Talking with the Toothcop

Introduction: Join Duane Tinker as he welcomes Leah Roling, an acclaimed life coach and celebrated author of "Shift" and "Nobody's Coming to Save You." Specializing in dental professionals' growth and success, Leah shares transformative insights aimed at enhancing both personal and professional realms. Embracing the Platinum Rule with Leah Roling: Discover the transition from the Golden Rule to the Platinum Rule with Leah Roling. Understand the pivotal shift towards treating individuals based on their personal preferences and needs, a cornerstone for effective communication and relationships in and beyond dental practices. Enhancing Communication within Dental Practices: Explore with Duane and Leah how effective communication transcends traditional dental services, fostering deeper connections with patients and promoting a thriving practice environment. The Path to Personal Growth Through Discipline: Leah delves into the essence of personal discipline, the motivational triad, and the journey towards self-improvement and enhanced professional outcomes. Foundations of Habit Formation for Dental Professionals: Learn Leah's strategies for establishing a sustainable baseline in habit formation, aiming to bolster consistent progress without the risk of burnout. The Power of Self-Reflection and Gift Sharing in Dentistry: Revisit insights from a prior session where Leah discussed the impact of self-reflection and the importance of sharing one's unique gifts within the dental community and beyond. Upcoming Opportunities for Professional Development: Stay ahead with Leah Roling's "Manifest Mind" course starting April 1, designed to empower individuals through mindset shifts and actionable steps towards crafting their desired life. Additionally, mark your calendar for an October event focusing on leadership and personal growth. Connect with Leah Roling: Reach out to Leah through her official website, engage with her on social media, tune into her podcast "Becoming You" with Leah Roling, or get in touch directly via email for insights into transforming your dental practice and personal growth. Leah Roling's Impact on Dental Leadership and Team Dynamics: Leah Roling stands as a transformative leader in dentistry, emphasizing leadership development, team dynamics, and engagement strategies to combat industry challenges such as burnout, turnover, and absenteeism. Through her innovative approach, Leah fosters environments of empowerment, confidence, and creativity, ensuring dental practices not only meet but exceed modern expectations. Engage with Leah Roling: Discover Leah's comprehensive suite of resources for dental professionals seeking to enhance their practice's dynamics and patient satisfaction through her website, LinkedIn, Facebook, YouTube, TikTok, Instagram, and her inspirational podcast. Your Invitation to Transform Your Dental Practice: In the ever-evolving changes in dentistry, the success of your practice hinges not just on the quality of care you provide but also on the health and harmony of your team. Recent shifts in the workforce landscape have brought to light the critical need for evolved leadership strategies that go beyond traditional management.   As a dedicated leadership and team engagement strategist specializing in dentistry, I understand the unique challenges you face—burnout, turnover, and absenteeism are not just issues; they're barriers to your practice's growth and patient satisfaction. It's clear: to thrive in today's environment, simply leading and managing isn't enough. The key lies in enrolling your team in their potential, fostering a culture of confidence, decisiveness, and creativity, and shifting from expectations to empowerment.   Are you ready to assess the health of your practice and explore practical strategies that have proven to reduce absenteeism by a staggering 81% and turnover by 18%? With the average cost of hiring reaching $45,000, reducing turnover isn't just beneficial; it's essential.   I invite you to book a complimentary leadership call with me, where we'll conduct a 5-question assessment to pinpoint the health of your practice. Together, we'll tailor engagement strategies to your unique needs, setting you on the path to a more harmonious, productive, and resilient practice.   The workforce has changed. Has your leadership? Let's explore how you can adapt and excel in this new era.   Leah Roling Phone Number: 515-865-6716 Email: leahtfl@gmail.com   Social Media Handles Website: www.leahrolingcoaching.com LinkedIN- https://www.linkedin.com/in/leahroling/ Facebook-https://www.facebook.com/profile.php?id=100087511623234 Youtube - https://www.youtube.com/channel/UCkSOBSTuY97mQXacTbiufTA TikToK- https://www.tiktok.com/@leahrolingcoach Instagram- https://www.instagram.com/leahrolingcoaching/ Podcast: https://podcasts.apple.com/us/podcast/the-becoming-you-show-with-leah-roling-inspire/id1608085445

Clinical Recordkeeping for Dental Assistants for Nifty Thrifty Dentists Group  

Amanda Hill RDH, BSDH has been a dental hygienist for over 26 years. When she took her annual infection control training in 2017, the speaker covered waterlines. She never knew that she had to do more than flush her waterlines. No one else in her dental office knew that they were supposed to do more. Her practice failed their first water test, badly. So Amanda dug in and got them to pass their water testing. Then she started offering to help other dental offices. In this episode, Amanda shares her expertise and we have a deep discussion about waterline testing.  Outline of This Episode [1:56] Learn more about Amanda Hill AKA the “Waterline Warrior” [6:24] Open line versus closed waterline systems [11:10] What is a biofilm and how do you kill it?  [16:08] Amanda's favorite germicide delivery system [19:39] Reasons you need to do waterline testing [26:25] Why you want to be consistent with treatments [28:40] How frequently you should test your waterlines [33:24] Addressing the flushing your waterlines debate [38:33] Waterline testing must include documentation Resources & People Mentioned Email: amandahillrdh@gmail.com  Friend on Facebook Follow on Instagram Connect on LinkedIn Check out Amanda's Website Deanna Otts-Whitfield, RDH, BSDH, MSHQS BluTube Dental Unit Water Purification Cartridge Dental procedures during pandemic are no riskier than a drink of water Preventing Airborne Diseases in Dentistry with Michelle Strange CDC warns of bacteria in dental waterlines after children are infected Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Without question, the Covid pandemic had a large impact on the healthcare field. It highlighted monstrous changes that needed to occur in the infection control space. MCS put its resources into investigating standards of care in infection control.  MCS came out with some new technologies that will transform the world of infection control. Paul Saueressig outlines the solutions they've created and how they can benefit your dental practice in this episode of Talking with the Toothcop. Do NOT miss this one! Outline of This Episode [2:12] Learn more about MCS Infection Control Solutions [8:01] Solution #1: Protective Coating Solutions [15:03] Solution #2: Rapid Testing Solutions [26:08] Two options for healthcare facilities [35:53] The problem with Healthcare-Associated Infections (HAIs) [39:56] Providing long-term proactive solutions for the healthcare space [41:09] How to get more information about MCS infection control solutions Resources & People Mentioned MCS Paul Saueressig Hygiena Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Have you heard of the federally implemented “No Surprises Act?” Were you aware that it applies to dentists? The No Surprises Act protects uninsured and self-pay patients from receiving surprise medical bills. So what does that mean for your practice? Find out in this episode of Talking with the Toothcop!  How the “No Surprises Act” applies to dentists As of 1/1/2022, you need to provide patients an estimate of anticipated charges for dental services, i.e. “Good Faith Estimates” or GFEs. They must be provided upon request or upon scheduling an appointment—well in advance of the treatment plans and financial estimates you may be currently providing.  Because you're already providing financial estimates in advance of service, does that mean you're exempt? NOPE. Sorry to tell you, that's not the case. At this time, it applies to uninsured and self-pay patients. It may apply to insured patients in the future.  What do you have to do? Here are the basics:  You have to provide notice to your patients of their right to receive a GFE You must post a notice on your website You must post a notice in your practice where scheduling and service costs may be discussed (so a check-in desk). You need to implement a good faith form in your practice. You have to issue this to current and new uninsured and self-pay patients before you provide—or continue providing—services. This applies to anyone who even contacts your office. If they ask what you charge for a dental cleaning, you have to provide them with that estimate.  What else do you need to know?  Even if you provide a GFE verbally, it must also be provided in writing (mail, fax, or encrypted email). Before you give out this information verbally, it's wise to tell a potential patient that you must follow up with this information in written form and ask for their name and address (and assure them this is federal law). It must be provided within a specific time frame (1–3 business days after an appointment is scheduled or 3 days after an inquiry)  GFEs must be mailed to current patients before you continue with treatment  You have to maintain the estimates that you provide in a patient's charting and document in their progress notes that you've talked about the GFE They have to be maintained for six years (even GFEs for patients who never scheduled) A GFE is the cost of services that you anticipate providing for a patient over a year. If those costs change, you must issue a new GFE.  None of this is difficult. But it is just one more thing you have to implement. That's why we've created a toolkit for you to help you implement this in your practice.  Why does any of this matter? If there is a difference of more than $400 between your GFE and billed charges, the patient can initiate a billing dispute that the HHS can investigate. Those decisions are reviewed by a third-party contractor. If the decision doesn't go in your favor, you can lose out on legitimately earned fees. Secondly, this may become like HIPAA. A complaint may lead to your practice being audited and civil monitoring down the road.  Outline of This Episode [1:23] The Federal No Surprises Act  [3:35] What you have to do [7:03] When did this become effective?  [8:04] Why does any of this matter? [9:52] Where this falls in order of operations [11:00] Q&A session with Laura  [17:49] How to connect with Laura [19:46] Important compliance reminders OUR SPONSORS:  ProEdge Dental Water Labs: https://ProEdgeDental.com/Toothcop  Protective Dental: https://DentalCompliance.com/DrugKit Resources & People Mentioned The No Surprises Act implementation guide and toolkit Connect with Laura by email: ldiamond(at)dsedlaw.com Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Everyone needs a compliance program tailored to the needs of their practice. Justin Withrow jumps in when a compliance program is absent and things go horribly wrong. Perhaps a client was employing an individual that's excluded from participation in the Federal Healthcare Program that should have been caught.  There is a multitude of things that could happen that could have been prevented by a compliance program. In this episode of Talking with the Toothcop, we dissect the importance of exclusion monitoring, the basics of the false claims act, self-disclosure protocol, and much more. The importance of exclusion monitoring  Justin worked with a multi-location practice where the owner worked with walk-in and Medicaid clients frequently. He was doing criminal background checks and checking licenses with the dental board. But he didn't know an exclusion list existed with the Federal Healthcare Program that could exclude providers from working with the Medicaid program. Unfortunately, one of his providers knew they were excluded and didn't tell him. It resulted in a fraud investigation of his practice. He was looking at jail time for something that could easily have been avoided.  It feels like science fiction but it's the real deal. It's as simple as running your licensed staff members' names through a website. You need to know they're authorized to work with your patients so you can get reimbursed for services rendered. If you don't, they'll take that money back—and then some. Justin dissects the basics of the false claims act and the fines you could be looking at if you were caught in this situation. Don't miss it.  The submission of “unclean” claims If you submit a claim for reimbursement by a provider who is excluded from a state Medicaid program, that claim is labeled as a false claim. Let's say a practice employs someone who they knew was excluded and billed services as rendered by a credentialed provider. If it was determined the service was rendered by an excluded provider, that triggers a false claim. Any service rendered by an excluded provider and submitted for reimbursement to Medicaid is a false claim.  If a provider has been excluded, that individual can't have contact with any patient insured with Medicare or Medicaid. If they work on that patient that claim cannot be reimbursed. That's why it is SO important to do exclusion checks. This applies to dental assistants, hygienists, and even administrative staff. Every member of your organization needs to be regularly run through exclusion databases.  Defining self-disclosure protocol A compliance program helps you identify improper practices (something coded incorrectly, overpayment, etc.), catch them, and self-disclose or clarify that you made a mistake. You can let the governmental agency know a mistake was made and correct the mistake. Usually, you're given a certain time period—60 days—in which to self-disclose. The government knows mistakes happen. That's why this protocol exists.  If you're in the general ballpark of 60 days, it's usually fine. Even if you're outside of the 60-day window, doing nothing is the wrong approach. You will get in trouble down the road. It's always appropriate to rectify your mistakes when they're identified. Just work with a professional to do it appropriately. What a compliance program must address A compliance program must address the policies and procedures that an office uses to operate (i.e. OSHA, HIPAA, dental board regulations, state and federal regulations, etc.). You must properly and safely render care to patients while adhering to various laws of various agencies. It's an all-encompassing document that dictates how you do everything in your practice. It's who you are and how you operate. It has to be reflected in the day-to-day operation of your practice. People always say, “We're too busy.” That's NOT okay. It's an excuse. These things can't fall by the wayside. This has to be a staple of your business. There needs to be a compliance officer that is someone other than the dentist. They are your professional lifeguard. They stop the real cops from coming into play. If you're “Too busy” it's only a matter of time before you're audited or investigated. Outline of This Episode [3:56] The importance of exclusion monitoring  [6:30] The basics of the False Claims Act [11:56] Defining self-disclosure protocol [16:21] What a compliance program must address [24:12] Managing the merger and acquisition process [29:21] Possible reductions in fines and penalties [31:44] How to connect with Justin Withrow OUR SPONSORS:  ProEdge Dental Water Labs: https://ProEdgeDental.com/Toothcop  Protective Dental: https://DentalCompliance.com/DrugKit Resources & People Mentioned DENTAL COMPLIANCE RULES: NEW IN 2021 [PART II] DENTAL CHART AUDITING [WHY IT'S SO IMPORTANT] Connect with Justin Withrow Connect with Justin on LinkedIn Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

When you're in the midst of a busy day in your dental office, the details are the things that you typically let slide, right? But in the dental business, it's the details that keep you on track and it's the details that protect your office from huge fines and your Doctor from losing her licenses. This episode highlights some of the things I've seen recently that I think all dental office workers need to have top-of-mind. If you don't take these things seriously, you're going to have issues eventually. Online training or in-person training? Which do you need? Every dental office is going to be required to do Continuing Education from year to year. BLS, ACLS, and PALS are common certifications that need to be upgraded. Many times, compliance teams do their training through “approved” course providers through an online course. That's OK, but you can't assume that because it says “approved” or “certified” that it's truly that across the board. Your STATE may have additional requirements that the course provider is not aware of. For example, for some of the CE requirements, you can do the didactic part online and the testing part online. But you must have a hands-on, in-person evaluation of skills to finish up the CE credit. Don't get caught out of compliance because you didn't finish a course as was required. If you discover that's the case for you, simply fix the issue as soon as possible. Office Inspections: Things I'm seeing that you should consider As I do reviews at offices to help them get ready for State Board Inspections, I come across a variety of things that are of concern and should be addressed. One of the most common points where I'm finding errors recently is the Pre-Op Sedation/Anesthesia Checklist. State inspectors are fanatical about the form and want it to be used without exception. The title on your form must be exactly that: Pre-Op Sedation/Anesthesia Checklist. There is a lot of information on that form that is required to be ON the checklist. You will fail your sedation review if that is not the case. These are little things you need to make sure are properly in place to pass the inspection. You don't want to be embarrassed or look bad in front of the board. If you are not 150% sure on your checklist, send me a copy and I'll send you input on what you are missing (if anything). Compliance around drugs is a huge issue I'm seeing of late We all know there are compliance regulations in force surrounding the topic of expired drugs. But lately, I've come across offices that have terrible problems in this area. Many offices have their checklists but they are not accurate or up to date. In one situation I encountered, the NEWEST expiration date on drugs in their facility was dated 2016. That's so problematic! You MUST be up to date by removing expired drugs from the premises, and by keeping accurate records. You're playing a risky game if you're not taking compliance issues like this seriously. Don't just check the boxes on the forms, pay close attention to the reality of you drug inventory. Protect yourself and your patients. It doesn't matter until it matters, and then it matters big time!  Why office inspections are powerfully helpful for your dental practice The beauty of what I do and how I do it is that I'm able to do office inspections as a neutral 3rd party. That means I'm able to be entirely objective because I am not tied to the outcome in any way. I'm not so close that I can't see the issues. This helps me identify what needs to be fixed, help the staff fix the issues, and move on. It really is that simple. There's no need for panic or concern because you find something of concern. Just call and I'll come out and assess everything, give you my recommendations, and point you in the right direction to fix any compliance issues I find. Quotes for this episode: “If you continue to think the way you've alway thought, you'll continue to get what you've always got.” - Kevin Trudeau “Do all the good you can, by all the means you can, in all the ways you can, in all the places you can, at all the times you can, to all the people you can, as long as you can.” - John Wesley  Outline of This Episode [3:58] Continuing Education requirements - changes, updates, clarifications [10:35] Office reviews and concerns that I'm seeing as I do these reviews [18:05] Best-practices for Dental office reviews (the article is linked below) [25:15] The quotes we've found helpful this past week Resources & People Mentioned OUR SPONSORS:  ProEdge Dental Water Labs: https://ProEdgeDental.com/Toothcop  Protective Dental: https://DentalCompliance.com/DrugKit  Get the physical newsletter: The Dental Legal Update (Jeanine's website) Dental IQ: Survivor: Dental office audit edition Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

During the 4th Quarter of 2021 we saw a lot of enforcement activity, from the agencies that are announcing their fraud enforcement efforts to insurance companies that are initiating audits, etc. So whatever you're involved with (Medicare, Medicaid, Indian Health Services, etc.), be sure you have an audit process in place that includes good records on the steps you've taken. You need to be able to prove your compliance should an audit or investigation comes your way. Narcotics charges against a Michigan Dentist, and lesson for all of us A Michigan Dentist was busted recently on narcotics charges, and it's easy to sit at a distance and pass judgement. But regardless of the facts in this case, there are other things that happen along this line that are more common. For example: sometimes only one Dentist has a DEA license but the others in the practice may write scripts using the other Doc's DEA number. That's a dangerous habit to get into. This news story demonstrates that the powers that be are not looking the other way. Don't share your credentials and don't allow other providers to use your credentials. Sharing is not caring in this situation. Are you considering the purchase of a dental practice? If you are considering buying a dental practice and the practice has been guilty of compliance issues, you will become liable for those issues the moment you buy the practice. So you need some kind of due diligence process that will assess the practice before you buy to ensure you're not buying a piece of junk that you can't get into compliance. But the good news is that not all things that look terrible are terrible. Duane has seen many situations where a practice was able to be easily fixed, then sold (like house flipping) for a profit. If you're looking for support in the purchase of a dental practice, reach out!   Outline of This Episode [3:06] Duane's interest and belief in goals (and another puppy) [7:13] Regulatory action is taking place, so be sure your audit process is up to date [8:44] A Michigan dentist is guilty on narcotics charges brought by the DEA [14:38] The Self-Disclosure Protocols have been renamed [17:27] The DOJ reintroduces corporate compliance monitors [26:31] NEW SEGMENT: Inspirational Quotes Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! The Pro Edge Water team - www.ProEdgeDental.com/Toothcop (affiliate) Michigan Dentist busted by the DEA Self Disclosure Protocols renamed CIA's are back! The Justice Department's criminal fraud page “We don't rise to the level of our expectations, we fall to the level of our training.” “Don't practice until you get it right, practice until you can't get it wrong.” “Most people never run far enough on their first wind to find out they have a second wind.” Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

I started the Talking with the Toothcop podcast in December 2017. Andrea has been with me since early 2019. We love doing this podcast together. Sadly, it's time for us to hit the pause button. We will be back—I promise! But we have a lot on our plates right now and it makes sense to pull back temporarily. If this podcast has been rewarding and educational for you professionally, take some time and go back to listen to our episode archive!  Outline of This Episode [0:22] What's happening in our lives! [4:18] Check out ProEdge Dental [7:01] Sharing some bittersweet news [9:07] Learn more about protectIt dental  Past podcast episodes to check out! Check out some of our most popular and episodes packed with need-to-know information:  Dental Unit Waterlines: the Good, the Bad, and the UGLY (with Mike Rust + Kellie Thimmes The 7 Elements of Dental Compliance Programs How a Compliance Program can Save Your Bacon Sedation Inspections + EPCS + Continuing Education The Importance of Sterilization Processes - Stephen Kovach We're always here to answer questions, so don't be afraid to reach out. Until we return, subscribe to our email list!  Resources & People Mentioned Check out ProEdge Dental at https://proedgedental.com/toothcop!  Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

