills in all dental disciplines for comprehensive patient care. • To provide close faculty interaction to carefully guide student learning experiences. • To provide quality patient care.

11. How do we do it? -- The Year as a Transition • Designed to introduce students to comprehensive patient care with an emphasis on diagnostic skills. • Teach students to manage dental cases. • Prepare students for more complex patient care cases.

12. 2nd Year Clinic Blocks Perio Recall Perio Surgery Assisting Oral Surgery Radiology Other Blocks Local Anesthesia Endo Block Implantology Fifth Quarter -- The Blocks

13. Staff Some Patient Scheduling Financial Contracts Patients Recall Patients “check up & cleaning” Simple New Patient Cases Faculty Manage Patient Care Same Students with Same Faculty Students Patient Exposure (Be there and be prepared) 1st Impressions are Important Pay Attention Patient Scheduling Fifth Quarter -- The Operation

14. 40 - 50 Percent Block 2nd Year Clinic Blocks Perio Recall Perio Surgery Assisting Others: Same as Last Quarter Other Clinic Blocks Same as Last Quarter Pedo Block 10-12 students scheduled for 10 consecutive clinic sessions Sixth Quarter -- The Blocks

15. Staff Some Patient Scheduling Financial Contracts Patients Increased flow of new patients Encourage students to bring in their own patients Faculty Increase Student/ Faculty Ratio Assisting in procedures, less patient management Students Increased Independence Comprehensive Patient Care Patient Scheduling Sixth Quarter -- The Transition

16. 40 – 50 Percent Blocks Perio Blocks 50 – 60 Percent Open Clinic Time See your own patients Other Main Clinic Blocks Same as Last Quarter Other Blocks Same as Last Quarter Seventh and Eighth Quarters -- Turning It Over

17. Clinical Services in the Second Year Clinic • Comprehensive Patient Care • Relatively Simple Restorative Cases • Clinical Experience

18. Fifth Quarter Mostly ODTP & Perio Almost Any Operative Almost Any Endo Almost Any Single Crown No Removable Sixth Quarter ODTP & Perio Almost Any Operative Almost Any Endo Almost Any Single Crown Still No Removable Clinical Services in the Second Year Clinic -- (continued)

19. Seventh Quarter ODTP & Perio Almost Any Operative Almost Any Endo Almost Any Single Crown Maybe Posterior Bridge Full Denture Cases No Partial Dentures Eighth Quarter ODTP & Perio Any Operative Any Endo Any Single Crown Maybe Posterior or Anterior Bridge Any Removable Case Clinical Services in the Second Year Clinic -- (continued)

20. D0150 -- Initial Oral Exam (ODTP) D0120 -- Periodic Oral Exam (Recall) D0210 -- Full Mouth Series (FMX) D0274 -- Four Bitewing Films D1110 -- Prophylaxis, Adult D4341 -- Root Planing (per quadrant) D4910 -- Supportive Periodontal Therapy (SPT) D2140 -- One Surface Amalgam D3310 -- Anterior Root Canal Therapy D2790 -- Full Cast Crown (FVC) D2750 -- PFM Crown Clinical Services -- Most Common CDT5 Codes

21. New Patient Intake Service • Screenings are done on a first-come, first-served basis. Sign up starting at 8:30 and 12:30. • Done by Faculty • Monday-Friday • 9:00 a.m. to 12:30 a.m. and 1:00 p.m. to 4:30 p.m.

22. Patient registers at Front Desk Fills out paperwork Demographic Form Preliminary Evaluation Health History Patient Rights & Responsibilities Dental Materials Fact Sheet HIPPA Acknowledgement Patient returns forms to Front Desk Patient directed to Radiology for Pano and 2 Bite-Wings ($25) Radiology technicians give forms and radiographs to Screening Faculty Patient Intake Flow

23. Patient Intake Flow Chart -- (continued) • Faculty member: • discusses patient’s chief concern/desire/ expectations • explains clinical protocols • briefly reviews patient’s medical status • medical consult form, if needed • determine patient’s dental needs • determine teaching case status • provides patient with very rough cost estimates

24. Patient Intake Flow Chart -- (continued) • If faculty member and patient agree to make patient a teaching case, then: • faculty member suggests Junior or Senior Clinic • faculty member prescribes remaining films to have FMX (for an additional $70) • FMX taken or appointment made • If patient brings in FMX, Radiology Faculty determine acceptability of films

25. Patient Intake Flow Chart -- (continued) • After FMX: • Patient Intake Manager, Mr. Robert Trezia, brings cases to Group Practices on a rotating basis. • GPA and AA’s assign based on needs list and procedure tracking. • Students check patient lists regularly for new pts. • Student makes first phone call and appoints ODTP.

