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GPS Managing Professional Risks

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Identifying the risks that exist in a dental practice is the first step to effectively managing them. Once you know what the risks are, you can develop plans, systems and protocols to reduce the likelihood that one of those possible risks will become a reality that has the potential to significantly damage your ability to practice, your professional reputation and your financial stability.

This ADA Guidelines for Practice Success™ (GPS™) module on Managing Professional Risks discusses some of the preventive steps you can take to protect yourself and your practice.

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  • Record Retention

    The length of time a practice should keep dental records after a patient’s last visit will vary according to state laws and the provisions of contracted dental benefit plans. It’s a good rule of thumb to check with your attorney, state dental board or state dental association for specific information regarding the requirements in your state.

  • Record Destruction

    Dental practices are required to follow specific regulations when destroying paper dental records. This is because patient charts are confidential records and may include highly sensitive information. You as the dentist have an obligation to protect the patient’s privacy and personal health and financial information.

  • Subpoenas for Dental Records

    The Health Insurance Portability and Accountability Act of 1996 (HIPAA) permits covered dental practices to disclose patient information in compliance with, and as limited by, the relevant requirements of a court order or court-ordered warrant, a subpoena or summons issued by a judicial officer, a grand jury subpoena, or certain administrative subpoenas.

  • Subpoenas for Forensic Radiographs

    At some point in his or her career, it’s possible that a dentist may be contacted and asked to assist in a forensic investigation. While these cases might require some extensive research, their potential to bring closure to a family that has lost a loved one makes the effort important and worthwhile.

  • Retention of Other Business Records

    The proper retention period for various business documents will vary from state to state and can even differ from practice to practice. The linked table details a typical schedule of retention periods; “retention period” refers to the number of years documents should be kept from the date tax returns are filed. The information provided here is for general purposes only and is not offered as legal advice. Consult an attorney to establish a schedule for documents in your own practice.

  • Managing Patient Referrals

    It’s up to each dentist to determine whether he/she has the education, training, and experience needed to deliver the treatment needed by a particular patient. Referring patients who are beyond the scope of your expertise may help minimize claims against you.

  • Audits

    While the word “audit” might cause fear, anger or trepidation, an audit doesn’t have to be a difficult situation. When self-managed effectively and with a defined purpose and an open mind, an audit can ensure that your practice is following the appropriate policies and protocols that are in effect in your practice.

  • Minimizing Your Risk of – or During – an Audit

    While no one, not even the American Dental Association (ADA), can offer advice to make a practice 100% audit proof. Implementing certain best practices can minimize the likelihood that an audit of your practice will result in citations for violations.

  • Recordkeeping and RAC Audits

    Most CMS programs require potential recipients of healthcare to meet certain criteria in order to receive care. Similarly, healthcare providers must meet certain criteria and follow specific steps in order to enroll in CMS-supported programs and receive reimbursement for treatment provided to participants in these plans. The ACA includes certain provisions, such as the Recovery Audit Program (RAC), designed to identify and correct improper payments made through the Medicare program or federally funded healthcare program.

  • Documenting Medical Necessity for CMS

    Dentists who are participating providers in federal or state programs supported by the Centers for Medicare & Medicaid Services (CMS) are required to document medical necessity, which means providing information not only on what treatment has been provided but also why it was done.

  • Medicaid Compliance

    CMS has numerous resources to assist healthcare providers in ensuring that they’re in compliance with programs requirements and standards. Each component of the program offers guidance on what constitutes sound documentation practices and how to achieve them.

  • Medicaid Fraud

    The U.S. Department of Justice estimates that health care fraud results in improper payments of tens of billions of dollars each year. Know what to look out for and how to avoid this in your dental practice.

  • Securing Legal Support and Advice

    Dentists should expect to work with several different attorneys. Like many dentists, many lawyers have specialty practices and limit their counsel to certain topics and matters of law.

  • Managing Risks with the Dental Team

    Your dental team is vital to your practice. How they treat patients, how well they do their jobs, and how well they work together directly impacts the success of your practice.

  • Employee Risk Management Education

    Investing in staff training can pay huge dividends: after all, your staff works to keep patients safe and the practice in compliance.

  • Wage and Hour Audits

    Wage and hour audits may occur at any business at any time and are usually in response to a complaint filed by an employee.

  • Clerical and Billing Errors and Omissions and Collections

    The dentist always has full responsibility for ensuring that dental claims have been completed accurately, correctly and at the time the patient received treatment.

  • Staff Use of Cell Phones and Personal Mobile Devices

    Staff misuse of cell phones and other personal mobile devices while on the job can be a significant liability.

  • Managing Natural and Man-Made Disasters

    Having a clear plan outlining what to do and in what sequence can safeguard the practice’s assets and minimize any loss of revenue.

  • Managing Patients’ Medical Emergencies

    While only a small percentage of dental patients experience a medical emergency while at the dental office, it’s important for you and your team to be ready to respond in the event that an untoward event does occur.

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