I work with dental offices and do a lot of dental inspections/consults. I help people identify what they need to do differently. We talk through OSHA, HIPAA, infection control, radiology, medications, state board compliance, etc. But I get really excited about infection control and sterilization. That's my stage—my moment to shine. In this episode of Talking with the Toothcop, we're going to talk about instrument processing and cleaning procedures. Find out what you could be doing wrong and what to do instead! Outline of This Episode [0:49] Time to redo the 75 Hard Challenge! [6:00] Check out ProEdge Dental at https://proedgedental.com/toothcop!  [7:16] What a sterilization room should look like [10:46] Don't neglect monitoring your ultrasonic [14:37] Follow manufacturers instructions for use [16:45] Other things to note when using your ultrasonic [20:20] Learn more about protectIt dental at https://dentalcompliance.com/drugkit  [21:46] Check out the 2021 Dental Compliance Bootcamp!  What a sterilization room should look like I've seen thousands of sterilizations rooms. Some are great, some are poorly designed, and some just don't shock me anymore. What should it look like? It needs to be physically segregated into different areas for instrument receiving and cleaning, decontamination, preparation and packaging, sterilization, and storage. There needs to be a “cleaned” area and a dirty area. I can't tell you how often I see cross-contamination issues. When you bring the instruments into sterilization, the rest of the processes need to move in one direction. If you move in the opposite direction, you're contaminating what's supposed to be sterile.  Don't neglect monitoring your ultrasonic A sterilization area contains two major processes: instrument cleaning and sterilization. If you don't do one part right, it impacts the entire process. There are monitors in place for the sterilizer, color-changing indicators on instrument peel-pouches, and indicator tape on instrument cassettes. They give us visual confirmation of whether or not the sterilization process worked.  People often monitor the sterilization indicators but neglect the cleaning side of the process. You can't just assume the instrument washer or ultrasonic is working effectively. Just because it sounds like it's working properly doesn't mean it is. You need a qualitative test—like a foil test—to make sure that it's working properly. It needs to be done frequently. When those machines fail, they don't sound any different. It is not obvious. I don't love the foil test. What do I prefer instead? An ultrasonic cleaning monitor. It can be ordered through your dental suppliers. Get and use that weekly. Record in your records that it passes inspection. It gives you information on several data points: cavitation, enzyme concentration, and more.  Follow manufacturers instructions for use (IFU) Are you using the correct concentration of enzymes in the ultrasonic? More than half of dental offices aren't. Whatever product that you use for ultrasonic enzymes, make sure you follow the manufacturer's instructions for use. People frequently use the wrong concentration, which is why I'm partial to tablets. It's easier to calculate.  Secondly, people don't understand the water capacity of the ultrasonic. The box says “one tablet per gallon” so they drop one tablet in, not realizing they have a three-gallon unit. One tablet won't cut it—you're off by a lot. I was in an office last week that had a three-gallon ultrasonic and they were putting in one tablet. According to the IFU, they were supposed to be using two tablets per gallon. They should have been using six tablets total!  What's an easy way to track this? Buy a label maker and print the name of the product and the number of tablets/ounces required each time you fill an ultrasonic.  Other things to note when using your ultrasonic What else do you need to focus on? Run the ultrasonic with the cover on. When the cover is not in place, you're spewing aerosols of biohazards into the air. If you don't have a cover, get a replacement. Anything that has moveable parts or hinges must be in the open position before it goes in the ultrasonic. If you're not doing this, bioburden accumulates in the jaw or hinge. Those parts must be exposed to be adequately cleaned and sterilized.  Cleaning time is important and it varies per dental instrument. Review the IFUs for each individual piece you have as well as peel-pouches and instrument cassettes.  If you run the instruments and find when you're rinsing them that they're still dirty, what do you do? Run the cycle again. Fight the urge to manually scrub instruments. You will never do as good of a job as the instrument washer/ultrasonic.  Tune in next week for part II—the sterilization process! Resources & People Mentioned Check out the 75 Hard Program Ultrasonic Cleaning Monitor Check out the 2021 Dental Compliance Bootcamp!  Check out ProEdge Dental at https://proedgedental.com/toothcop!  Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

It's September! And it's officially Dental Infection Control Awareness Month! We get you're probably sick and tired of hearing about COVID and infection control. So guess what? Andrea and I will cover infection control without mentioning COVID, other than right now...We'll cover getting a point-person in place and written policies and procedures. Check it out!  Outline of This Episode [0:20] Dental Infection Control Awareness Month! [1:20] Check out ProEdge Dental at https://proedgedental.com/toothcop!  [3:02] Every office needs a point-person [6:17] Make sure you have written infection-control protocols [10:31] Learn more about protectIt dental at https://dentalcompliance.com/drugkit  Every office needs a point-person This is an opportunity to use the time we have in Slowtember to review infection control protocols. Every office needs to have an infection prevention coordinator—or OSHA safety coordinator—to oversee all things related to employee safety and infection control. If more than one person is in charge, no one is in charge. Andrea points out that you don't want to run into a situation where you're saying, “Oh, I thought you were taking care of that.”  Secondly, you want to make sure if that person leaves their role is reassigned to someone else. If you don't know who it is, you probably don't have someone in place. I promise you, there will be someone in your practice who wants to do the role. But if no one steps up, so be it. Someone has to lead the pack and you get to choose who that someone is. But make sure you give them the paid time to get it done. Make sure you have written infection-control protocols You need to have written policies and procedures that establish how you do things. According to the CDC, you need written procedures specific to the dental setting. This includes things like: Procedures for containing respiratory secretions Rules for sick employees Infection control education Policies for immunizations and vaccinations (Hepatitis B, Chicken Pox, MMR, Tetanus, Diphtheria/Pertussis) Safe injection practices for sharps/needles Rules for cleaning and sterilizing contaminated dental instruments Having instructions for use for medical devices and instruments (handpiece, sterilizers, x-ray machines, etc.) Cleaning and disinfection protocols for surfaces Cleanups of chemical spills or bodily fluids Testing dental unit waterlines + water treatment Protocols for the correct use of sterile water  Rules for how to manage boil water advisories A tuberculosis exposure control plan (review the statistics for your country and state) Many dental offices that have a written set of protocols have never read them. That means practices are simply assuming their staff has been trained on these things. Not good. The dentist is expected to have the most knowledge and experience with infection control. Sadly, they're often the least knowledgeable and experienced. Don't let that be you! You also want to have a detailed conversation with your staff about these protocols. Does your staff know them? You're only as strong as your weakest link.  Mark your calendar for Dental Compliance Bootcamp 2021! Bootcamp is all things compliance and risk-management related. It's available to non-clients (even better, It's FREE for current clients). Resources & People Mentioned Check out ProEdge Dental at https://proedgedental.com/toothcop!  Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Mark your calendar for Dental Compliance Bootcamp 2021 Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Did you know that September is National Preparedness Month? So in this episode of Talking with the Toothcop, we share some quick tips your practice can follow to be prepared—for whatever may come. We also share a few ways you can take advantage of “Slowtember” and prep for the year to come.  Outline of This Episode [0:22] Quick tips for emergency preparedness [6:00] Take advantage of Slowtember [11:57] Check out Compliance Bootcamp [12:45] Shoutout to some podcast listeners! Quick tips for emergency preparedness What are some easy things you can do to prepare your practice for emergencies?  Check that emergency lighting (exit signs) are working properly if there's a power outage. Check your fire extinguishers and make sure they aren't overdue for inspection. The fire department can do—and will sometimes just walk in—fire extinguisher checks for you. Check your smoke detectors and change the batteries regularly.  Make sure that you perform an annual emergency drill. Have your staff put their John Hancock on a sign-in sheet and keep documentation proving you completed training. If it ain't written, it didn't happen. Get out your medical emergency plan and review it with your staff. Make sure that you walk through every part of the process (except calling 911).  Take advantage of Slowtember September is a slow month for many dental practices, so make sure—if you haven't already—to get your compliance training knocked out. Cover bloodborne pathogens, HIPAA, cybersecurity, etc. If you participate with Medicaid/Medicare, you'll also need to do your Fraud, Waste, and Abuse training.  Take a few minutes to review everyone's credentials and make sure they're up-to-date. You should check CPR certifications, DEA registrations, sedation permits, even your driver's license and vehicle registration. Check anything that has an expiration date on it—both personally and professionally.  What else can you do? Mark your calendar for Dental Compliance Bootcamp 2021! Bootcamp is all things compliance and risk-management related. It's available to non-clients (even better, It's FREE for current clients). Resources & People Mentioned Check out ProEdge Dental at https://proedgedental.com/toothcop!  Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Mark your calendar for Dental Compliance Bootcamp 2021 Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

In this episode of Talking with the Toothcop, you get a glimpse into the “behind the scenes” of what recording an episode really looks like. From food pranks to our favorite Starbucks orders—every tangent that we usually edit out is on full display. Don't miss a fun and quirky episode that also includes some important news about our Dental Compliance Bootcamp! Listening may even get you some FREE coffee! Outline of This Episode [0:21] Food pranks: Starbucks + Subway [6:10] Check out ProEdge Dental at https://proedgedental.com/toothcop!  [12:12] Dental Compliance Bootcamp 2021 [20:00] Record-keeping + Compliance Programs + Cybersecurity [27:48] Learn more about protectIt dental at https://dentalcompliance.com/drugkit Learn about Dental Compliance Bootcamp 2021 Bootcamp is coming up, November 19th-20th in Hurst, TX (in the DFW area) at the Hurst conference center. The Hilton Garden Inn is attached to the conference center. We are going to have some hands-on medical emergency training. After attending, dentists will be able to facilitate training for their staff. Secondly, bring your team and run through some scenarios together. Justin Bonner, DDS Board Certified in Oral and Maxillofacial Surgery & Garrett Starling, MD Board Certified Anesthesiologist will be there! (the course instructors for our pain management course)  You'll get some courses on insurance with Tonya Burns (Pediatric Consultant).  Laura Diamond—a healthcare attorney—will be returning this year. She'll be presenting in our risk-management and record-keeping course.  The goal is to provide you hands-on clinical training that you can immediately put into practice. This years theme: Record-keeping + Compliance Programs Most of our presentations will center around: We will go in-depth on the nuts and bolts of a corporate compliance program for people who participate in Medicare/Medicaid. We will also complete a mock compliance committee meeting. You'll learn what you need to talk about and cover in these meetings. Record auditing is a major element of compliance. We'll cover what you need to audit/monitor, what it looks like, what records to create, and how to solve problems when you run into them. If you have any compliance responsibilities, come and immerse yourself in the experience. It's not your typical conference. It is hands-on and immersive and you will get to experience everything with us. This is an opportunity to learn great things to apply to your organization. It's also a chance for you to interact with our clients to decide if we're a great fit for you. What's your favorite drink from Starbucks? Let me know at toothcop(at)dentalcompliance.com and I'll put you in a raffle for a gift card! Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Mark your calendar for Dental Compliance Bootcamp 2021 Hurst Conference Center Hilton Garden Inn Hurst Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Did you know there are specific rules from the Office of the Inspector General (OIG) regarding giving things of value (i.e. gifts) to solicit potential customers? In this episode of Talking with the Toothcop, Andrea and I talk about some of the specific rules on gifts and kickbacks. This is stuff that you need to be aware of so you don't get hit with penalties and fines for breaking the law.  Outline of This Episode [3:34] The OIG Backpack Rule [11:26] Texas Administrative Code Rule 108.58 [15:25] The anti-kickback statute (42 U.S.C. 1320a-7b) [20:34] Section 259.008 Dental Practice Act [23:03] “But everyone is doing it” [28:08] Dental Compliance Bootcamp 2021 The OIG “Backpack” Rule The OIG released a special bulletin entitled “Offering Gifts and Other Inducements to Beneficiaries.” This advisory from the OIG clarifies how the state interprets and applies the rules and statutes to giving things of value to Medicaid benefit recipients.  While they understand the competitive market and desire of dental practices to differentiate themselves in the mind of potential patients, they must uphold the integrity and fairness of the Texas Medicaid program. Giving gifts may raise concerns among the community and other providers.  The OIG reinforces Texas Administrative Code §371.1669, which prohibits a person “From transferring or offering any remuneration which the person knows or should know is likely to influence the beneficiary's selection of a provider, practitioner or supplier of Medicaid payable items or services.” The state of Texas has announced that they will enforce more stringent rules than the HHS OIG, including: Providers are prohibited from offering items or services to influence health care decisions. The OIG presumes that any items that do not exceed $10 per patient were not provided to influence their decisions. Likewise, anything offered to a patient must be directly related to dentistry (i.e. a toothbrush, toothpaste, floss, etc.). You are NOT allowed to give patients backpacks and school supplies, even if your intentions are good. We get that it's back-to-school time and people like to give out back-to-school supplies. Dental providers cannot do that.  You may never offer patients cash or gift cards.  Is it different for non-Medicaid providers? Non-Medicaid providers still have to adhere to the Texas Occupations Code Section 102: Solicitation of Patients, which includes rules about not giving gifts to patients (though it doesn't explicitly call out backpacks). Can non-Medicaid providers give gifts or do giveaways for current patients? Listen to learn more about Texas Administrative Code Rule 108.58 The anti-kickback rule (42 U.S.C. 1320a-7b) The Anti-Kickback Statute is a criminal law that prohibits the knowing and willful payment to reward patient referrals or the generation of business involving any item or service payable by the Federal healthcare programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients). This includes things like rent, hotel stays, meals, excessive compensation, paying referrals, etc. Physicians or dentists who accept or pay kickbacks will be penalized up to $50,000 per kickback plus three times the amount of the remuneration. Dentists make attractive targets for kickback schemes because you are a source of referrals.  Kickbacks in healthcare can lead to overutilization, increased program costs, corruption of medical decision-making, patient steering, and unfair competition. I hear of offices that offer free or discounted dental care for parents if they bring their children on Medicaid to the practice—which is clearly a violation of Federal law. Taking a kickback can never be justified, even if the service rendered was medically necessary. More of this is coerced in Texas Occupations Code Sec. 259.008 Unprofessional Conduct.  When people say “But everyone is doing it” Some dentists have pointed out to me that there is an unfair advantage because dentists in their community do these things. The temptation to get involved in a scheme like this is high because “everyone is already doing it.” Firstly, don't do something that everyone else is doing. That's not how you grow your business (especially with something illegal).  Instead, find out what's legal in your state (and federally) and then run tests to see what works. It can be as simple as focusing on giving your patients the greatest experience possible. You can make it a memorable and pleasurable experience. How can you take customer experience up a notch? Lastly, if people in your community are doing illegal things, perhaps they aren't aware. If you have the gumption, you can talk to them about it.  We cover a lot in this episode. Listen to the whole thing for all the nitty-gritty details! Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Check out ProEdge Dental at https://proedgedental.com/toothcop!  Offering Gifts and other Inducements to Beneficiaries Texas Occupations Code Section 102: Solicitation of Patients Texas Administrative Code Rule 108.58 42 U.S.C. 1320a-7b - Criminal penalties for acts involving Federal health care programs Texas Occupations Code Sec. 259.008 Unprofessional Conduct Mark your calendar for Dental Compliance Bootcamp 2021 Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Are PMP inquiries required for sedation meds that are dispensed in the office? A listener read through the rules in January 2020 and spoke with a sedation officer and was advised that they did not need to do the PMP check if they were dispensing in the office. But the way the rule is worded makes it seem as though you do need to. So in this episode of Talking with the Toothcop, Andrea and I will cover Chapter 111 and spell out the PMP rule in detail. Hopefully, this will clear up any confusion you may have!  Outline of This Episode [3:43] Rule 111.1: Additional Continuing Education Required [6:24] Rule 111.2: Self-query of Prescription Monitoring Program [7:43] Rule 111:3: Prescription Monitoring by the Dentist [10:51] Breaking down the PMP inquiry rule [12:54] Rule 111.4: Prescription Monitoring by the Board [14:12] Rule 111:5: Electronic Prescribing Waivers [16:51] Subscribe to our email list to stay up-to-date! Rule 111.1 Subsection B: Additional Continuing Education Required According to Rule 111.1 Subsection B, effective September 1st, 2020 every dentist that prescribes controlled substances must complete two hours of continuing education “...related to approved procedures of prescribing and monitoring controlled substances.” This can be taken annually to count toward continuing education. Dentists have found this confusing because many have already taken the course. However, the requirement reset September 1st, 2020. So anyone who completed the two hours of continuing education on controlled substances before that date must retake it before September 1st, 2021. I know several thousand dentists have not yet taken this course. We offer this course on our site—that you can complete at your own pace—so check it out.  Rule 111.2: Self-query of Prescription Monitoring Program Rule 111.2 became effective Dec. 25th of 2016:  “Each dentist who is permitted by the Drug Enforcement Agency to prescribe controlled substances shall annually conduct a minimum of one self-query regarding the issuance of controlled substances through the Prescription Monitoring Program of the Texas State Board of Pharmacy.” Many dentists don't even have a login for the PMP. You need to do this. The state board of pharmacies can report you and you'll have to answer for your failure to comply. You will face disciplinary action, which starts with paying a fine and lead to jurisprudence assessment. Rule 111:3: Prescription Monitoring by the Dentist Rule 111:3 became effective March 1st, 2020, and says: “(a) Prior to prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol, a dentist shall access the patient's prescription drug history report through the Texas State Board of Pharmacy's Prescription Monitoring Program (PMP) Clearinghouse. Failure to do so is grounds for disciplinary action.” The rule goes on to say that an employee of the dentist can do the PMP check when directed by said dentist. The only exceptions? The PMP inquiry does not have to be completed if the patient is diagnosed with cancer or receiving hospice care and it's noted in their record.  If the dentist cannot do the inquiry due to circumstances outside their control—but has attempted—is not considered to have violated the rule. What circumstances might be outside of the dentist's control? This would include something like the PMP website being down, your internet is down, etc.  You need to get a process in place, look at the drugs you prescribe, and make sure that you check the patient's drug history through the PMP before you prescribe opioids, benzodiazepines, barbiturates, or carisoprodol. Administering versus prescribing or dispensing: What Gives? The PMPinquiry rule doesn't apply to administering these drugs but prescribing or dispensing. Dispensing is giving it to the patient to take it later. Prescribing usually entails the patient picking up the medication from the pharmacy. In both cases, the patient has possession of the controlled substances with the opportunity to take them. A PMP check is not required prior to administering to a patient in your chair immediately. Why? Because you are controlling how it's administered and how much is administered. So if you're doing in-office sedation and giving it to the patient immediately from your office supply, you don't need to do the PMP Check. If you prescribe the drug for the patient to pick up and you to administer, then you do need to complete the inquiry before doing so.  We cover a few other pertinent rules in this episode so be sure to listen all the way through! Let us know if you have any questions at toothcop(at)dentalcompliance.com. Resources & People Mentioned Rule 111.1 Subsection B PRESCRIBING & MONITORING PRACTICES Texas Prescription Monitoring Program E-Prescribing Waiver Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Check out ProEdge Dental at https://proedgedental.com/toothcop!  Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