26. To Determine: Chief Concern Expectations Needs Medical Status To Discuss: Introduce Clinic Comprehensive Care! Finance Fees Payment Plans Screening Goals

27. Screening Goals -- (continued) • Is this patient a teaching case? • Based on patient needs and expectations • Based on faculty assessment • If patient is a teaching case, then: • Order FMX ($70) • GPA assigns to appropriate student • If patient is not a teaching case, then give patient referral advice and films

28. Patient must fill out patient information form. Chart must be made for patient Information Desk Complete ODTP steps 1 & 2 on clinic floor Faculty determines appropriateness of case for 2nd year student Radiograph Rx from faculty How to bring in your own patient

29. Main Clinic Business Protocols

30. Clinic Business Protocol – Prelude • ODTP -- Step 7 • Prioritize Treatment Plan • Entered into Computer in Proper Sequence • Clinical Approval • ODTP – Step 8 • Signed Treatment Printout in Chart • All Charting in Computer • All Forms Signed and Organized in Chart

31. Discussing Treatment Alternatives • Explain clinical importance of preferred procedure • Respect patient’s ability to pay for services • Patient Autonomy and Standard of Care Practices

32. CARE and Denti-Cal • CARE office • Luis Rodriguez • Denti-Cal Approval from GPAs or Department Chairs • After approval, chart taken to PCC for final financial approval

33. Type accepted treatment plan into computer Get instructor to give clinical approval Print out treatment plan Have patient sign treatment plan Patient fills out Patient Credit Information Form Preauthorization done Sign up to see Patient Care Coordinator (PCC) Wait for PCC to page See PCC for financial arrangements and approval Clinical and Financial Approval

34. Road to Clinical Approval • Discuss Treatment Options & Costs with Patient • Treatment Plan Acceptance • Enter Accepted Treatment Plan into Computer in Planned Delivery Sequence • Have Faculty Member give Clinical Approval Hint: Ask for clinical approval from the faculty member you worked with during the ODTP process.

35. Ways to Lose Clinical Approval • Change the sequence of the clinically approved treatment plan • Add anything to the clinically approved treatment plan • Delete anything from the clinically approved treatment plan

36. First Steps to Financial Approval • Patient signs clinically approved treatment plan printout • Patient fills out Patient Credit Information Form • Complete pre-authorizations as needed • Go to Patient Services • Student signs up to see Patient Care Coordinator (PCC)

37. Patient Services (PCCs) • Located directly behind the Front (Information) Desk on Level C • Patient Care Coordinators • Irene Vargas • Maria Bran • Jerilyn Thompson

38. Patient Care Coordinators • Answer patient account questions. • Send out and monitor insurance pre-authorizations. • Send out and monitor insurance claims. • Give financial approval to ALL patients.

39. Patient Care Coordinators -- (continued) • See a PCC if you need information or assistance with: • Financial Approval • Private Insurance • Denti-Cal (Public Insurance) • Contracts (Financial Arrangements) • Patient Accounts

40. Payment Options • Full Payment in Advance • Contracts (Under $500 or Over $500) • Pay for Treatment As They Go (Depending on amount. Can bill under $300)

41. Advantages: To Patient: 5 percent discount To Student: Financial approval every visit (as long as treatment plan does not change) Disadvantages: To Patient: May not have all the funds at that time. To Student: None Full Payment In Advance

42. Contracts -- Qualifications • Employment or Income Information • Major Credit Card • Bank Account (Savings or Checking) • Down payment equal to one month’s payment (Procedures requiring laboratory fabrication need 25% down payment Contracts run no more than 20 months with a $40 per month minimum payment. (Total amount Divided by 20)

43. Contract Under $500 If patient or co-signer has employment verification plus either a major Credit Card or Bank Account Treatment plan can be broken down into ~$500 increments. Contract Over $500 Patient or co-signer has all qualifications. Contracts

44. Insurance • Private Insurance • We accept any dental insurance plan that will accept us. • Every plan has different rules (see your PCC) • Public Insurance • Denti-Cal or Medi-Cal • Pre-authorizations a MUST • Eligibility needs to be checked EACH month.

45. Denti-Cal Procedures Requiring Pre-Authorization • Root Planing • Root Canal Therapy • Dentures • Relines • Crowns (No posteriors unless abutments for RPD) • Stayplates • Partial Dentures • They are only a benefit if opposing a full denture. Failure to wait for pre-authorizations will result in your not receiving credit for the procedure.

46. Ways to Lose Financial Approval • Add or subtract anything to or from the treatment plan. • Patient becomes more than 60 days past due (delinquent account). • See your PCC

47. Financial Approval • Be prepared! • Always accompany your patient when making financial arrangements. • Only a PCC can give financial approval ALL PATIENTS NEED FINANCIAL APPROVAL

48. Thank You…