In this episode of Talking with the Toothcop, I share some sobering news that recently happened in Kansas. I'll also share some important updates that dentists need to be aware of that were highlighted in the Texas State Board of Dental Examiners Newsletter. Stay up-to-date on the latest dentistry compliance issues—don't miss it.  Outline of This Episode [0:21] 3-year-old boy dies during dental procedure [3:13] Get your dental unit waterlines tested through ProEdge! [4:30] Electronic Prescribing Waiver [6:03] Texas administrative code Rule 108.7 sub-section 16 [7:44] Tele-dentistry rule (HB2056) passed [12:50] Questions about Rule 108.7 sub-section 16 [14:33] Do dentists prescribe anxiety medication frequently?  [15:26] Learn more about protectIt dental's emergency medical kit [16:43] The Professional Recovery Network 3-year-old Boy Dies During Dental Procedure A 3-year-old boy in Wichita, Kansas went in for a simple procedure. He was sedated to have some teeth removed after a gum infection. Unfortunately, something went awry during the procedure and the boy passed away after being transported to a nearby hospital. The incident is currently under investigation though it appears there was no wrongdoing.  However, incidents like these are a sobering reminder to have your dental office prepared in case of emergencies. You need a written protocol in place, your team needs to be aware of their role, and it needs to be referenced as often as possible.  Electronic Prescribing Waiver As of January 1, 2021, the Texas Health and Safety Code 481.0755 dictates that “Prescriptions for controlled substances be issued electronically, except in limited circumstances, or unless a waiver has been granted by the appropriate agency.”  The waiver applies to dentists that issue prescriptions for controlled substances—but don't prescribe many at all. They can apply for a waiver to avoid setting up electronic prescribing. If granted, the waiver allows dentists to write up to 25 prescriptions for controlled substances per year. You can re-apply for your waiver up to 30 days before it expires (it lasts a year from when it's issued).  Please Note: Many drugs that you may not consider are classified as controlled substances. Do your research and don't let yourself get caught off guard by this.  Texas administrative code Rule 108.7 sub-section 16 Rule 108.7 sub-section 16 was the COVID rule. It's now been replaced with what was sub-section 17: You must “Hold a Level 1 permit (Minimal Sedation permit) issued by the Board before prescribing and/or administering Halcion (triazolam), and should administer Halcion (triazolam) in an in-office setting.” Basically, if you want to treat patients with these meds, you must hold a Level 1 permit.  In the newsletter, the featured a question a reader asked, “Can I prescribe or dispense a drug for sedation without a sedation permit?” The answer is no. You have to have a minimal sedation permit to prescribe sedation medications to patients (dosage recommendations in board rules 110.1 and 110.4). Texas Legislative House Bill 2056 Passes The bill passed on June 16th, 2021. But on August 11th at 1 pm, the Texas State Board of Dental Examiners will host a stakeholder meeting to address the specific rules for teledentistry. This is your opportunity to make your voice heard and shape these rules on the front end. What can you do? Look at other state's regulations and see what they're doing and what their recommendations are. Too often dentists don't get involved when they have the opportunity. If you're not involved, you can't complain about it! I think we will see rules formed by March.  Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Get your dental unit waterlines tested through ProEdge! 3-year-old Boy Dies During Dental Procedure The Texas State Board of Dental Examiners Newsletter TWT Episode: Electronic Prescribing of Controlled Substances Texas administrative code Rule 108.7 sub-section 16 https://tsbde.texas.gov/ The Professional Recovery Network Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

A lot of people get the Treatment, Payment, and Healthcare Operations (TPO) Exception wrong. So in this episode of Talking with the Toothcop, Andrea and I dissect what it is. We also talk about what to do if you need patient authorization and the importance of informed consent for treatment. Don't miss it!  Outline of This Episode [0:21] Coffee + Rom-Coms [4:07] Learn more about ProEdge Dental! [5:24] The treatment exception [10:00] The payment exception  [11:01] The operations exception  [12:14] If you NEED authorization [13:25] Informed consent for treatment [17:49] Learn more about protectit dental! The treatment exception You can communicate with other healthcare providers (i.e. dentists/specialists) to care for a patient (consults, discussions, coordination of care, etc.). Under HIPPA you don't need authorization from your patient to communicate with healthcare providers regarding treatment. Some state laws are more restrictive. For example, in Minnesota, this does not apply and you are required to get authorization. Federal HIPPA laws allow communication if your state does not have more restrictive requirements.  The payment exception  If Grandma stops by to pay a patient's bill, you may have to follow the minimum necessary principle (that a legal guardian is the only one allowed access to patient information). So you may not be able to close the date of service or the procedure but you sure can take payment. If it's necessary to state a balance to get paid, it's perfectly fine.  The operations exception  The operations exception allows dental offices to access and use/disclose their patient‘s information. You don't need authorization from the patient or legal guardian. How does that look in practice? Duane is allowed to access a patient's records without them being notified because it's for compliance purposes.  If you NEED authorization  If you need authorization from a patient to disclose PHI to a third party, there is a form you need them to complete with specific elements that need to be on it. Most information release forms don't have the necessary information. So what's needed? It must clearly identify your entity and who you're allowed to release information to What part of the patient's record you're authorized to use or disclose The explicit purpose for the disclosure A notice that informs the patient they have the right to revoke the authorization at any time (this is what most dental offices are missing) A signature on the form by the patient or legal guardian  NOTE: Get familiar with your state's recommendations to make sure they don't have specific requirements for authorizations. If you're from MN hit me up at toothcop(at)dentalcompliance.com for a template for the form you need! Informed consent for treatment This seems like an ongoing issue I encounter regularly. Different states have different requirements for informed consent. Common sense dictates—to protect yourself and your practice—you should obtain informed consent from your patients. They should know the potential risks of a procedure and alternative treatments that could be appropriate (including no treatment). They should also be informed of the potential consequences if they choose not to have a procedure done.  If you practice in multiple states, follow the most stringent standard in all of your locations. Then you'll never run the risk of being out of compliance. In Texas, you need consent for everything that comes with a risk. In Texas, Medicare requires consent for every procedure on the date of service it's being completed. If you don't get consent, the insurance companies can recoup what they paid for the services.  Have any good coffee bean recommendations? Send me an email with your suggestions!  Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Movie: New in Town HHS Guidance on TPO Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Recently, I've dealt with some level of confusion surrounding the Hepatitis B vaccinations (HBV) and post-vaccination testing requirements. So in this episode of Talking with the Toothcop, I'm going to cover what both OSHA and the CDC require for the HBV and post-vaccination testing.  Outline of This Episode [2:03] Hepatitis B vaccination requirements in dentistry [5:08] OSHA requirements for post-vaccination testing [10:22] Hepatitis B vaccination recap Hepatitis B Vaccination Requirements When a dental office hires a new person, they need to determine if that person will have exposure to bloodborne pathogens. Front office staff may have exposure in one dental office and others won't, whereas a clinical staff will have ongoing exposure. It all depends on the activities of your staff and whether or not they're cross-trained. But it's not like a bloodborne pathogen follows the rules and won't cross into an area they're not supposed to. If a new staff member will likely face exposure throughout their employment, they need to be offered the Hepatitis B vaccination. The employer must: Get a copy of the employee's vaccination record If the employee declines the vaccination, they must sign a declination form. (i.e. they may have already had the vaccination). Dentists, you must show you offered the vaccination within 10 days of hiring the new staff member. Document your attempt to get the vaccination records. Include all of this in your new hire paperwork.  The vaccination is a three-shot series given over six months. At the conclusion, your staff member's blood needs to be tested to ensure they've developed antibodies for Hepatitis B.  OSHA requirements for post-vaccination testing In a 2000 OSHA response to Christopher S. Taylor, M.D. (a flight surgeon), OSHA stated that: “The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure follow-up to all employees who have had an exposure incident." (Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, [CPL 2-2.69]) In short, according to OSHA, the employer must pay for post-vaccination evaluation and follow-up at no cost to the employee (2 months after the vaccination series is complete).  In 2015, Richard L. Raimondo, Jr. D.D.S, posed two questions to OSHA. Once my employees have completed the 3-dose hepatitis B vaccination series, is there a requirement to obtain a test for hepatitis B antibodies? OSHA responded that, yes, a test is necessary for antibodies (according to the CDC).  Dr. Raimondo also asked if anyone hired before this standard was in effect must be tested for antibodies and offered the vaccination series. OSHA responded that at the time, they didn't recommend further vaccinations or titer testing for anyone vaccinated before December 26, 1997. However, for anyone vaccinated after December 26th, 1997, they did recommend anti-HBs [titer] testing. Hepatitis B vaccination requirement recap What does this mean for dentists? Determine who needs to be vaccinated. Offer them the vaccination and prove you've made the offer (i.e. declination form and vaccination record).  Document, document, document. If it isn't written, it didn't happen.  Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Check out ProEdge Dental for waterline testing! OSHA response to Richard L. Raimondo, Jr., D.D.S OSHA response to Christopher S. Taylor, M.D. Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

This episode of Talking with the Toothcop is a two-parter! In the first half, you'll get a look behind the curtain and get to know me—Duane Tinker—and my co-host, Andrea Baysinger. In the second half of this episode, we share an important reminder about nitrous oxide compliance rules. Don't miss it!  Outline of This Episode [3:01] How Andrea became my co-host [6:05] I'm an introvert—until I take the stage [8:09] Andrea is an introvert disguised as an extrovert [9:29] Country versus city living (who is who?) [12:22] Raising Australian Shepherds on a ranch [13:05] Dentists that administer nitrous oxide [14:31] How dentists get busted for lack of compliance I'm an introvert—until I take the stage I am an introvert. I'm like Sylvester Stallone (Hawk) in the Movie “Over the Top.” Hawk is a professional arm wrestler preparing for a national event in Las Vegas. At the end of the movie, Hawk is interviewed. He said that before he steps in the ring, he turns his hat backward and it's like he turns his face and becomes a different person. That's how I feel when I'm about to walk on a stage and speak. I'm a shy wallflower until I take the stage.  Andrea is very talkative and is a self-proclaimed social butterfly. But she believes it's just a different version of her. She has a degree in English and loves writing and being introspective. So she's at her best when she's chosen to be alone. She feels at peace. She recharges, then gets back out with people.  Country living versus city living My wife and I have a ranch and sometimes I'll go weeks without leaving it. We've got everything we need here (including fast internet). Andrea grew up in the country, too, in a small town of 1,500 people. She thought she was going to stay there for life but she followed her brother to Texas. She packed everything in her Maxima, got a part-time job within two weeks, and has been here for almost 8 years. She'd never in a million years thought she'd end up in a field close to healthcare and now she can't imagine anything else (including living in the country again).  My wife and I have 6 Australian Shepherds, five of which are related. We have a lot of livestock (sheep, goats, ducks, and geese) because my wife does competition herding with her dogs. Supporting my wife in training the dogs is my extracurricular activity. Plus, there are always things to do around a ranch.  Dentists that administer nitrous Switching gears, I've been getting a lot of calls and emails from dentists who are shocked about rules that have been in place for three years now. Many dentists are way out of compliance and don't know where to start.  How are dentists getting busted for lack of compliance? The state only does inspections for those with level 2, 3, and 4 sedation permits. Those who are administering nitrous will never be inspected for that. But let's say a new patient comes to see you for a second opinion. You prepare a treatment plan, make your recommendations, and the patient decides to go with you for treatment.  Six months down the road, you get a letter from the state board. They want to copy the patient's record and the dentist's emergency plan, and the dentist has no idea what they're talking about. Nine times out of ten, it's a complaint against another dentist. That's how dentists get busted for not having emergency plans. It's how the conversation starts with me.  Dentists who administer nitrous: What you should be doing What do you need to do? You need to have a written emergency plan in place and train your staff on that plan. You need an AED, stethoscope, blood pressure cuff, backup suction unit, and emergency oxygen unit. Most of the dentists that are calling me had no clue. Luckily, it's an easy fix.  The takeaway? Be in the know. Get the newsletter from your state licensing board. Visit their website frequently for important information and updates. Get on our email list. We'll inform you of new rules and regulations. Something is always changing and impacting dental offices. Need help with compliance? Give me a shout! Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Over the Top with Sylvester Stallone More information on sedation inspections Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

In our last episode, we talked about how the Texas State Board allowed their COVID-19 rules to expire. We think it's a good thing! But a lot of dentists are not happy about it. So in this episode of Talking with the Toothcop, Andrea and I dive a little deeper into the topic. We'll share why we think it's a good thing and what dentists can do moving forward.  Outline of This Episode [2:51] The feedback on the COVID-19 rule expiration [5:22] You can continue what you were doing [8:10] Dentists are encouraged to follow CDC guidelines [11:00] Let us know if you have any episode requests! The feedback on the COVID-19 rule expiration I'm not entirely surprised dentists aren't happy with the expiration of the rule. Many dentists want to know what they have to do—they like structure. I thought it was a beautiful thing that the state board was allowing dentists to take the reins again.  But a large cross-section of dentists like the comfort of being told what to do. I don't entirely understand. I get that you want to focus your energy elsewhere. But I like to be recognized for my ability to think, reason, and make my own decisions. Not everyone feels the same way as I do.  Oddly enough, there were a lot of gray areas when regulations were first announced last year. Dentists wanted clarity. Now they've taken clarity away again and it can be overwhelming. So what can you do? Continue what you were doing We want to be clear. Just because the Texas state board allowed their COVID-19 rules to expire does not mean you have to stop following them. If you—and your patients—were comfortable with the level of safety it afforded you, then by all means stick with it. Work within your comfort level.  However, I believe you need to get comfortable stepping outside of your comfort zone. It's how you grow. You learn to trust your instincts and your ability to trust your own decisions. As a dentist, you've earned respect and you're recognized as someone qualified to make tough decisions beyond the average person (when it comes to oral health). But everything that pertains to your patient's health is your responsibility. Don't be afraid to do your own research and make your own decisions. Dentists are encouraged to follow CDC guidelines The state board encouraged dentists to follow CDC guidelines but did not instruct them to. It sounds like this governing body understands it's stressful, so if you want guidance, you can continue to follow the CDC recommendations. But they are giving you room to make your own interpretations. By the tone of the ruling, there is flexibility and forgiveness if you get something wrong.  Any recommendations for requests for our next topic? Let me know at toothcop(at)dentalcompliance.com! Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! The expiration of the COVID-19 Rule Texas Dental Board Rule 108.7 Subsection 16 CDC Guidance for Dental Settings Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

The Texas dental board let the COVID-19 rule expire (rule 108.7 subsection 16). How does that impact dentists moving forward? What rules do some providers still need to follow? What procedures are still recommended by the CDC? We cover it all in this episode of Talking with the Toothcop!  Outline of This Episode [3:20] The impact of the expiration of the COVID-19 rule [4:41] The OSHA Emergency Temporary Standard [9:25] 1910.504: The Mini Respiratory Protection Program [16:35] Subscribe to the podcast and sign up for our newsletter! The impact of the expiration of the COVID-19 rule How does this impact you? Maybe very little. There is no longer a Texas State Board rule that says you have to follow these specific rules. You don't have to wear N95 masks. You don't have to do twice daily temperature checks. You don't have to screen patients and check their temperature. But many of you have gotten used to the process and feel like it's best to continue. You absolutely can! You get to decide how to care for and keep your patients and staff safe—whatever that looks like for your practice.  The OSHA Emergency Temporary Standard There is an OSHA standard—the “Emergency Temporary Standard”—that was released a few weeks ago and was effective immediately upon release. That means it is an enforceable federal law. Who is impacted by this law? Those who work with people who are suspected of having or confirmed to have/had had COVID-19. This can include employees at: Hospitals Nursing homes Assisted living facilities Emergency responders Home healthcare workers Employees in ambulatory care facilities It does not apply to non-hospital care centers where non-employees are screened before entry and those with COVID-19 are not allowed to enter. So if you screen everyone that walks in the door, this rule doesn't apply to you.  If it does apply, you must have a written safety plan, patient screening management, transmission-based precautions, PPE, physical distancing, and more. What qualifies as screening? Listen to find out! OSHA Standard 1910.504: The Mini Respiratory Protection Program When respirator use is required, the respiratory protection standard applies. This requires medical evaluations, fit testing, a written safety program, user seal checks, and training. What does the “mini” version require? User seal checks and proper training. 90% of dental offices are already here.  CDC COVID-19 guidelines are still recommended The state board still recommends finding the CDC guidelines: Postpone procedures if they aren't medically necessary Implement Teledentistry and Triage Protocols (doesn't apply yet)  Screen and triage everyone entering for signs and symptoms of COVID-19 Monitor and Manage Dental Healthcare Professionals (if you're sick, stay home) Create a process to respond to COVID-19 exposures among DHCP and others Implement universal source control measures Encourage physical distancing Consider COVID-19 testing for patients and staff who don't exhibit symptoms (we recommend you don't do that) Do things to minimize exposure Implement universal use of PPE Familiarize yourself with this stuff! Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! The expiration of the COVID-19 Rule Texas Dental Board Rule 108.7 Subsection 16 COVID-19 Healthcare ETS The Mini Respiratory Protection Program CDC Guidance for Dental Settings Save the date for bootcamp: Nov. 19th and 20th Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Are you doing proper sedation and anesthesia reviews? Are you making sure you don’t have drugs sitting in your office that expired pre-COVID? Are you checking with a patient’s primary care provider before administering anesthesia? Being busy and overwhelmed isn’t an excuse for not doing your due diligence. In this episode of Talking with the Toothcop, Andrea and I touch on the importance of doing a proper review.  Outline of This Episode [4:09] Sedation and anesthesia reviews [8:49] Upcoming anesthesia course Check for expired drugs and equipment I’ve done a lot of sedation and anesthesia reviews in the last few months, and I can tell that some offices have been quite distracted. Those that have been quite busy aren’t staying on top of the things they should, like an annual inspection of the sedation process and equipment reviews. As a result, I’m finding a lot of expired stuff. They’re lucky I found it—not the state board. You need to be routinely checking to make sure you’re not storing expired drugs.  Sedation and anesthesia reviews You also need to be diligent in your patient screening and selection for anesthesia. Don't overlook even the slightest detail. Get the proper medical consultations done versus just getting medical clearance. “Medical clearance” is not an absolution of viability for you. You can’t just exchange paperwork with their primary care physician. Take the time to document the conversation in your clinical notes (with great detail).  Take your pride out of the equation. Even if you’ve done something 1,000 times, there may be one time something goes wrong. If you can’t prove you’ve done your due diligence and properly screened your patient, you won’t have a leg to stand on. Err on the side of caution. If a conversation happened—but it’s not in your records—it didn’t happen.  Upcoming anesthesia course We have an anesthesia CE course coming up on June 5th from 8 am to 12 pm central, but open to anyone across the US. The course is “Principles and Practices of Dental Office Anesthesia,” taught by Dr. Justin Bonner and Dr. Garrett Starling. If you’ve done the same anesthesia course, change it up. Hearing the same thing from a different perspective might impact you in a more meaningful way. Learn more by clicking the link in the resources! Call to action: When you get to your office, check the expiration dates on your emergency drugs and all of your equipment. Make sure they aren’t expired.  Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Principles and Practices of Dental Office Anesthesia: https://dentalcompliance.com/products/live-anesthesia-principles-and-practices-of-dental-office-anesthesia Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Last week, I read an article about an oral surgeon in North Carolina who got busted after a patient died. So in this episode of Talking with the Toothcop, we’re going to talk about what happened, why it happened, and how it could have been prevented. This isn’t to shame the dentist or staff involved, but to learn from the mistakes that were made. Tragedies in the dental office should never happen.  Outline of This Episode [0:22] Death in the dental office [8:50] Get professional help before it’s too late [13:45] The Professional Recovery Network  [18:21] Your patients may not trust you anymore [20:20] The current action being taken [24:15] Upcoming CE courses Death in the dental office According to the article Leland oral surgeon suspended by Dental Board, under investigation by SBI for drug misuse, Dr. Mark Austin had his license suspended following an investigation by the State Board of Dental Examiners. The patient in question came in for an appointment to receive a dental implant. The doctor administered sedatives before and during the procedure. Unfortunately, the patient’s oxygen saturation dropped significantly, and after attempting to place an endotracheal tube, 911 was called. The patient died a few days later in intensive care.  This prompted an immediate investigation by the dental board. The DEA and state board combed through this dentist’s practice. Even worse, in an earlier audit, the doctor couldn’t account for substances that were supposed to be maintained at his office, including Fentanyl. The investigation also alleges that he used illicit substances personally for two years while practicing.  The patient was at 60-70% oxygen for 20 minutes. Brain death happens when it’s deprived of oxygen for 4–6 minutes. When EMS arrived, the patient didn’t have a pulse. The Dr. had not administered CPR prior to their arrival. His brain was deprived of oxygen for far too long, and he suffered irreversible brain injury and died 4 days later.  Get help—or get busted If you or someone you know is struggling with a drug or alcohol problem, get help. It can be done anonymously before you impact your patient’s lives. Because when a dental board gets involved, they’ll issue an emergency suspension which creates a public spectacle. This situation is attached to Dr. Austin’s license for the rest of his life. Every insurance company he attempts credentialing with will know. Some won’t take the risk. If someone had recognized he had a problem it could all have been prevented. It’s hard to get help. But when you do, you go to a special rehab just for doctors. You’re there with other dentists or physicians in recovery. You avoid a public stigma while getting acceptance and support. This isn’t about shaming dentists, it’s about getting them help.  It’s sad that a world-renowned cardiologist—someone who devoted his life to helping people—lost his life in a preventable situation.  You have a moral obligation to protect your patients Someone had to have seen the signs in this doctor and did nothing. You can’t hide a drug addiction for over a year. If you work with someone who is struggling, you have an obligation and responsibility to report this behavior. You’re either part of the problem or part of the solution. The staff had a moral and ethical obligation to make a decision. They didn’t make the right one.  The proper training and preparation for something like this could have prevented someone’s death. This is why we’re talking about this. Dental offices need to be taught the right way to do things. A reasonable person should ask, “What could I have done to prevent that?” Sadly, these staff members will carry guilt with them for the rest of their lives.  The current action being taken The dental board received information that Dr. Austin had prescribed controlled substances for staff members—outside the scope of dentistry. The board also received evidence that he was unable to account for controlled substances and had been taking them for two years. In a nutshell, he agreed to a suspension of his license.  Resources & People Mentioned Leland oral surgeon suspended by Dental Board Professional Recovery Network (Texas) Consent Order Suspending License Dental Compliance CE Courses Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

I recently realized it’s been so long since I’ve played my guitar that the strings have started to rust. It’s sad and embarrassing to realize I’ve let something I love that’s important to me get forgotten. But it made me question: Where do you have rusty strings in your dental practice? Where are you not putting in the energy and effort into things that you should be? Have you let the things that are important to you go to the wayside? In this episode of Talking with the Toothcop, our goal is to bring you back to your current reality.  Outline of This Episode [0:22] Where do you have rusty strings? [2:23] You have to sweat the little things [6:22] Take a moment for self-reflection [8:26] Get on my schedule for a chat! Where are your rusty strings? We’ve had a lot of distractions with the pandemic. Because of this, I’ve seen a lot of “rusty strings” in dental practices. People are forgetting to do a step-wedge test for their x-ray machines. They’re forgetting medical emergency training and preparedness. Many people are just going through the motions.  In every sedation inspection that I’ve done recently, everyone has had grossly expired equipment. These people are filling out their checklists but not really paying attention—which defeats the purpose of the checklist! Some of these things expired pre-pandemic.  You have to sweat the little things Think about everything that happened in the last year. All of your energy and focus may have gone into keeping your practice afloat. It begs the question—is there something you can do to prepare for the next pandemic?  When a crisis happens you focus on priority #1. With COVID, it was infection control. But you still have to focus on step-wedge testing and check for expired drugs. You still have to do your OSHA and HIPAA training. These things are basic and don’t require much effort to do. But all of the focus was on the pandemic.  Maybe this won’t happen again in our lifetime, but other things will happen. You need to focus on the things that you still need to be doing and don’t forget the little things, or they will morph into bigger problems. It’s always the little things that fall through the cracks.  Take a moment for self-reflection: mental checklist Take a moment to think through where you’re at right now. Did you do your HIPAA security risk assessment? Have you done your OSHA training? Have you done emergency training? What are the things you need to be doing regularly? Are you on top of everything? What are the things that you’re missing? Figure it out and get back on track. We aren’t bringing this up to shame anyone. But it’s easy to get caught up in the moment, and it’s important to take a breath and realign. Take a mental inventory, make a list of what you need to catch up on, and execute.  Are you stressed and don’t know where to start? Head on over to DentalCompliance.com and get on my schedule for a complimentary consultation. Just fill out a simple form, and Andrea will get you on my schedule for 30 minutes of my undivided attention. Then you can ask all of the questions you want. Resources & People Mentioned FREE 30-minute Consultation Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Who says compliance training can’t be fun—or funny? In this fun episode of Talking with the Toothcop, we take a short break from our scheduled programming to hopefully share some laughs. Plus, we drop some important news about upcoming events. Don’t miss it! Outline of This Episode [2:08] Why OSHA training is dangerous [6:44] An intentional demonstration [12:19] Bootcamp is coming BACK! Why OSHA training is dangerous Those who know me know I LOVE public speaking. Recently, I was doing an in-person OSHA/compliance training (which was awesome). I was speaking in a movie theatre and this particular movie theatre had a short stage about one foot off the ground. Toward the end of the presentation, I was talking about medical emergency preparedness.  I like to lean on things and decided to lean on a bar. Turns out, the bar was pretty low—a lot lower than I had anticipated. I ended up awkwardly squatting into a semi-sitting position to learn on the bar. But as I did, I slid back onto the platform and fell on my back. As I’m falling, I’m saying “It’s important to be prepared for unexpected emergencies.” Splat. The audience was confused and perplexed.  I couldn’t figure out how to get back up without looking ridiculous. I managed to sit up and continue my lecture while sitting. I finally figured out a plan to get up and quickly hit the next slide, which said, “We don’t rise to the level of our expectations, we fall—HA—to the level of our training.” I walked off the stage and made a beeline for the door. People asked the hostess if I did it on purpose and she was like, “Yeah, he does that stuff all the time.”  The takeaway? Come see me speak live! Need a speaker for an upcoming event? Throw my name in the hat! Bootcamp is coming BACK! Bootcamp is coming back in 2021! The planning is in motion. It will be a two-day event on the 19th and 20th of November. More details to come.  Resources & People Mentioned Dental Compliance Live Training Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

In the first episode of this series, we talked about what a corporate integrity agreement is. In the second episode, we covered focusing on compliance. In this episode of Talking with the Toothcop, we are going to walk through an actual corporate integrity agreement. If you’re caught in the OIG’s crosshairs, this is just one example of what you might expect.  NOTE: These are NOT confidential and are public documents on the OIG website. Outline of This Episode [2:15] A pediatric corporate integrity agreement [9:27] Reach out to us for support [12:02] Compliance Bootcamp 2021 A pediatric corporate integrity agreement This CIA was executed in August 2016 with a three-year term (a CIA is typically a five-year term). The CIA stipulated that the dentist and all employees and contractors (including billing) had to establish a compliance program that included: Posting a notice in their office that patients could see—within 60 days of the effective date—that provides the OIG hotline number as a confidential means to report fraud or abuse. They had to include three hours of training and education for the practitioner and all covered entities within the first reporting period. That may only be satisfied by taking courses provided by the CMS Medicare Learning Network. It must include a billing, coding, and claims submission course and a medical record documentation course. New employees had to receive three hours of training within 45 days of being hired. An independent review organization was hired to conduct a review of the doctor’s coding, billing, and claims submission to CMS. Ineligible persons include anyone barred or suspended from participation with federal healthcare programs (this shows the importance of continued exclusions checks). Doctors had to prove that they had checked and tracked that their employees were not on an exclusion list. For the purpose of this CIA, an overpayment meant the amount of money a doctor had received in excess of the amount due and payable under any federal healthcare program requirement. If an overpayment was identified, they had to repay it to the appropriate payer within 60 days. They then had to take steps to prevent overpayment from happening again. Any paid claim had to be supported with proper documentation. This CIA didn’t even flesh out all seven elements of a compliance program. Even if the situation is over, it’s still a public record forever.  Get the help you need—now Don’t wait until you’re in trouble to get help. Set up a compliance program to protect your practice so you don’t end up on the chopping block. The prevention is worth it. Just because it hasn’t happened doesn’t mean it won’t. If you’d like to schedule a call with me, call our office at 817-755-0035 to speak with Andrea and set up a Zoom call.  Resources & People Mentioned Closed Corporate Integrity Agreements CMS Medicare Learning Network Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

In the last episode, we talked about what a corporate integrity agreement is and what compliance programs should look like. In this episode of Talking with the Toothcop, we continue our series on corporate integrity agreements by looking at the OIG’s Focus on Compliance roundtable discussion. If you participate with Medicare or Medicaid, you HAVE to pay attention to this.  Outline of This Episode [3:23] Corporate Integrity Agreements [5:21] The focus on compliance document [8:59] The board of directors [10:53] The role of the internal audit [11:26] Claims review requirements Corporate Integrity Agreements  Just to recap, according to the OIG, a corporate integrity agreement is “Part of the settlement of Federal health care program investigations arising under a variety of civil false claims statutes. Providers or entities agree to the obligations, and in exchange, OIG agrees not to seek their exclusion from participation in Medicare, Medicaid, or other federal healthcare programs.”  A CIA usually remains in effect for five years. If you don’t agree to this, you lose the ability to participate in federally funded programs. If Medicare or Medicaid represent a large cross-section of your business, you could lose your business by losing the ability to work with them. It’s a large reason why organizations agree to CIAs. CIAs have evolved into what they are today.  Focus on Compliance: The Next Generation of Corporate Integrity Agreements In 2012, the OIG held a roundtable discussion with stakeholders with entities and organizations that were under an active CIA to get feedback. The goal was to tweak CIAs to make them more effective to organizations.  In this discussion, the CIAs required each participant to have a code of conduct setting forth their commitment to compliance. They also had to implement policies and procedures governing the compliance program and adherence to program requirements.  A code of conduct is a great foundation for a compliance program and establishing policies and procedures. Your written policies and procedures should address each of your risk areas. The OIG now leaves it up to the organization to identify what topics you need further training on based on the CIA. So they’re moving away from an hours-driven training program to topic-driven. The government is responding to and taking feedback on some of their requirements.  The board of directors involvement  We do work with some dental partnership organizations and DSOs. CIAs require that the board of directors also receive training, reports from the compliance officer, and pass an annual resolution certifying the board is overseeing the compliance program.  The board’s responsibilities result in more engaged board members, which assists in the allocation of resources to mitigate risk. An engaged board motivates executives and healthcare providers to commit more fully to compliance.  I spend a lot of time working actively with boards and compliance committees and I see this. It takes a few meetings to see people get why it’s necessary. Once things click, I become more of a silent presence and less of the person leading the charge. This is how it should be.  What is the role of an internal audit? Why is it so important? Listen to learn more! Claims review requirements Most CIAs require the provider to conduct a discovery sample of 50 paid Medicare claims randomly selected from those submitted by the provider during a specified 12-month period. If the error rate is 5% or greater, the provider must conduct a full sample systems review—which is far more involved.  When an organization is under a CIA, they have to maintain an error rate of less than 5% in their audits. Based on my experience, this is difficult to accomplish. I’ve been doing record audits for over 10 years and the average error rate is north of 15%. Why? Because auditing processes aren’t in place and people don’t go back and check for mistakes. The average dentist thinks they don’t make that many mistakes, but unless you do audits and have definitive proof, you don’t know. If you’re playing the Medicaid/Medicare game, you’ve got to know that your error rate is below 5%.  You’re not expected to have a full-time compliance officer in place—but you are required to have auditing and monitoring processes in place. So if you’re a small dental office, you must pull and audit at least 50 coding and billing records a year.  Need help with this process? Send me an email and I’ll share some samples of overpayment lists.  Resources & People Mentioned TWT Episode: The 7 Elements of Dental Compliance Programs Focus on Compliance HHS Compliance Resources LIVE Compliance Training Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

This episode is the beginning of a series about corporate integrity agreements. One of the important elements that is part of a corporate integrity agreement is implementing a compliance program. Why is it so important to have a compliance program? What should it consist of? How can a compliance program save your practice? Find out in this episode of Talking with the Toothcop! Outline of This Episode [2:40] Corporate integrity agreements  [4:41] Compliance program guidelines [6:48] Why you want to implement a compliance program What is a corporate integrity agreement (CIA)? A corporate integrity agreement addresses a specific issue while attempting to accommodate or recognize the elements of compliance programs. A CIA typically lasts for five years with a certain amount of requirements attached. What are those requirements? The organization must hire a compliance officer and appoint a compliance committee They have to develop written standards and policies They must implement a comprehensive employee training program Retain an independent review organization to conduct annual reviews Establish a confidential disclosure program Restrict employment of eligible persons Report overpayments, events, ongoing investigations, and legal proceedings Provide implementation reports to the OIG on the status of compliance activities A large part of demonstrating compliance is creating a compliance program. What should that consist of? Compliance program guidelines The OIG provides compliance guidance documents for the healthcare sector, including dental practices. Regardless of what sector of healthcare you’re in, these compliance guidelines center around 7 elements of compliance:  Conduct internal monitoring and auditing processes Implement written policies and procedures Designate a compliance officer and compliance committee  Conduct effective compliance training and education Respond promptly to violations and take timely corrective action Develop effective lines of communication  Enforce standards through well-publicized disciplinary guidelines  A corporate integrity agreement is agreeing to create a compliance program—with the added bonus of a babysitter, the independent review organization.  The best way to learn is from others' mistakes, right? It’s less painful and less costly. Compliance programs are NOT cheap. The government wants you to feel the pinch. They expect you to invest time, money, and effort into compliance.  Why you want to implement a compliance program Long before the OIG came out with guidance, the US Judiciary came up with federal sentencing guidelines that existed for different types of crimes. Chapter 8 deals with healthcare fraud. The OIG compliance guidelines come directly from these US Federal Sentencing Guidelines.  If an organization gets busted for something—but has a reasonably effective compliance program in place—it can reduce fines and penalties up to 90%. When an organization is busted, the government's first ask after an audit is the highest amount. It can be millions of dollars. If you can reduce that by 90%, it can take $1 million down to $100,000. That’s a big deal.  That is where your return on investment comes in. An effective compliance program will pay off. But it’s also my goal that our clients never realize this investment. These are systems that you need to implement. When it comes to compliance, there’s no such thing as “Set it and forget it.” Resources & People Mentioned LIVE Compliance Training Compliance Guidance for Individual and Small Group Physician Practices Compliance Program Guidance for Third-Party Medical Billing Companies TWT Episode: The 7 Elements of Dental Compliance Programs Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Emergency medical kits are essential for dental practices—but most have a kit thrown under a cabinet that’s stocked with expired medications. Scott Sankary is the Co-Founder at Protect It First Aid & Safety, a company striving to change this unsafe practice. They supply emergency products and monitor expiration dates to keep customers in compliance. What do they offer to dental practices? How is their solution better than their competitors? Find out in this episode of Talking with the Toothcop! Outline of This Episode [0:35] Scott Sankary with Protect It Dental [5:47] Protect It Dental’s EMK series [8:11] How to become a customer [14:34] Their subscription-based program [21:58] How are they different? Protect It Dental’s Emergency Medical Kits Protect It Dental is best known in the dental world for their emergency medical kits—their EMKs. The kit itself is made of white metal, weighs approximately 9 pounds, is 15.5” by 6” by 10.5”, and has a handle. It’s well-marked as an emergency medical kit. It can be wall-mounted or stored on a countertop. They also have a grab-and-go magnetic wall mount. It’s well organized and everything has a customized slot. There is also a product key on the inside door. The kit is designed to bring order and calm to a chaotic situation.  They have four kits to choose from, each with seven essential medications, consistent with ADA and GADA guidelines.  EMK #1: This is the basic and most popular kit. It includes two diphenhydramine vials, two epi ampules, 1 albuterol, 1 adult EpiPen, 1 EpiPen trainer, 2 naloxone vials, nitroglycerin tablets, glucose, aspirin, ammonia inhalants, a CPR mask, and 2 syringes. If you don’t work with kids or seniors, this kit will work for your practice. EMK #5: This is the same kit, except the nitroglycerin tablets are replaced by nitroglycerin spray—which is best practice for elderly patients who have swallow reflex issues. If you work with seniors—but not kids—this kit could be a good choice for your practice.  EMK #10: This is the same as kit #1, plus a pediatric epi pen. If you see kids in your practice but not seniors, this is the kit for you.  EMK #15: This is the same as kit #1 + a pediatric EpiPen + nitro spray. If you see both kids and seniors, this is the kit for you. How to become a customer Protect It Dental allows you to buy a kit, onboard existing medications (using proprietary technology), or purchase individual medications a la carte. But to get the full benefit of their program, you need to sign up for auto-replenishment. The problem is that so few people are willing to commit to sign-up for auto-replenishment because they’re worried about cost.  Those that don’t buy a kit and use the EMK onboarding wizard can ease into it. If you choose to onboard an existing kit, their site will walk you through the onboarding process, which will only take 10–15 minutes. The drugs get entered into the Protect It system so you’re set to get replenished on the medications as they expire or are used. You’ll receive a notification saying it’s time to order and you simply pay as you receive replenishment medications.  If you’re set up for auto-replenishment, you receive products 30 days before their expiration date. It comes with a postage-paid disposal bag to ship to their third-party destruction source. The subscription-based program Protect It Dental is now offering one-year or two-year subscription options. If a dentist chooses to continue to a second year after the first, they convert them to the two-year pricing and so on. When a customer purchases a kit, all meds and supplies are pre-loaded into their system and management is simple. The subscription program solves everything. They receive a new kit for a single monthly payment. As items expire, new ones arrive and old ones can be disposed of.  Even if drugs are used—and not just expired—the replenishment is also included in the subscription program. They made it easy and cost-effective to acquire a new kit and enroll in the auto-replenishment program. You shouldn’t have to worry about expiration dates and constant monitoring—Protect It can do it for you. The solution makes it really easy for dental practices to say “yes.”  The dentist’s investment is being protected. Patients are being protected. Some of these medications are life-saving. This subscription is eliminating apprehension and providing dentists with quality care. This is hard to compare to other options out there.  What sets Protect It Dental apart? Protect It Dental is privately owned and there to serve the dental practice—not a shareholder. They’re small, innovative, and high-tech. They have in-house developers and custom programming to fit their business. What they do is driven by conversations with customers and prospects. They’re a small business supporting small businesses. Their pricing is customer-friendly and they have a genuine desire to help people.  Resources & People Mentioned Scotts Phone #: 817-800-9541 Scott(at)ProtectItNow.com Scott Sankary Protect It Dental EMK Kits Onboard Existing Meds Individual Medications Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Are you cultivating a culture of compliance in your dental practice? Are you careful about what you post on social media? Are you staying on top of X-ray machine maintenance? In this episode of Talking with the Toothcop, Andrea and I dive into some important compliance reminders you need to be mindful of—especially because OSHA is cracking the whip. Outline of This Episode [3:21] It’s time to create a culture of safety [4:59] A brief social media etiquette guide [6:22] OSHA is stepping it up [8:14] How to maintain your X-Ray machine [12:35] The topic of patient selection  [15:18] What to do before administering Nitrous OSHA is stepping it up On March 12th, 2021 OSHA sent out a news release that said they launched a program to protect workers with safety concerns. OSHA is stepping up its enforcement efforts and protecting workers’ rights to a safe work environment.  It’s time to take this stuff seriously and step up your game. Don’t look for loopholes—get this stuff done. We are seeing a shift under the new administration to enforce these things. If you get busted, it will be considered a serious violation. If you’re willfully negligent, it could be up to a $150,000 fine for a single violation. They are out for blood.  A brief social media etiquette guide I’ve gotten some questions about whether or not practices should post specific photos on social media. Before you post photos on social media, make sure you get signed releases from patients. Secondly, make sure anyone in the photo is wearing the proper PPE based on what the situation looks like—not what it is. We are still in a pandemic, so you better be wearing your respirator and other PPE whenever required. Rember, anything posted on social media can be evidence for anyone to use against you. Maintain your X-Ray machine There are things you need to do regularly to maintain compliance with your office’s X-rays and to pass state inspection. I recently got a call from a client with an inspector in their office. I dropped everything to walk them through the situation. I talked directly with the inspector and directed her to the information that said what they were supposed to be doing. But it shouldn’t have come to that. The office luckily didn’t receive a fine but got slapped with a violation.  You have to use a multi-dimensional device or commercial device (i.e. a phantom or step wedge) with every sensor. You must test every sensor on every machine. The distance with the sensor and the cone head must be consistent every time you do the test to control variables. You have to do the same test with the same equipment with the same settings every single time.  What is the best way to do it? Listen to learn more! If you’re still confused, shoot me an email if you have questions! I’m happy to help. The topic of patient selection  Just because someone walks into your office doesn’t mean they're your patient. They become your patient when you examine them and create a treatment plan for them (in Texas). If your first interaction is with the patient and some red flags come up, do not move forward. You can send them another dentist and go your separate ways.  But once you plan their care and present them with a treatment plan, you can only dismiss them with proper mechanisms (so you’re not “abandoning” a patient). Listen to your gut feeling. These patients are the types that sue you or file state board complaints. You may have a huge compassionate heart—but you must protect it. Don’t take on patients that you shouldn’t.  Listen to the whole episode for more tips on creating a healthy work culture and a reminder of what you should be doing before administering nitrous!  Resources & People Mentioned The National Emphasis Program Risk Management and Record Keeping Course (w/Laura Diamond) X-Ray Dental Compliance Episode Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

If you fail to follow the infection control protocols that you KNOW will prevent the transmission of disease, you’ll find yourself dealing with an infection control breach. In this episode of Talking with the Toothcop, India Chance, Michelle Strange, Andrea, and I wrap up our conversation on infection control breaches. We talk about posting on social media, the CDC’s steps to evaluate an infection control breach, and things you can easily implement to prevent infections in your dental office. Don’t miss it! Outline of This Episode [0:35] Don’t advertise your mistakes on social media [8:51] The CDC’s 6 steps to evaluate an infection control breach [14:45] Your duty to report extends beyond saving your reputation [17:35] Get a fresh perspective on your infection control practices [25:16] Why you should implement video cameras in the dental office Do NOT do this on Social Media Michelle has seen dental professionals advertising their mistakes flippantly on social media. One person said they were reusing single-use items and just throwing them in their autoclave. This same person also wasn’t wearing and using utility gloves when necessary. But when something happens in that person’s office and they have a breach, anyone can look on social media and demonstrate a history of non-compliance. Why are they advertising their infection control breaches? Nothing is stopping someone from taking a screenshot and taking that to the state dental board. India has never had a dental board inspection based on a post on social media. However, class action lawsuits immediately scour social media for breaches that could be used in their case. Anyone suing a dentist will look at social media and they’ll tie-in infection control breaches to whatever the complaint is.  The CDC’s 6 steps to evaluate an infection control breach India recently saw a practice post a video on their YouTube channel (and Facebook). It was a training video with multiple practitioners learning how to do procedures. There were probably 15 people in the different operatories. The problem? There was an egregious amount of infection control breaches in the training. She was so shocked they posted it online.  The CDC outlines six steps to take when an infection control breach happens: Identify the infection control breach: In the video India mentioned, they weren’t using sterile water, only half of the people were wearing masks, and they reused single-use items in surgery.  Gather additional data: What was the timeframe of the breach? Which patients did it impact?  Notify key stakeholders: Notify infection control professionals, risk management, health departments, healthcare providers, etc.  Perform a qualitative assessment: Categorize your errors and identify risks.  Make decisions about patient notification and testing: What patients were impacted? What is the risk of transmission? Do you have a duty to warn patients and the public? Figure out communication and logistical issues: How and when will you notify the affected patients? Inform them if they’ll need testing done. Have a plan in place to answer media inquiries. What will you implement to prevent these breaches from happening again? You have to show that you’ve done your due diligence. If you don’t hire an infection control specialist, the CDC has checklists and even has an app. Do something to get ahead of infection control breaches and protect your staff and customers—and reputation. Get a fresh perspective on your infection control practices Sometimes, infection control coordinators are too close to the issues at hand. You may have no idea that you’re a few degrees away from where you should be. But a fresh set of eyes can give you a completely different perspective. You don’t have to hire one of us. But, you could work with another practice to trade a staff member or OSHA safety coordinator to do inspections.  India recommends that you get an admin without clinical experience to take the infection control checklist and do an inspection. They’ll follow whatever is written down word-for-word. They don’t have a bias because they’re going off that checklist—not experience.  We all agree that a professional can complete the most accurate assessment. They can help you shift and pivot in the right direction. But no matter what, you need buy-in from the doctors and all other employees. How can you foster that buy-in? What can you do to give your staff consistent reminders? Listen to hear our thoughts! Implement video cameras in your dental office What about putting a video camera in the dental office? When I was a cop, having a body cam saved me many times. Quality control is so important—and the camera doesn’t lie. A video that you can watch can help you understand context when something doesn’t seem right. It’s why I recommend dental practices put video cameras in operatories and sterilization areas. This can give you an added layer of quality control accountability. It can show you where you’re weak and where things need to be addressed.  All of the major sports teams film the entire game. They watch it, look for areas to address, and learn and improve. Hospitals and doctor offices use these “extreme” measures. Having oversight won’t hurt you—it will help you. Listen to this episode for our entire conversation around handling infection control breaches and learning what you can do better. Resources & People Mentioned Level Up Infection Prevention Evaluating an infection control breach Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

What qualifies as an infection control breach? What is the easiest way to prevent them? In this episode of Talking with the Toothchop, India Chance and Michelle Strange return for a conversation about infection control breaches. We talk about what they are, why we can’t ignore them, and how we can do our part to prevent them.  Outline of This Episode [7:05] What is an infection control breach? [13:11] Have written protocols in place [15:56] The most common infection control breach [21:30] Why training + preparation is important  What is an infection control breach? A breach in infection control is when there is a lapse—a failure to break the chain of infection—that impacts patients and employees. You have to recognize that there was a failure and notify those who were affected.  In 2013, the dental board in Oklahoma exposed Dr. W. Scott Harrington for unsafe practices in his dental office. One of his patients contracted HIV from his unhygienic practices and up to 7,000 others were exposed to hepatitis B, hepatitis C, and HIV.  It’s not always egregious or newsworthy breaches. It can be a corner that got cut. It can be something that got dropped on the ground. These protocols aren’t just in place to protect patients, they’re in place to protect staff as well. The bottom line is that the medical field doesn’t mess around with infection control breaches—neither should dentistry.  Have written protocols in place All of us run into difficult conversations with staff about personal hygiene—even something that seems as silly as wearing nail polish and fake nails. It’s uncomfortable. Plus, research has been done on how nail beds with chipped polish and artificial nails are perfect reservoirs for bacterial loads. It’s why India and Michelle encourage dental practices to have written protocols in place for personal hygiene. It’s less of a headache when you have a policy and it isn’t just “anything goes.”  Common infection control breaches I think the most common infection control breach I see is with sterile processing. Michelle got a call from a dental office with a big sterilization breach that had to do with a malfunctioning sterilizer. They weren’t doing the necessary prevention protocols.  India sees a lot of little small breaches like someone cutting corners or simply weren't sure they were doing things correctly (and they weren’t…). But she agrees that the large breaches where patients must be notified seem to be with sterilization. Michelle sees a lot of needlestick injuries. Michelle once witnessed a hygienist get punctured by a tip and was bleeding. Her reaction was “Oh I’ll just wash my hands” and didn't get a medical follow-up. Luckily, she wasn’t working with a patient. Her exposure could’ve been far worse, especially because a lot of dental practices don’t take adequate medical histories. Many dental offices don’t use the health history section of their digital charting much—if at all. If you do have one of those injuries, you need to have a grab-and-go kit in place. You just grab it and head to get medical attention. At LevelUp, they’re training infection control coordinators to do that across the board. Regardless of the injury or hazard, they have a grab-and-go packet for medical attention. No one wants to have to dig to reference infection control protocols—have it ready.  Why training + preparation is important  When I do OSHA and infection control training, I talk about what an occupational exposure is as well as what steps to take after exposure. But I don’t want you to have to remember the protocol. The sad truth is that if you know what to do, you’ve dealt with it too many times. You need to do a root cause analysis and find out why it keeps happening. Is it a systemic failure? Was someone just not paying attention? Was someone not wearing PPE? More training needs to happen upfront before you even touch a patient so dental staff aren’t questioning what to do if something happens. We need to do our part to train our staff with the correct protocols, infection control programs, standard operating procedures, etc. We need to have written policies, and reinforce a culture of compliance.  Dental practice owners need to understand the cost analysis with infection control breaches. Occupational hazards are so expensive to deal with. They don’t know how much more it’s costing them. Safety is good for business. Prevention is less expensive. It will save you time and money. We must shift the perspective in infection control breaches from the standpoint of reacting to one of prevention. Tune in next week for the rest of our conversation about infection prevention! Resources & People Mentioned Level Up Infection Prevention Evaluating an infection control breach Story on Tulsa Dentist Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Why is the role of an infection control coordinator so important? How do you simplify safety so any dental office can appoint an infection control coordinator and properly train them? In this episode of Talking with the Toothcop, Michelle Strange and India Chance join Andrea and I to talk about the importance of having an infection control coordinator in your dental practice.  Outline of This Episode [2:17] The importance of an infection prevention coordinator [6:27] Who should fill the role of ICC? [11:41] Teamwork makes the dream work [21:00] How to communicate effectively with your team [29:21] Do you need an infection control coordinator? Simplifying the role of an infection control coordinator Let’s face it—the role of an infection control coordinator can be overwhelming. Infection control and OSHA guidelines, rules, and regulations have a lot of nuances. When people are overwhelmed, they tend to do nothing. So India and Michelle created the Level Up Infection Control podcast + company to create a community of support and simplify the role of an infection control coordinator. They share step-by-step how-tos and useful information and take you as the listener on a journey as if they were training you in-person.  Who should fill the role of ICC? India and Michelle note there are a few things to consider, namely—who is interested? Do they have time to give outside of their clinical hours? Who wants to do it? A clinical background is important, but you can’t assign this role flippantly. They need great communication + problem-solving skills and can hold others accountable. You have to know your team members.  What if you don’t have someone that wants to take on the role? At this point, India points out that it makes sense to pick a clinical team member. A lot of the protocols and systems deal with the clinical side. You need experience with that to successfully implement those protocols and mandates. The infection control coordinator role itself and what you have to manage can be extensive at times. The key to infection prevention is that it must be implemented daily. You can't let things build up and only review once every three months. Patients are looking at dental practices. OSHA is following infection control and prevention closely. Regardless of who you choose, they need proper training.  Teamwork makes the dream work Getting things done comes down to delegation. If you’re the infection control coordinator, you don’t have to implement the whole program yourself—you can delegate. But the bottom line is that you chose to go into healthcare. You have to find the time.  Michelle and India concede that it is a lot of time on the front end as you create processes, systems, and standard operating procedures. But as you start to become unconsciously competent you start to just “do it.” Creating a team approach where everyone knows their roles, will save you time.  Developing unconscious competence How do you develop unconscious competence? How do you foster a team approach to infection prevention? Michelle shares that she once strolled into a room after a patient and threw the instruments that were used in the ultrasonic. But she got distracted and forgot to turn it on and run it. A new assistant pointed out that she forgot to turn it on. If she hadn’t said something, Michelle would’ve created a breach in infection control.  You have to have a team that notices and comes alongside to help you if something is missed. You have to keep each other accountable to keep your patients safe. The moral of the story is that you have to have an infection control coordinator role, but it is a team effort to implement an infection control program. If you’re committed to a team approach, each person helps to carry the load.  India emphasizes that infection control isn’t just about protecting the patient—it protects you as the clinician as well. This role protects every single stakeholder in a dental practice. It’s not your job to be the sheriff. But you must deliver the information in a way that is supportive, encouraging, and promotes change. So how do you tactfully but firmly let someone know it’s time to make a change? How do you communicate with people that don’t like change? How do you motivate them to be changemakers? Keep listening to hear India and Michelle share their thoughts. Resources & People Mentioned Level Up Infection Prevention Level Up Infection Prevention (podcast) A Tale of Two Hygienists (podcast)  OSAP Infection Control Coordinator Role Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Dr. Lisa Kane is to New England what I am to Texas. She is THE compliance guru. She practiced dentistry for 20 years before switching to consulting. After years of dealing with migraines from leaning over patients, she made the move—which she’s done for the last four years. She’s always loved the business side of dentistry and it was the perfect fit.  Outline of This Episode [0:21] Dr. Lisa Kane joins the Toothcop [3:50] Compliance, education, PHI, & civil rights [7:58] What people misunderstand about consultants [9:44] What Dr. Lisa Kane offers with consulting [12:43] Are peers receptive to her feedback? Compliance, education, PHI, & civil rights Dr. Kane spends her time opening people’s eyes to regulations they need to follow. Before the COVID pandemic, no one took infection control and OSHA guidelines seriously. In Massachusetts, whatever the CDC says you must follow. In Texas, the state board requires the use of N95 respirators. It’s been hard educating people on the science behind these regulations and that it is actually for their health.  At the same time, there’s an intersection between protecting one’s health and protecting their civil rights. I worked with a hygienist who is hearing impaired and reads lips. When a patient is wearing a mask, she can’t communicate. Where is the line between protecting oneself and overcoming civil rights issues? Where is the intersection between conflicting regulations? Sometimes, there’s no good answer. What people misunderstand about consultants People don’t always understand that Dr. Kane is there to help. She doesn’t go into a dental office and bark orders like a drill sergeant. She’s sure to point out that the process is a conversation. She is sharing the regulations and what you need to do and it’s up to the dentist to make decisions for their office. She’s giving them protocols and walking them through the things that are daunting. If someone comes into your office, you have to keep them safe. You don’t want to say “I didn’t have time” when faced with consequences for not keeping a patient safe. What Dr. Lisa Kane does Dr. Kane typically starts by running an infection control or OSHA class for a practice. Then she walks through the dental office and recommends board regulations (OSHA and CDC) to implement. She does a lot of explaining with staff (i.e. why they need to wear gloves) and helps them brainstorm how to do things safely. She can also help implement monthly protocols, run safety meetings, keep OSHA handbooks up-to-date, and more. She does a lot of fit testing for masks as well. She has partners that offer CPR and HIPAA training. Are peers receptive to her feedback? Dr. Kane can say that she has been in their shoes and knows what it’s like to have to juggle this stuff. Whereas I was a cop, and was the enforcer of rules. Dr. Kane finds that people are appreciative of her experience and that she can form a connection with practice owners. They know that she knows what she’s talking about.  Want to learn more about Dr. Lisa Kane and what she offers? She just launched a newsletter that will highlight protocols and why you need them. Check it out! And be sure to sign up for our email list to stay up to date on the latest regulations.  Resources & People Mentioned Connect with Dr. Kane on LinkedIn Dental Office Compliance of New England Sign up for Dr. Kane’s Newsletter Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

We like to provide clients all the materials they need to prepare for the next calendar year. We usually try to get it to them before Christmas, so it’s a sort of Christmas present. One of the things we include in this packet is a blank master chemical list. We’ve been getting a lot of questions about this list, as well as establishing a code of conduct. Listen to this episode to learn about both of them!  Outline of This Episode [0:40] A compliance Christmas present [5:11] Nail down your code of conduct [7:29] Maintain a master chemical list [9:37] The lowdown on safety data sheets [11:10] Check out our live training! Nail down your code of conduct If you participate with Medicare, Medicaid, Tricare, or other government programs, you need to have a written compliance plan that includes the seven elements of compliance. It’s a supplemental document to your office policies and procedures (employee handbook, SOPs, OSHA policies, HIPAA policies, compliance policies, billing protocols, etc.).  It’s impossible to have written procedures for every scenario that may occur in the dental practice. So this supplement establishes a decision-making framework for your staff in the absence of a policy or procedure. They are principles to follow to reason through any situation. In short, it’s a behavioral guidance tool. To remain compliant, this code of conduct needs to be reviewed by your staff at least annually. It should be part of the new-hire process and repeated with everyone in the practice—doctors, clinical staff, and administrative staff. You have to read it, discuss it, and sign off on it.  Whether a signed form goes in each employee record or a compliance manual, you just need to be consistent. You have to be able to prove that you have a reasonably effective compliance program in place.  How to maintain a master chemical list Another thing we include in the update packet we send is a blank master chemical list. Why? Because you need to know what chemicals are being used in your practice. They need to be accessible in the event of a power failure. If you prefer to keep things online, make sure you can access it on your cellphone or have it transferred to a thumb drive for easy access. If you can meet that threshold, you should be good. You can delegate this to a staff member or OSHA coordinator, as long as someone knows where it is.  Safety data sheets We've been getting questions about where to store safety data sheets. Does it have to be printed? Can it be online? The short answer is that it can be online, but needs to be maintained in the office as well. It should be a table of contents for your practice.  In 2012, we migrated to a DHS system in which they had standardized the format for safety data sheets. Before this, they had been known as material safety data sheets (MSDS). The formatting is now consistent. If you have printed MSDS sheets, it’s time to upgrade them to the proper format. Resources & People Mentioned LIVE Compliance Training Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Needlestick injuries have been cropping up again in the last few months. These injuries are considered “occupational hazards” in dentistry—but should they be? Why is it happening? What’s the contributing cause? In this episode of Talking With The Toothcop, Andrea and I talk about this costly “never event” and how to best prevent it.  Outline of This Episode [0:52] The protocol with needlestick Injuries [5:25] Coordinating testing with patients [8:20] Annual Sharps Evaluation + Usage [10:59] Live OSHA Safety Coordinator Training The high cost of needlestick injuries The CDC came out with some statistics that said the average needlestick injury costs $700–$750. That’s a load of crap. If you can’t get a negative test from the source patient, the employee must be treated as though an infection occurred. The post-exposure treatment includes taking costly antiviral medications.  If a hygienist slices their fingers open or someone gets poked by a root tip, you have to ask the source patient to get a blood test. But OSHA doesn’t outline who pays for the patient’s blood draw. I recently helped an office with a patient that didn’t want to get a blood draw. I followed up to understand what her concerns were. Turns out, she didn’t mind doing the blood test—she just couldn’t afford it. So we arranged transportation and the practice paid for the blood test. It saved a lot of headache—and medication usage—for the employee.  Andrea points out that the majority of people understand that you’re human and make mistakes. They’re willing to do the right thing and are reasonable. You just have to be honest. Some of the recent incidents have involved pediatric patients. It’s uncomfortable to have to ask a parent to take a child for a Hepatitis B or HIV test but it’s a conversation you have to have. Start taking preventative measures  While it’s considered an occupational hazard, a needlestick injury is a “never event” that should never happen. Sharps containers should be located as close as feasible to the point of use. One simple thing that could be implemented is having the doctor break down their own needle. At that point, the odds of a staff getting stuck with a needle go down to almost zero. But a lot of dentists would rather have their staff do it for them. Proper sharps usage is imperative It’s clearly defined under the bloodborne pathogen standard that dental offices must use sharps with engineered sharps injury protection (SESIPs). These needles have a built-in safety mechanism that reduces exposure. There are only two products that meet this threshold. One is the Verena SimpleCAP. The other is the Septodont Ultra Safety Plus XL Safety Syringe.  We recommend doing a yearly sharps training to educate your staff on how to properly use needles. Make sure all non-management clinical staff that works with these needles participates in the annual evaluation. Keep those records with your OSHA training records. Resources & People Mentioned Live OSHA Safety Coordinator Training Measuring the Cost of Sharps Injury Prevention Septodont Ultra Safety Plus XL Safety Syringe Verena SimpleCAP Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

In this episode of Talking with the Toothcop, we’re sharing a few more important reminders and things to stay on top of in 2021. This includes evaluating X-ray equipment, quarterly water testing, new CE requirements, completing CPR courses, and handling your exclusions monitoring. Why is it so important to stay on top of these things? Find out in this episode! Outline of This Episode [2:27] X-ray equipment [6:26] Quarterly water testing [7:53] Human trafficking CE [9:51] CPR courses [12:04] Exclusions monitoring Do NOT neglect your X-ray equipment Texas has some of the most stringent enforcement in the country. X-ray rules were updated in 2019 and effective today. If you have digital X-ray machines, you’re required to have a Quality Assurance/Quality Control (QA/QC) process. That means you need to get out your X-ray manual and do an equipment performance evaluation (EPE).  For 2D technology, you must do this evaluation within 2 weeks of installation and every four years. If you have a 3D X-ray machine, the evaluation is required within 30 days of install and every year thereafter (in a time-period no later than every 14 months).  If you miss the inspection, you may get lucky with a slap on the hand. If it happens again? A $4,000 fine. Don’t mess this up.  Get your quarterly water testing completed Now would be a great time to do quarterly water testing. You want to make sure that your output meets safe drinking water standards (500 CFU or less). It doesn’t matter what treatment protocol you have—you need to verify it’s working properly with water testing. You can do it yourself, or mail a sample off. If you don’t have one in place, I recommend ProEdge Dental.  Complete a hands-on CPR course The state audits 5% of all licensees every year in the state of Texas. This year, people are getting busted for not completing the hands-on CPR courses. You can’t try to sneak by with the online-only courses. You have to do a hands-on skills evaluation or it will be rejected. If they reject it—and you waited until the last minute to complete your certification—your license may expire. That could mean you’re practicing without a valid license, which is punishable.  The bottom line? Track your credentials. We know they all expire at different times, so set up a calendar and plan. Make sure you meet your requirements for the year. You can also compile the expirations for all of your staff and get a reminder in the calendar 45 days before. Don’t wait until the last minute. Exclusions monitoring If you work with Medicaid, a federally qualified healthcare center, private dental practice/DSO, and you provide service to Medicare or Medicaid patients, you must do exclusions monitoring. Check before you hire someone and every month after hire. The more frequently you check, the fewer claims will be affected. If one of your staff members is on the exclusions list—even if they’re administrative—every claim filed will be tainted. You might have to return hundreds of thousands of dollars of claims that have been paid to you. Minimize your risk by doing your due diligence. Check every doctor and staff member monthly, no matter their role. Resources & People Mentioned Pro Edge Dental OIG Compliance Toothcop Compliance Training Human Trafficking Training Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

What’s new in 2021? CE requirements are changing, PMP self-query rules are in effect, and e-prescribing has officially kicked off. Andrea and I talk about all of the changes—and where to learn more—in this episode of Talking With The Toothcop. Don't miss it! Outline of This Episode [0:21] The first episode of 2021! [2:26] PMP Self-query [4:20] Check patient history [6:04] E-prescribing rules [9:07] NEW CE requirements PMP Self Query According to Rule 111.2, if you have a DEA registration (or multiple) you’re required to check your prescriber history at least once a year in the PMP platform. Login and enter the dates you wish to check. You don’t need to document it—the state automatically records that you’ve checked. If you don’t, you may end up in front of the state board for lack of compliance. In Andrea’s words, “Check yourself before you wreck yourself.” Diligently check patient history As of March 1st, 2020 every time you prescribe a controlled substance you have to check the patient’s history in the PMP. This can be delegated to another staff member to do (under their login—not yours). This helps you make an informed decision about what to prescribe.  E-prescribing rules in Texas Effective 1/1/2021, Texas dental providers are required to e-prescribe. There are standalone systems available or some that tie into your current software (linked in the resources). It’s not cheap, but you need to do it. The state board does allow for some exceptions, including if you prescribe fewer than 25 prescriptions a year (i.e. all of 2020). NEW CE requirements Dentists used to be required to take a two-hour CE course every three years regarding opioid and controlled substance use in their dental practice. As of 9/1/2020, dentists with a DEA registration need to take a course on prescribing and monitoring controlled substances. Rule 104.2 takes effect 1/1/2021: every dentist with direct patient care responsibilities must complete two hours of education per year—or four hours per renewal period—on pain management. Duane has hired some clinicians to teach this course, check out the resources for the link to our training! If you took the old prescribing and monitoring course on or before 8/31/2020, it’s completely different from what’s required after 9/1/2020. You have to take it again. Secondly, if you don’t have direct patient care responsibilities (i.e. you’re a consultant with a dental license or a teacher) you don’t have to do the training. The bottom line? If you touch a patient, you should take the course.  Listen to the whole episode for all of the details! Resources & People Mentioned Dental Compliance Training LIVE Courses Texas Administrative Code Chapter 111 Dentistry Rules + Regulation Changes in Texas The DEA and Dentistry [Need to Know Updates] Texas State Board E-Prescribing Waiver E-Prescribing Waiver Form iPrescribe  Allscripts iCoreConnect Veradigm MD Toolbox Surescripts Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

If COVID has taught us anything, it’s given us clarity. The first thing you should question for 2021 is “What do you want?” Dentists are realizing that “I might” or “I should” needs to turn into a solid plan. Do you want to recover losses? Do you want to grow? Do you want to slow down? Sometimes the best way to implement goals is to have someone come alongside you to help you through the process. That’s where Tonya Burns comes in. Tonya is a consultant working exclusively with pediatric dental practices. Her mission is to empower dental practices to reach success—whatever that looks like for them. Listen to this episode of Talking with the Toothcop to learn more! Outline of This Episode [2:20] Tonya Burns: Pediatric Dental Consultant [3:41] Tonya is MORE than a consultant [6:33] How to implement goals in your practice [12:32] What years of consulting have taught us [29:41] Implementing automation in dentistry [37:49] Tracking metrics with clients [39:20] Systems are great—so is accountability [41:58] Learn how to embrace change [43:07] How to connect with Tonya Burns Tonya is MORE than a consultant Tonya feels the word “Consultant” often comes with bad connotations. She wants to change the stigma. She comes into dental practices to help devise plans based on that office's wants and needs. She crafts her approach to each practice and what they’re capable of. She reinvents the wheel all the time. She enjoys being involved in every part of the process, from goal formation to implementation. She’s there to hold them accountable and give them direction. Sometimes she helps them fine-tune their own systems and redesign them. Her goal is for a practice to achieve their goals without leaving any patients behind. No one should fall through the cracks. A lot of patients falling through the cracks in pediatrics. Why? Because there’s so much volume. You need to identify holes in your practice and fix them before it’s too late. That’s where a wonderful consultant like Tonya can step in and be a game-changer for your people and your business.  Implement SMART goals in your practice Tonya emphasizes that right now is a great time to be in pediatric dentistry. It isn’t feeling the effects like other specialties and general dentistry has. Parents will always do for their kids what they won’t do for themselves. Dental practices are also doing a great job at making their patients feel safe. Tonya also points out that now is a great time to set SMART goals (specific, measurable, attainable, results-oriented, and timebound). Do you want to recover losses? Do you want to grow? Do you want to slow down? What do you need to do to get the practice in the right position? You should set realistic goals that you can measure and attain. Let your team set some goals as well. What would they like to see happen? Have you realized you need more education to be more efficient?  Consultants CAN empower change Tonya was hired to work with a practice that had a toxic environment. The dentist said, “I just want them to be happy.” The dentist had bought out another office, merged the practices, and told them “This is how it is.” They had broken processes. No one had any respect for each other. There were power struggles. They would even cuss each other out through their headsets.  They worked through the problems and at the end of the relationship, she had all the “mean girls” texting her and thanking her. They didn’t realize how bad they were. The practice turned around and did well. People want to trust who they’re working with. It’s all about finding a connection and making sure you’re a good match. But you also have to walk away from people if you know you can’t help them.  Implementing automation in dentistry Tonya is now helping implement automation in dental offices as part of her consultation service. They take repeatable processes, put a bot into use, and then teach the team how to use it properly. This is a way to work leaner and help your overhead. Robots can do insurance verification, track claims, do payroll, and even send claims and statements. They’ve now taught the robots to read EOBs and they should be able to post payments soon. You can program the bot to do anything that you want.  But they still need a human running them. Implementing automation removes human error with small things and removes things that offices hate doing. It can clean up the process and streamline it. It all happened because Tonya met a pediatric dentist whose husband owned an automation business. She started helping to program them to work with a team in an office. Now they’re going live with clients.  How long does it take to implement? If you want the robots customized to your practice—which is what Tonya advises—then the process takes about two weeks from testing and implementing to using.  Wonderful things are coming for the pediatric community. Listen to the whole episode for the full conversation about pediatric consulting, implementing new technology, and the future of dentistry. Resources & People Mentioned Go to ProEdgeDental.com/Toothcop for a special offer! Connect with Tonya at TonyaBurns.com Tiny Bubbles by Don Ho Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Texas has rolled out some regulations and rule changes that dentists need to stay on top of. From controlled substance CE changes and equipment performance evaluations to medical emergency preparedness training and sedation inspections—we cover it all in this episode of Talking with the Toothcop. Don’t miss it!  Outline of This Episode [0:21] A trip down memory lane [4:41] Controlled Substance CE changes [13:57] Controlled Substances: EPCS + patient query [19:11] The Human Trafficking Course requirement [21:30] X-ray equipment performance evaluations [25:02] Step-wedge test + medical emergency preparedness training  [27:30] What dentists are getting busted for in sedation inspections [34:17] Mail Bag: Does your office need to use respirators?  [37:13] Georgetown Dental’s violations Changes to Controlled Substances Regulations A lot of controlled Substance CE changes came out in 2016. Some dentists still aren’t in compliance with these rules. Rule 111.1 is a CE requirement for every dentist in Texas with a DEA registration. Up until 9/1/2020, dentists were required to complete a two-hour CE course on opioids and the use of controlled substances in the dental practice. Now you’re required to do an additional two-hour course on monitoring and prescribing practices for controlled substances.  This takes effective As of January 1st, 2021 all dentists with direct patient-care responsibilities are required to complete a pain management CE (Rule 104.1 ). It is a two-hour CE course that you must complete annually. Some CE requirements are annual OR every other year. I.e. the human-trafficking course must be completed per renewal period or every two years. NOTE: A dentist is NOT required to have a DEA registration if you’re not prescribing. But moving forward, the only way you can prescribe any controlled substance will have to be done through Electronic Prescribing of Controlled Substances (EPCS).  Controlled Substances: EPCS + patient query Under rule 111.2, any dentist with a DEA registration is required to login to the PMP (Prescription Monitoring Program) and complete a self-query to review your prescribing history. Even if you don’t prescribe controlled substances, you still have to log in and perform the search. Luckily, there’s no need to document it. They monitor the keystrokes and searches you perform when you log in—which is why you have to do it.  Before issuing a prescription for a controlled substance to a patient, you’re required to check the patient’s history in the PMP (Rule 111.3). If you’re administering a controlled substance from an office supply (and not ordering it or prescribing it) you don’t need to do the search.  Rule 111.4 allows the state board to monitor dentists prescribing practices. In Texas, it’s managed by the State Board of Pharmacy. Some dentists have disciplinary actions on their license for failure to comply with these rules—so we aren’t just saying them to say them. They are important.  X-ray equipment performance evaluations (EPE) The most common thing dentists get busted for is not having equipment performance evaluations (EPE) completed in time. It’s simply a calibration check that must be performed by an outside party. The state requires it for two-dimensional x-rays every 4 years from the date of the last EPE. It’s such a common violation that half to most dental offices have been busted for this. They don’t give second warnings—you’ll get a $4,000 fine after your first warning. This is one of the easiest rules to comply with. NOTE: If you have a three-dimensional x-ray machine, it must be checked annually. What dentists are getting busted for in sedation inspections The first thing dentists get busted for is expired AED pads OR not having pediatric AED pads. You have to have pediatric appropriate equipment if you administer nitrous to children under 13.  Another thing is not checking vital signs intraoperative or perioperative. That includes blood pressure, heart rate, O2 Sats, and respiratory rate every 10 minutes. I know dentists who are in hot water right now because they’ve failed multiple times. Don’t let something so silly leave a black spot on your record. Pull up your Pre-Op Sedation/Anesthesia Checklist and look at rule 110.3. Make sure your pre-op checklist has everything that’s required and it’s titled “Pre-Op Sedation/Anesthesia Checklist.” No joke—if it doesn’t say that, they will make you fix it. This is true for level 1 and Nitrous Oxide only as well.  Mail Bag: Does your office need to use respirators?  When most people hear the word “respirator” they automatically think of elastomeric respirators (i.e. a Darth Vader type mask). Dental offices do wear N-95 masks, but it’s actually called a face-filtering respirator. It’s still a type of respirator—just not what you think of. Texas (Rule 108.7 Subsection 16) requires the use of an N-95 Respirator mask when working within 6 feet of aerosol-generating procedures (anything where you use a handpiece). It applies to dentistry in Texas and other states.  Why you HAVE to follow the rules OSHA reported that since the pandemic, there has been $1.4 million in fines issued to healthcare providers. There was only one dental office on that list—Georgetown Dental in Massachusetts. They were busted for over 7 violations, but here are a few: 1910.134(c)(1) – No Written Respiratory Protection Program. You need a written plan.  1910.134(e)(1) – No Medical Evaluations for Employees. You must provide them a medical evaluation to make sure they can use a respirator.  1910.134(f)(2) – No fit testing. They must be fit-tested before initial use of the respirator.  1910.134(k)(1). Employee training. The employer shall ensure that each employee can demonstrate knowledge of how to use, maintain, and store the respirator.  Any dental office needs to make sure they comply with these rules. To get the full details on all of the rules and regulations that have changed, give the whole episode a listen—and take notes.  Resources & People Mentioned SedationCE Sedation Inspections + EPCS + Continuing Education SOAR Health and Wellness Training 1910.134(c)(1) – No Written Respiratory Protection Program Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Why do you need to monitor and audit your charting? Why is verifying that your billing is done correctly so important? Because your life and your livelihood depend on it. An ongoing evaluation process is so important to a successful compliance program. Are your standards and procedures accurate? Is your compliance program working? Are claims being submitted properly?  All of these questions are important to answer. So in this episode of Talking with the Toothcop, Andrea and I walk through the OIG standards for record monitoring and chart auditing. We share some important definitions, my auditing process, and other things that are important to track and monitor. Don’t miss it! Outline of This Episode [1:37] Recap of the last episode [4:03] The OIG Auditing and monitoring procedures [11:38] Avoid a Corporate Integrity Agreement (CIA) [13:08] The definition of an overpayment [13:56] Understanding the False Claims Act [15:00] Proper charting review and noting [19:57] The threshold for fraud is low  [22:18] Guidance for compliance officers for CIAs [29:59] What do you focus on in a record audit? [34:03] Other things you need to monitor [37:00] Find the time to do audits [39:49] The OIG Self-Disclosure Protocol What does the OIG consider an effective monitoring program? An audit is one of the best ways a dentist can make sure they’re following proper procedures with their charting and billing. It’s also a great way to find problems and nip them in the bud before they continue. The OIG defines two types of review: (1) A standards and procedures review; and (2) a claims submission audit. I’ve found that a review of standards and procedures is almost nonexistent in most dental offices because most don’t even have written standards and procedures.  The OIG states “In addition to the standards and procedures themselves, it is advisable that bills and medical records be reviewed for compliance with applicable coding, billing and documentation requirements.” Who should be included in the audits? Ideally, the dentist, dental hygienist, and whoever is in charge of billing.  The OIG recommends that you take a snapshot i.e. a benchmark to track that your practice is reducing the number of claims that are overpaid or denied.  What do you focus on in a record audit? A self-audit is primarily to determine:  Bills are accurately coded and reflect the services provided  Charting and documentation is being completed correctly The services provided are necessary Are there any patient safety or qualitative issues? Look at any issues that will pose a problem to your license and your freedom. You’re more likely to be audited on your higher-dollar items, but they’ll often include records for limited exams and hygiene. There are just a few of the things you need to monitor: Vital sign records for sedation (document at certain time intervals, time and amount given, etc.). Calculate your time correctly, you will be scrutinized on it.  Improper coding and billing Document tooth number and surfaces Make sure you’ve gotten proper consent Exclusions monitoring Pre-hire screening You need to be adept at identifying non-compliance from patient intake through submission and payment. Through this process, you can identify what needs improvement. The OIG recommends that you conduct periodic audits at least once per year. They also recommend a random selection of patient records to review (but preferably 5+ per payor and 5+ per dentist). I share the process that I prefer, listen to learn how it’s different (but still compliant).  What do you do when you find problems?  If you identify problems while doing your review(s) you need to determine whether it merits further training and education with staff or changes to your process. If you find risk areas or vulnerabilities, they need to be addressed. The OIG notes that the specific actions taken depend on the circumstances of the situation. It can be as simple as a repayment to a payor with an explanation of the overpayment.  I worked with a dentist whose clinical notes were inadequate to support what was billed. The acting dentist didn’t take x-rays, note what teeth were affected, and didn’t clarify why the work was done. When we uncovered that, they had to figure out how much was paid and return the money.  You have to do that to protect your integrity when you don’t meet the criteria of what is expected of you. When the OIG comes knocking on your door because of a complaint, they can see your history of integrity. It could save your bacon. What do you do if your practice conducts a review and must notify the OIG? What process do you follow? What is the definition of an overpayment? Listen to find out. Ingrain chart auditing and monitoring into your practice You have to find time in your busy schedule to do chart audits. You have to do this. It’s not that difficult to create an audit checklist. You can train your staff how to conduct an audit and assign each of them 10 records to go over. Have them report back to you with the feedback you need to reduce your number of inaccurate claims.  I also recommend auditing some of your own records—and be tough on yourself. Allow yourself to be your own worst critic to get better at charting. If you find a problem, fix the errors with that record (with a note—do NOT change the original record). Do some additional snooping to make sure it’s not a systemic problem. Dig until you find more and figure out how to report it.  Compliance is a scale. It might not be possible to hit 100% compliance. But my goal is to get you to a higher percentage on that scale. It’s about putting systems into place to help you sustain positive changes long-term. If you’d like one of my sample checklists, shoot me an email! We cover this topic in-depth, so for more detail, listen to the whole episode!  Resources & People Mentioned OIG Compliance: Auditing and Monitoring OIG Self-Disclosure Information The Next Generation of Corporate Integrity Agreements Third-Party Medical Billing Compliance Program Guidance Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Years ago, the federal judiciary realized that federal judges needed sentencing guidelines for healthcare fraud. In the process, they issued compliance guidelines for different healthcare industries. Each incorporates the seven elements of compliance to combat healthcare fraud. The ramifications of violating the false claims act are tremendous. So what do you need to do to protect your dental practice? What are the seven elements that need to be incorporated into compliance programs? Listen to this episode of Talking with the Toothcop to find out! Outline of This Episode [10:22] The evolution of compliance programs [12:27] The 7 elements of compliance programs [16:21] #1: Implement written policies and procedures  [21:50] #2: Designate a compliance officer [24:53] #3: Provide effective compliance training [30:16] #4: Develop effective lines of communication  [36:08] #5: Conduct internal monitoring and auditing [43:38] #6: Enforce standards through disciplinary guidelines  [44:56] #7: Respond promptly to violations and take corrective action [47:54] #8: Whistleblower protections in New York state [50:41] Give us some feedback! How can we serve you better? What are the seven core elements of a compliance program? Every healthcare provider that participates with Medicare or Medicaid has to establish a healthcare compliance program that incorporates these seven elements:  Implement written policies and procedures Designate a compliance officer and compliance committee  Conduct effective compliance training and education Develop effective lines of communication  Conduct internal monitoring and auditing Enforce standards through well-publicized disciplinary guidelines  Respond promptly to violations and take timely corrective action Any organization that has been busted for healthcare fraud—rather than being kicked out of the Medicaid program—has to establish a compliance program. It also comes with a babysitter for 5 years and compliance with a Corporate Integrity Agreement. It’s five years of probation. It’s also why it’s imperative that you read, understand, and implement each of these elements. Implement written policies and procedures  You need to create policies and procedures for whatever compliance risks you face as a practice. Some of the risks you might face could be related to sedation (general anesthesia), patient information and HIPAA regulations, infection control, electronic billing reference materials (CDT coding books), controlled substances/drug policies, medical emergencies and much, much more.  You need to identify your risk areas and write policies and procedures to serve as a reference guide for your staff. How do you establish them? Write down a brain-dump list of every risk you can think of that your dental practice might face. Ask the questions: Can I lose money? Can I lose my license? Can I lose freedom? If you can answer yes to any of those questions, it’s time to frame up some policies and procedures.  The bottom line is that the government wants to see that you have policies and procedures in place to deal with overpayments and your response to an identified overpayment. Andrea and I take a deep-dive into element #2—so keep listening.  Provide effective compliance training and education There are certain things every staff member should be trained on including code of conduct training, fraud, waste, & abuse training, continued education for billing staff, OSHA and HIPAA training, infection control training, and more. It’s your job to figure out what needs to be done and who needs to complete it. It’s not an excuse to say “I didn't know.”  The code of conduct is somewhat of a catch-all. You can’t predict every situation that might happen in your practice. It’s just not possible. Your written code of conduct is a set of principles that you want your staff to use to problem-solve. It should communicate your practice’s values, mission, vision, and purpose. Train your new employees on your code of conduct immediately. Effective training isn’t just giving someone information—you have to make sure they’re retaining the information, too. Keep listening to hear why element #4—developing effective lines of communication—is so important. Conduct internal monitoring and auditing AND enforce corrective action Two elements absolutely HAVE to be implemented—number #5 & #7. They involve checking your work—and fixing your mistakes. Having both processes in place is important. You need people in place to keep things in check. Put systems in place to track and stay on top of those things that you need to monitor.  Review your employee handbook periodically and update it to reflect current regulations. It should outline disciplinary guidelines. Many follow a progressive guideline such as a write-up, suspension, time off without pay, etc that leads up to termination—while reserving the right to fire when necessary. It needs to be well-published and applied evenly and fairly at every level of the organization. If you have a bad apple, you have a responsibility to carve them out of your organization before they harm someone.  Listen to the rest of the episode to hear about element #6 as well as the important topic of exclusion monitoring—if you don’t do this you can bankrupt your business. Resources & People Mentioned Healthcare Fraud The False Claims Act Office of the Inspector General Website Corporate Integrity Agreements OIG Compliance for Individual and Small Group Physician Practices HEAT Provider Compliance Training Videos Measuring Compliance Program Effectiveness: A Resource Guide Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Did you know that October is the National Substance Abuse Prevention Month? In keeping with that theme, this episode of Talking with the Toothcop is all about drug regulatory issues and updates, schedule II drug monitoring, and substance abuse prevention. We share some helpful resources and DEA regulation updates—don’t miss it! Outline of This Episode [1:33] DEA drug regulatory changes [3:53] Medicare consolidating credentialing in TX [4:28] Electronic 222 forms for schedule II drugs [6:36] Why you NEED to keep inventory [9:34] The topic of background checks [12:27] Substance Abuse Prevention Month [13:32] Controlling patient information [14:42] Annual DEA CE now required [15:17] How to check a patient’s drug history [21:36] The Professional Recovery Network The DEA is making bank The DEA is raising their fees. Effective 10/1/2020, the DEA registration fee is going from $721 to $888 per registration. For those of you that have multiple practices or registrations, it will get expensive.  What else is changing? The DEA will now require electronic 222 forms. You must fill out a 222 form to send to the DEA to order controlled substances for office use. You can use up the paper 222 forms until 10/31/2021. But what you don't use will have to be shredded. We recommend that you don’t keep too many of these forms on hand—or too many controlled substances. If they expire, you have to send them to a reverse distributor. You can’t send them to the supplier you purchased them from. The fees you have to pay for expired drugs costs more than purchasing them in the first place.  Why you NEED to keep inventory There are TWO things I recommend you do consistently: You need an up-to-date drug log and inventory. The DEA requires an inventory count every-other-year. Track the total on-hand. Track each concentration and form separately. Routinely get out your receipts and 222 forms and check your math. Make sure you aren’t missing anything. Doing these things help prevent improper use and abuse of controlled substances. I’ve seen situations where staff members order extra bottles that disappear. If someone is using your credentials to perform duties related to controlled substances—trust but verify. They’re called controlled substances for a reason.  Do your background checks Dental offices need to do background checks on employees. Some states are only allowed to allow full background checks in limited situations, such as when you’ve made a conditional job offer. But the DEA requires that anyone who works with controlled substances has a background check done on them. Ideally, it’s a full criminal background check. If you won’t do a background check, you must do a basic screening for abuse or misuse potential. Secondly, if a staff member handles or prepares subscriptions, put the designation in writing and maintain a record of that. Most dentists are more comfortable doing the ordering themselves and I support that. If you use a designated agent or a power of attorney, you’re still responsible for overseeing their activities.  How do you check a patient’s drug history? When do you need to? What are some unexpected schedule II drugs? Listen for the details.  The Professional Recovery Network If you or a dentist you know has a drug problem or mental health issue, there are professional recovery networks available. If you turn yourself in, you can get services confidentially. If a staff member turns you in it becomes a public health issue and it will be attached to your license. Keep yourself accountable. Don’t face emergency suspension of your license. If you or someone you know has a problem, be proactive and get help.  If you’re going through a rough time in your life they can help. It doesn’t have to be severe drug abuse. It’s okay to say you’re not okay and reach out for help. Don’t wait until you get arrested for a DWI. Substance abuse isn’t the number of times you’ve done it. It’s the reason why you’re doing it and the fact that you did it in the first place. Andrea points out that everyone is human. No one plans on becoming an addict. It takes one opportunity. One bad decision. No one says “I’m probably going to get hooked on it, but it’s okay. It’s worth it.” Don’t give yourself or someone else the opportunity to make one bad decision. Put systems in place to protect you from yourself as much as you keep your staff accountable. It doesn’t matter if you claim you’re a good guy, you have to walk the talk. Learn what else is changing and more valuable resources by listening to the episode!  Resources & People Mentioned Pizza Hut Commercial Designated Agent Screening Form DEA Power of Attorney Format Goodhire (background check) PMP CE Option Controlled Substances Professional Recovery Network: 800-727-5152 Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Every five years, Texas conducts inspections of any practice that uses sedation. Some practices have recently undergone their initial inspections. From what I’ve heard, most have gone pretty well. Some are getting busted for things they consider nit-picky—like missing information on their preoperative checklist—but that the state board takes seriously. So in this episode of Talking with the Toothcop, Andrea and I chat about preoperative checklist requirements, the Electronic Prescribing of Controlled Substances (EPCS), as well as continuing education requirements. These are things you NEED to stay on top of—so don’t miss it! Outline of This Episode [4:10] Texas: Updates regarding sedation [10:34] Physical examination subsection C [13:09] Anesthesia-specific examination subsection B [13:48] Special pre-op considerations: pediatric or high-risk [15:25] Rules on equipment and use [16:24] EPCS: Electronic Prescribing of Controlled Substances [29:48] Continuing Education: Human Trafficking Training [33:17] How to keep everything straight The required preoperative checklist for nitrous oxide + sedation + anesthesia You can find the preoperative checklist in its entirety HERE. I’m referencing specific line items in this checklist that must NOT be neglected. Firstly, do NOT remove anything from the pre-op checklist. If you don’t heed this warning, the state board will make you fix it.  At a minimum the preoperative checklist must include documentation of the following when applicable (summarized):  Medical history (allergies, surgical history, review of family surgical history, medications) Confirmation that pre and post-operative instructions were delivered to the patient Medical consults were conducted if needed Physical examination and documentation (weight, blood pressure, pulse, respiration rate)  Anesthesia specific physical exam (airway assessment, ventilation and respiratory rate) Pre-procedure equipment readiness check Confirmation of pre-procedure treatment review Special preoperative considerations as indicated for sedation/anesthesia administered to pediatric or high-risk patients. So where are things getting missed? The physical examination section clearly states that you must obtain: preoperative vitals, including height, weight, blood pressure, pulse rate, and respiration rate. This applies to every level of sedation, from nitrous oxide to general anesthesia. The issue that’s coming up most frequently during inspections is that dentists and their staff aren’t documenting the respiratory rate. Now, a lot of pediatric dentists are not taught that they’re required to document the respiratory rate. You may not be accustomed to it—but you need to start doing it. Not only that, but vital signs need to be recorded every ten minutes or less. It’s the rules. So is recording the height and weight of an adult patient every appointment. It may not feel necessary, but you can’t just say “It’s not that big of a deal because it’s only nitrous.” You have to comply with the rules to stay out of trouble.  You must also make sure you’re recording the Mallampati score and/or Brodsky score. The state board is looking for how you verified the respiratory or ventilation rate. They want that to be clear (and it can be documented by observation, auscultation, or capnography). Keep listening to hear more about pediatric and high-risk patients as well as equipment and use instructions that are being missed. Want the latest version of my checklist? Shoot me an email at toothcop(at)dentalcompliance.com and I’ll happily share it with you. EPCS: Electronic Prescribing of Controlled Substances Electronic prescribing of controlled substances is already a requirement in many states. As of January 1st, 2021 Texas will join the list. It will require dentists, physicians, and healthcare providers to e-prescribe schedule 2 drugs. If you need help finding a prescribing platform that works best for you, I’ve linked many options below.  But wait—don’t confuse this with your PMP responsibilities. According to the state board rule 111.2: “Each dentist who is permitted by the Drug Enforcement Agency to prescribe controlled substances shall annually conduct a minimum of one self-query regarding the issuance of controlled substance through the Prescription Monitoring Program of the Texas State Board of Pharmacy.” You can log in to PMP Aware to check your prescribing history to make sure there haven’t been mistakes. If you find something blatant, figure out if you need to address it.  Another change? Until September 1st, you were required to do a 2-hour CE once every 3 years (use and prescribing in the course of dentistry). Now it’s an annual requirement to do the CE and a self-query check. Every time you issue a prescription it needs to be justifiable and you have to perform a patient history search—every time. What are the exclusions from this? Who can do the PMP check? What is the maximum you can prescribe? Listen to find out! Continuing Education: Human Trafficking Training Human trafficking is becoming a pandemic in its own right. Texas isn’t the first state to require it, but every healthcare provider—who is not a physician—is now required to complete a course on human trafficking. There are a lot of courses available online, but as of right now the state requires a Health and Human Services Commission approved course. It’s required training before your next license renewal.  Are you wondering how you’re supposed to keep everything straight? How do you track all the training, continued education, and compliance measures you’re supposed to take? I’ve linked a detailed list below that should help you stay on track! Resources & People Mentioned Required Preoperative Checklist iPrescribe  Allscripts iCoreConnect Veradigm MD Toolbox Surescripts https://texas.pmpaware.net/login Texas State board rule 111.2 Blx Training CE Dental Anesthesia CE Human Trafficking Training Continued Education Requirements Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Water is the lifeline of your dental practice. If your dental unit waterlines are covered in biofilm, you’re in trouble. How do you test your water lines properly? How do you treat your systems? What do you do if you don’t have a closed system? With the heightened awareness of spreading germs due to the Coronavirus crisis, it’s more important than ever to be mindful of prevention in your practice. In this episode of Talking with the Toothcop, Dwight and I chat with Mike Rust and Kellie Thimmes from ProEdge Dental about what dentists can—and should be doing—to prevent infections.  Outline of This Episode [0:21] Mike Rust + Kellie Thimmes on the Toothcop [1:19] What people don’t know about Kellie + Mike [4:27] How to test your water lines properly [11:40] The CDC will revise dental infection control guidelines [20:40] Indicators that a dental office does or doesn’t care [28:28] Where does the problem originate? [31:58] Pro Edge’s new Flow-Cytometry technology [38:15] The Anaheim case that changed everything [42:01] What could happen when the CDC reviews their guidelines? [43:33] What do you do about open systems [55:17] UV disinfection technology [58:25] How to connect with Mike + Kellie Why biofilms originate in water lines Biofilms usually form in waterlines because they’re small, plastic, and the water sits stagnant. The bacteria sits there and thrives. It can also be found in anything with a filtration system—which can remove solids (like minerals and chlorine) but not small bacteria. So everything just sits there in their little pod and it’s the perfect breeding ground for bacteria. That’s why it’s so important to purge anything connected to your waterline unit. The extra flow of water in between patients helps move the germicide through the system and helps keep it clean—and prevents biofilms.  The Texas dental board recently relaxed its Cavitron regulations to allow dentists to start using them again. Most dentists haven’t been using them since mid-march of 2020. Why? Kellie points out that firstly, they create aerosols. Secondly, water lines tend to hold a lot of bacteria. Dentists don’t want to worry about COVID and other bacteria. It’s also because Cavitrons are harder to shock. The failure rate is over 50% and they have higher counts of CFU’s than any other water line. How to properly test your dental unit waterlines  You have to collect the water for the test from the right place. 9/10 times dentists that say they’re testing pull a sample from an air-water syringe. But dentists should be testing from the dirtiest thing(s) in the dental practice: a water sample from the Cavitron or Ultrasonic. If you’re passing your water test with samples from those you know you’re doing well.  Kellie recommends taking a collective sample from each room in your dental practice If there’s a failure, then you shock everything. Both Kellie and Mike advise using an aseptic technique when you’re taking a sample. Take the handpiece off and use a new air water syringe tip. It’s not as messy and easier to collect the sample. Test your water as if you were doing it for a new patient.  Are the current infection control guidelines enough? It was recently announced that the CDC will be revising dental infection control guidelines—which has been overdue for a while. It makes you question: Are the current guidelines as effective as we think they are? The CDC recommends periodic testing but doesn’t define the timeline. They say to defer to the manufacturer's instructions. You have to monitor your water regularly—at least quarterly if not monthly. Kellie and Mike agree that you must use an EPA approved shock product.  If you’re not aware, the EPA regulates drinking water standards and anything that could impact groundwater. The FDA regulates medical devices (they review and approve). Everything you use in the dental office is a medical device. For you to use it, the manufacturer had to get approval from the FDA. Whenever you deviate or use a device other than its intended use, it’s considered off-label use.  There are a lot of treatments for removing biofilm, so you have to find what works for your practice. Follow the IFUs for the products you’ve chosen and ask for help if you need it. Kellie states “I wish there was a magic bullet, but there’s just not. It’s called waterline maintenance for a reason—because it takes work.” If you’re committed to monitoring, you’ll get better results.  What are indicators that a dental office is doing what they’re supposed to for infection prevention? Listen to hear their take! Sometimes you have to humanize the problem The case that happened in Anaheim, CA impacted 71 families. 70 of the kids had major surgeries and some lost parts of their jaw from preventable infections. All because ONE dentist office didn’t properly test or treat their water lines.  Some dentists don’t want to test because if they find out there’s a problem then they have to do something about it. But it is your responsibility to know. You have to humanize the problem. It’s not about devices—it’s about those child’s faces.  No dentist goes to work and says “I want to hurt someone today.” But do they go to work today and say “I want to make sure that we don’t hurt anybody, ever.” It’s a huge difference. That’s why it’s so important that the CDC reviews its guidelines.  What to do if you have an open water system Many older dental offices still use city water and can’t introduce a germicide or antimicrobial into the system. You can treat your water, but you can’t efficiently shock the water. What do they do? You should retrofit your open systems so you can shock the water. Add a closed bottle system for $200 a chair + labor. In 10 minutes you can shock them with bleach and sleep at night. You just have to take the time to do it. Recently, In Corpus Christi Texas, they had water-boil advisories. Municipal water was contaminated. If you don’t have a closed system, that effectively shuts down your practice. It’ll cost you way more than converting your dental unit to closed bottles. Plus, you have to keep tabs on your city's boiled water advisories. Keep listening to hear our conversation about tap water versus distilled water and what Kellie and Mike recommend using.  Pro Edge’s new Flow-Cytometry water testing technology Proedge has launched a Flo™ Dental Unit Waterline Testing Service Kit that allows you to get same or next-day test results. It takes one hour for them to process the results. They’re counting the bacterial cells in the water with laser technology and fluorescent dye. Why does it matter so much? Other tests can take days or even weeks to get results.  Some practices have to remain closed when their water lines are being tested—only to find out they failed. That means they have to shock their systems, restest, and wait all over again. No longer. The price of this test is only a couple percent more. It’s a premium service without the premium price. Check out the resources for a link to an amazing deal on this new product. I want people to do the testing, work with good people, and save money while doing it.  Resources & People Mentioned Special Dental Compliance ProEdge Offer Flo™ Dental Unit Waterline Testing Service Kit Dental Infection Control Washington state Mike Rust on LinkedIn Kellie Thimmes on LinkedIn ProEdge on Facebook Call ProEdge at 888-843-3343 Environmental Protection Agency (EPA) U.S. Food and Drug Administration Boil-Water Advisory Dental Unit Waterline Contamination in Anaheim Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

HIPAA security compliance isn’t talked about often in the dental community. But the Office for Civil Rights (OCR) can and are investigating dental offices. If you’re not properly or adequately protecting your patient’s protected health information (PHI) you’re at risk of a hefty fine. In this episode of Talking With The Toothcop, I talk about the HIPAA security rule, business associate agreements, and how a data breach can impact your practice.  Outline of This Episode [1:20] HIPAA Security Compliance [4:43] The HIPAA Security Rule [9:00] Consistently work toward compliance [10:13] The Business Associate agreement  [14:57] Have adequate cyber insurance in place [17:38] Will OCR hit practices harder because of COVID? HIPAA Security Compliance: What a breach looks like I received an email from OCR (AKA the HIPAA Police) titled: “Small healthcare provider fails to implement multiple HIPAA security rule requirements.” So I opened it. Essentially, Metropolitan Community Health Services has to pay a $25,000 fine to OCR and has to adopt a corrective action plan to settle violations. Why? Because on June 9th, 2011—9 years ago—Metro filed a breach report that affected 1,263 patients. The OCR investigation revealed long-standing non-compliance. Metro failed to conduct risk-analysis and failed to implement any security rule policies, procedures, or training until 2016. Providers are supposed to safeguard their patient’s information.  The moral of the story? We need to implement measures so we don’t have to report a breach affecting 500+ people. This is a classic example of where prevention could’ve made a world of difference.  The HIPAA Security Rule The HIPAA privacy rule states that you must have agreements with vendors who have access to information, train your staff properly, and establish notice of privacy practices (how we can use and disclose patient information). The HIPAA Security rule is what people seem to have trouble with. It deals exclusively with the security of protected health information. One of the key components of the rule is to have someone appointed as the security officer. They establish access control for authorized users and set up firewalls, firmware, antivirus programs, updates, etc. They are tasked with risk analysis and mitigation: #1 Identify the potential threats and risks to PHI #2 Address the higher-risk or potential risks areas This is where dental practices have significant gaps and fall short. OCR started conducting audits of covered entities and found that more than ¾ of providers had not addressed security issues or implemented security measures to address the rule. What should security training include? What issues do I see in dental offices? Listen to find out! The Business Associate Agreement You need to understand who your business associates are: Who are the vendors you work with who have access to your patient information? IT people? Coaches or consultants? Software providers? Identify those business relationships and make sure you have a signed Business Associate Agreement (BAA) with them. It’s required before they gain access to your patient information.  Let’s drive the point home: A data backup service was audited by OCR and they were connected back to a medical practice. The medical practice couldn’t produce a BAA—and got slapped with a $30,000 fine. It’s a big deal. There was another case in Florida: A former employee of a business had access to patient PHI. A BAA wasn’t in place and they were fined $150,000.  I don’t want to scare you—I want to motivate you. I want you to understand the importance of addressing these issues. How many tooth fillings, root canals, and crowns would you have to do to cover a $30,000 or $150,000 fine? The preventative measures are worth every minute of your time.  How does cyber insurance play a role? Will they cover fines? Keep listening... OCR takes their job seriously Very few dentists are in compliance. If they were audited by the OCR it would be a blood-bath. While perfection cannot be expected, there’s room for improvement for the industry. You must show consistent and periodic effort. OCR just loves to kick people’s butts, pandemic or not. They are proactive on the educational side and actively involved from a preventative standpoint. But they will take heavy-handed action when there is a breach of compliance. It is so important to protect your patient’s information. Hear all about it in this episode! Resources & People Mentioned Office for Civil Rights (OCR) HIPAA Security Rule Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

In this episode of Talking with the Toothcop, Dwight Shreve joins Andrea and I to cover some of the most-asked questions that have accumulated during the Coronavirus pandemic. We talk about face masks and respirators and how to use them properly. We also talk about addressing issues in your practice and the proper procedure if a staff member is diagnosed with COVID-19. If you have unanswered questions swirling around in your head, don’t miss this episode! Dwight Shreve worked at Crosstex for a couple of years as a Sales Manager and Infection Prevention Advisor. Now Dwight is an Independent Consultant with us at Dental Compliance Specialists. He has a passion for supporting patients and helping to make sure their needs are being met.  Outline of This Episode [0:21] Andrea and I are joined by Dwight Shreve [1:58] Lockdown in Texas has been lifted [3:20] What is a face mask anyway? [7:02] Guidelines to follow in dentistry [12:17] Respirator Medical Evaluation Questionnaire [15:35] Complete a respirator fit test [18:56] The pandemic uncovered a rift  [30:00] CDC return to work Criteria for staff [32:52] Do I have to pay my staff PTO? [34:28] Just because you don’t HAVE to do something… [35:45] Texas Dentists: get consent for every procedure you do [45:42] Surround yourself with a good team The difference between face “coverings” surgical masks, and respirators A face covering—which is being mandated almost everywhere right now—can be a bandana, a neck gaiter, or a homemade mask made of whatever fabric you have on hand. There are surgical masks (level 1, 2, or 3) and then there are different types of respirator masks such as N95 and KN95 masks. They are regulated by the FDA and the use is mandated in certain environments.  One of the biggest questions I get is, “Do I have to do it, or is it recommended?” Currently, this is federal law and stuff you HAVE to do. OSHA has standards (which are effectively law) and they have guidelines that are recommended (you should do it). If you don’t do it? The bottom line is that you can get in serious trouble.  Everyone working in a healthcare environment—even the dental office—should be wearing a surgical-grade face mask—NOT a face covering. You must focus on prevention to minimize the impact on the practice if someone is diagnosed with COVID. Why is it important? Listen to hear our discussion on the topic! Dentists: You HAVE to use a respirator correctly! Did you know that before you even put a respirator on, you’re supposed to have a medical evaluation and a fit test? If you haven’t done that yet—go back and get it done. OSHA provides a medical questionnaire for the medical evaluation that should be completed for each staff required to use a respirator mask. The evaluation needs to be completed by a licensed healthcare provider. I suggest you send your staff with the eval to get cleared by a physician (to control your liability). Why is it important? If you are not medically fit to be wearing a respirator then you shouldn’t be wearing one. In some instances, that means you cannot carry out the duties of your job. Only once a staff member is medically cleared do they get fitted for a respirator. What does that look like? Listen to find out! Address issues that can negatively impact your practice You have to look at issues that crop up for the potential that they have to dramatically and negatively impact your practice. You need to be proactive and look at things in advance while anticipating and weighing the risk versus benefit of applying a protocol—or disregarding the protocol and just continuing as is. Sometimes you have to put your personal feelings aside about things and do what's in the best interest of your practice. You have to implement these steps so you can defend yourself if someone does get sick and it’s linked back to you. it's always easier to prevent problems than it is to deal with them in the aftermath. Andrea emphasizes that there are laws and regulations in place you have to follow regardless of how you feel about the situation. Dwight points out that “Your practice is only as safe as your patients perceive it—and perception is reality right now. So if your patients don't perceive it's a safe environment to be in, they're not coming back.” What can you do to encourage open communication? Listen to find out.  Current guidelines on a team member who contracted COVID Another question that we’ve been asked frequently is: We have a staff member that’s sick, what do we do? How long until they can come back? Do we require them to get tested?  As of July 17th, 2020 changes were made to the guidelines to conserve tests. So the CDC is moving away from requiring tests to return to work and simply monitoring symptoms. There are three requirements a staff must meet to return to work:  There needs to have been at least 10 days since symptoms have first appeared AND At least 24 hours must have passed since the patient has had a fever AND Symptoms such as cough and shortness of breath must be improved The guidelines will likely change again, but you need to be familiar with them. Who pays for the tests—the employer or the team member? Listen to hear our answer.  A Note for Texans Participating in Medicaid: Get Consent While this applies most specifically to my Texan listeners, I believe every dental practice should embrace these procedures.  Make sure you have consent forms for every single procedure you carry out, for every patient, every time. This includes preventative procedures and things you don’t normally need to get consent for (fluoride treatment, x-rays, etc.). You must also make sure your clinical notes and all chart documentation reflect the service you’re providing. If it’s not written, it didn’t happen, and it will be presumed fraud.  Ignorance is bliss—until you get caught. Get auditing and monitoring processes in place to make sure your clinical charting is being done properly. Dwight implores you to get your house in order and keep up-to-date on compliance issues. Dentists may not have known what they signed up for when it came to all the business aspects of dentistry but they’re all inherently important to the small business that you operate and must be learned.  Resources & People Mentioned Families First Coronavirus Response Act FFCRA Employee Rights Poster CDC Return to Work Criteria CDC Potential Exposure at Work OSHA Respirator Medical Evaluation Questionnaire Connect with Dwight Shreve on LinkedIn BOOK: Rich Dad, Poor Dad Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

The impact of the Coronavirus is leading to heightened emotions and increased tension. I’ve been fielding a lot of phone calls from dentists who’ve had patients test positive for COVID-19—after they’d been seen in office. Some dentists have had staff who have been exposed or are testing positive for the virus. Dental practices are immersed in chaos and navigating through conflict has been difficult. Some dental offices function like one big dysfunctional family. So in this episode of Talking with the Toothcop, Andrea and I will cover some conflict resolution strategies to keep your practice running as smoothly as possible.  Outline of This Episode [0:21] Conflict resolution strategies for dentists [2:29] Find someone in your corner [6:03] Communication is the key to overcome conflict [17:04] Consider each point of view as valid  [20:36] How COVID-19 has impacted the dental industry [20:36] Limit your exposure to minimize your impact [23:47] Reference the links below for NEED to know info Find someone in your corner The first conflict resolution method I sort of stumbled upon when a dentist called me to walk through a situation. I was able to be a sounding board that wasn’t passing judgment and could help them reason through the situation—even though they did the majority of the problem-solving themselves.  Working through a difficult situation can be easier if you have someone in your corner who can help you muddle through the possible solutions. Andrea points out that having someone to talk to can give you peace of mind, even if they aren't part of the solution.  Conflict resolution strategies must include communication Of all of the conflict resolution strategies you could utilize, communication should be at the top of the list. I work with a dentist who was wrapped up in a situation where a staff member came to work sick—with a cough—and was later diagnosed with COVID-19. The staff hasn’t been diligent with wearing their face mask, so the doctor was stuck trying to figure out who had been exposed. She ended up furloughing part of her staff for two weeks while they quarantined at home.  One of the exposed staff members that were sent home was extremely upset and hurled some colorful hurtful words towards the dentist. The dentist knew they were upset and responding emotionally—but it was still hurtful. This staff member completely ghosted her and refused to return phone calls. The dentist finally had to call her and let her know that if she didn’t return her call she wouldn’t be receiving a paycheck. The staff member returned her call, completely embarrassed by her actions and profusely apologetic.  The situation started with a completely emotional blow-up, but the dentist and her staff members got their butts back to the bargaining table, cleared the air, apologized, and found a way to move forward. You MUST be willing to sit and do the work and figure out a workable solution. If you’re not willing to do that, it’s an easy decision—leave.  Step back from your emotions and exhibit empathy Are you being driven by fear? Are you anxious about keeping your job so you can provide for your family? Have you been personally impacted by the coronavirus? Everyone has a different frame of reference that dictates how they handle crises. To resolve conflict—or prevent it from reaching the point of conflict resolution—you need to step back from your knee-jerk emotions and exhibit some grace and empathy. It doesn’t mean anyone is right or wrong—but just have differing opinions.  Andrea points out that you can combat emotional outbursts with even more vile opinions and feelings, or you can empathize and put yourself in those persons’ shoes. You only have power over how you respond to the situation—so respond with grace. Give them the opportunity to apologize or leave. Be raw, real, transparent, and bridge the gap—in an appropriate way. Communicate on a different level to overcome conflict and misunderstandings.  Conflict resolution begins with a willingness to listen to your staff and understand their viewpoint and try and find some common ground. Consider their point of view before you dismiss their contribution—because they likely are trying to help you. Likewise, dental staff must work to gain understanding if you don’t understand what you’re being asked to do. Don’t allow your confusion or frustration to fester. Be willing and open to be educated and change your viewpoint if necessary.  Limit your personal exposure so you can minimize your professional impact COVID-19 has made a significant negative impact on the dental industry. We can hope and pray this doesn’t happen again. But in the meantime, we can work together to minimize the personal and professional impact it has on our lives. Be cognizant of the choices you make in your private life. If you take unnecessary risks and expose yourself to the virus it doesn’t just impact you. It impacts the practice you work in and it WILL have a cascade effect—so keep that in mind. Protect yourself, minimize exposure, and don’t expose your coworkers.  But what do you do if your office—patients and staff—are exposed to the Coronavirus? Do you need to close your office or furlough staff? We don’t have all of the answers, but we’ve linked to some of the best resources below to help you decipher what your next step should be. Always feel free to reach out with any questions. At the very least, I can be your sounding board.  Resources & People Mentioned Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic Families First Coronavirus Response Act: Employee Paid Leave Rights FFCRA Poster ADA Steps to Take if a Patient Reports COVID-19 Exposure After Treatment What to Do if Someone on Your Staff Tests Positive for COVID-19 Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Are you looking for a tax consultant for your dental practice? Do you understand the necessity of tax planning and preparation for your business? Even better—are you aware of the tax savings you’re missing out on? Tax Consultant Craig Cody joins us to talk about financial planning & taxes. Craig Cody is a Certified Public Accountant (CPA) and the President & Founder of Craig Cody & Company. He was formerly a cop with the NYPD and ended his career as a Lieutenant after 17 years on the force. Listen to this episode for some expert advice—and maybe a few cop stories. Outline of This Episode [2:33] From law enforcement to tax consultant [5:03] Strategies to manage tax savings [12:02] What can a CPA do for you? [14:20] Dentists should NOT double as bookkeepers [16:05] Craig and I share a cop story or two [22:30] Connect with Craig Cody & Company From law enforcement to tax consultant Craig was an Economics major in college, but after 3 years he left to join his dad at the NYPD. After 17 years on the force, he decided it was time to move into something else. He wasn’t unhappy, he loved his time with the NYPD, but it was the right move. Now, his son is with the NYPD, already at the rank of sergeant.  Many cops transition to lawyers when they retire from the force. But Craig Cody decided to go into financial planning. He thought getting his CPA would be the ideal way to stand out. But in the process, he fell in love with taxes and tax planning. Now he runs a firm that specializes in helping YOUR business keep more of what you make. Sometimes, $20,000, $30,000, or $40,000 a year.  What is the biggest tax mistake you can make? Craig points out that when we shop for a vehicle we do a lot of research. When we plan a vacation we research where we want to go. But what research went into the entity you chose for your business? Do you communicate with your CPA? Do you HAVE a CPA? Your CPA isn’t an expense. With the right tax consultant, they can be an income item. Instead of worrying about what you have to pay, they can help you think about what you can save. Maximize the legal deductions you’re allowed to take Before even forming a practice you should consult with your attorney and a CPA to decide which entity to operate under (LLC, S Corp, partnership, etc.). Choosing the wrong one could mean you lose out on the Qualified Business Income (QBI) deduction—a 20% deduction.  What about deductions for a home office? Or a home gym (if you have a pool, gym equipment, etc.)? Do you have a medical expense reimbursement plan? Craig helps his clients maximize the legal deductions they’re allowed to take and keep more money in the business.  Once you hit the Married Filing Jointly income limit of $315,000 of taxable income, that 20% deduction starts to phase out. But if you plan properly, you can keep more of that deduction. Keep listening to hear more of Craig’s tips.  Why Dentists NEED a tax consultant I learned early on that I should’ve talked with a consultant before even opening a bank account. Once I hired a CPA, my bank of choice wouldn’t give them access. Craig agrees—it’s important to start conversing with a CPA early. Not only can they help you avoid costly tax errors, but they can help you build a tax plan, go through your P&L and balance sheet, and even help with monthly bookkeeping.  Craig admits when he sees the books of a dentist who’s handled it themselves, he prays they’re a better dentist than they are bookkeepers. Even if they think they’re correct, they’re typically not even close. Craig states: “There is a reason they went to dental school—and it wasn’t to do accounting.”  Dentists often breathe a huge sigh of relief when Craig & Company step in and help take over their books and tax preparation. The value they offer is insurmountable. Listen to the whole episode to learn more about WHY you need a tax consultant. Craig and I also throw in some hilarious cop stories you don’t want to miss!  Connect With Craig Cody Get Craig’s FREE Book Craig Cody & Company Craig’s LinkedIn Profile The Progressive Dentist Podcast Craig(at)CCodyCPA.com Call at 516-869-4051 Resources & People Mentioned Voices of Dentistry Conference Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Many dental practices have been sitting closed, deemed non-essential businesses during the coronavirus crisis. Or they’ve only seen patients on an emergency basis. States will soon slowly start reopening businesses. But that begs the question—how will this crisis change dental practices? Will there be new standards put in place? Will infection control finally get the attention it deserves? Mike Rust with ProEdge Dental and India Chance with Learn2Prevent join me to talk through the implications for dentistry in this episode of Talking with the Toothcop.  Outline of This Episode [0:22] OSHA regulations: respiratory protection program [4:02] Pent up demand for dental services coming? [6:13] Interim guidelines for dentists [8:57] Upcoming concerns dental practices face [12:22] When will dental offices start opening? [18:50] Aerosols have ALWAYS been a problem [28:27] Why is their resistance to change? [32:45] Who is closing their practices? [38:43] Preparing to reopen your dental practice [41:40] Ways to make the transition positive [48:33] Dental Line Water Unit Safety Have a plan in place for your dental practice India shares an example of a client who saw a patient and found out after the fact that the patient was asymptomatic, but tested positive for the Coronavirus. He had rushed to reopen his practice and was immediately exposed to the virus. Now he’s suddenly faced with notifying everyone he’s come in contact with and closing his practice for another two weeks.  Do you have a plan in place to protect your practice? I’ve been telling clients to have a go-bag ready. If they’re exposed and can’t risk returning to their families, they need somewhere to quarantine for the next 14 days. Vaccines won’t be released anytime soon and dentists must implement everything possible to protect themselves, their staff, and their patients. Respiratory protection programs and proper PPE Dental offices often see patients who are ill, and exposure to aerosols and bodily fluids are unfortunately par for the course. But little has been done to rectify the problem. It’s sad that it’s taken a pandemic for people to open their eyes—but I’m amazed by the innovation and creativity that’s ensued. Solutions are being created and proposed and that needs to continue. Patients need to be assured we are doing everything possible to protect them—So do your staff.  We’ve heard talk that many hygienists aren’t planning to return to their jobs because the risks they face are too great to overcome. Their PPE isn’t sufficient to protect them from the aerosols they’re exposed to. That’s why it’s imperative you do your research and make sure you and your staff are equipped with the proper PPE. Communicate to them that your practice is doing everything possible to maintain their health and safety.  How should you prepare for reopening? I instructed most of my clients to drain their dental unit water lines before the shut-down ensued. If you weren’t able to, I highly recommend doing shock treatments at least 1 week before reopening. That gives you time to test the water lines and make sure they aren’t overgrown with biofilm. Mike shares some updates on ProEdge and the innovations they’re making to deliver faster results.  You also need to prep your autoclave and do any necessary maintenance, cleaning, and disinfecting. The CDC is making posters available that describe symptoms of the virus to post in your waiting rooms. They created another infographic for staff members that shows the symptoms staff must keep watch for. To hear more ideas and changes being recommended, keep listening! Will the dental industry bounce back? Many practices are considering closing their doors instead of reopening. In Maryland, dentists usually finish school with over $250,000 in debt. Opening a practice costs anywhere from $500,000 to 1.2 million. New dental practices can’t sustain long-term closures. Some practices who had just opened faced months with no income and are going to be filing bankruptcy. Dentists who’ve been in the industry for years are considering moving into DSO positions with no patient contact. Others who are close to retirement are simply retiring early. But on the flip side, there is likely some pent-up demand for dentistry. Most people haven’t been able to receive routine care and cleanings. Perhaps dentists will see an intense influx of patients that will help offset some of the time spent closed.  Whether dentists like it or not, necessary change is coming. The Coronavirus pandemic is affecting the infection control standards that are in place—and hopefully improving them. Many dentists are hesitant to make changes. Change is uncomfortable, scary, and even expensive—but imperative. Listen to the whole episode for our full discussion on the future of dentistry.  Resources & People Mentioned The CA Workplace Guide to Aerosol Transmissible Diseases COVID-19 Health Care Worker Protection Act of 2020 OSHA Respiratory Protection Guidelines The Shield Group Learn2Prevent ProEdge Dental Waterline Labs India Chance on LinkedIn Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube

Critical Incident Stress Management. Unless you’re in the military or a first responder, you’re likely not familiar with this terminology. It is a protocol developed specifically for dealing with traumatic events. I’ve shared many times that I was a cop before becoming the Toothcop. But what many don’t know is that I was also a chaplain. I was trained to help fellow first-responders through physical and psychological trauma.  In this episode of Talking with the Toothcop, Andrea and I talk about grief and the grieving process. We talk about critical incidents and how to recognize the signs and symptoms that you’re dealing with psychological trauma. We also share some stress-management strategies and resources for yourself and your team to work through critical incident stress. Outline of This Episode [0:22] Critical Incident Stress Management [9:06] Grief: experiencing psychological trauma [13:35] We must move through the 5 stages of grief [16:41] The pandemic: A series of incidents [21:42] Critical incident stress management system [25:08] Signs and symptoms of psychological trauma [33:49] Reduce the effects of trauma for yourself and your teams [38:48] What does this have to do with OSHA? The psychological trauma we’re all facing  We’re all grieving right now. Some of us have physically lost someone to COVID-19. Many have lost their jobs, their businesses, and their independence. We are mourning our loss of connectedness and dealing with severe loneliness. Whether you recognize it or not, we’re dealing with unprecedented levels of stress. Even though we can’t SEE the damage, the damage is just as pervasive, certain, and severe as physical trauma.  Andrea points out that losing a job is a normal occurrence in society—but we can’t cope with the repercussions the way we normally would. It isn’t as simple as going out and getting another job. Everyone is being affected emotionally. In most instances I’ve witnessed, it’s harder to come out of emotional trauma than physical trauma. I want to emphasize that it’s okay to feel how you’re feeling—but you need to recognize that you’re grieving to move through the 5 stages of grief (denial, anger, bargaining, depression, and acceptance).  The critical incident stress management system Critical incident stress management (CISM) is “an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem”. The way people respond to emergencies and disasters strains their ability to function. Their future depends on learning how to manage the psychological stress and impact of those incidents. The system is geared towards: Normalizing your instinctive reactions Lessening the impact of the incident Encourages the natural recovery process Restores adaptive functioning skills And helps determine the need for further support No one signed up for the trauma we’re all facing. We are grieving our old way of life—because when things return to “normal” they’ll never be the same. We may not all be dealing with death, but we are still dealing with loss. We must seek to understand it to lessen the impact.  Signs and symptoms of psychological trauma Stress is a mental phenomenon that can be manifested physically. Some of the symptoms include: Exhaustion, nausea, vomiting, weakness, chest pain, rapid heart rate, headache, excessive thirst, fainting, elevated blood pressure, exacerbate allergies, symptoms of shock, and more.  Our bodies are trying to tell us there’s something wrong. We can also experience cognitive, emotional, and behavioral reactions.  Cognitive reactions: blaming others, confusion, reduced attention span, poor concentration, troubled thoughts, nightmares, and so forth.  Emotional reactions: frustration, anxiety, guilt, sense of loss, anger, denial, fear of loss of control, feelings of isolation, and more.  Behavioral reactions: Emotional Outbursts, changes in activity level, disturbed sleep, increase in smoking or drug use, easily startled, anti-social, withdrawn, change in eating habits, fidgety and restless, change in sex-drive.  The odds are everyone is dealing with some of these symptoms in one form or another. You have to recognize that this is normal right now, but YOU have the power to change how you react and move forward. How to reduce the effects of trauma—for yourself and your team There are a few simple recommendations for dealing with the effects on an individual level:  Limit exposure to noise and odors Take 15-minute rest breaks Drink non-caffeinated fluids (water) Don’t eat excessive sugar or fat Don’t rush back to work Talk through your feelings Whenever we eventually return to our offices, owners and managers need to keep these things in mind. Many people may be hesitant to return to work and it’s your job to help them feel safe. You must also convey to patients that your office is safe.  One way you can help your team transition back to work is to facilitate a structured critical incident debriefing with your team. It’s a 7-step phase that helps you work through the psychological trauma together—because none of us are in this alone.  Listen to the whole episode for an in-depth discussion on each of these topics. For more resources, visit some of the links below for dealing with critical incident stress management or setting up a critical incident debriefingfor your team. Resources & People Mentioned International Critical Incident Stress Foundation OSHA’s Critical Incident Stress Guide Maslow’s Hierarchy of Needs Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube