Dental fraud. A dental consultant's view

Since most plans today are based on "cost plus", employers and unions, whose plans were negotiated a long time ago, cannot afford to pay an increase of $13 per amalgam as they were asked to do when new codes for bonded amalgams were added to the provincial fee schedule. Similarly, demanding strains were placed on drug plans when a $16 per tablet medication for migraine headaches was placed on the market. The plan says that if a physician prescribed it, it will be covered. But by whom? And for how long? Dental insurance is not, and has not been for a very long time, a source of profit for the insurance carriers. One large company, for whom I worked for a number of years, just sold all their group dental insurance to a large carrier. Another well-known company has placed their group insurance on the market and is anxiously seeking a purchaser. It is too much to ask of a dental plan (and let's face it, without the plan, the patient may not seek dental treatment) to pay $100 or more for an "examination and one periapical radiograph resulting from the referral of a patient by a general practitioner to a specialist for endodontic treatment." In the case of a difficult diagnosis, this might be entertained, but why charge this fee in every case, even when the patient is holding a radiograph? I am not suggesting that fraud is being committed by a large number of practitioners on a regular basis. At the same time, I think that we must realize that this type of activity may result in the removal of dental "insurance" from the benefits provided by companies to their employees. Most dentists are extremely honest, but the backlash produced by the few who are involved in fraudulent practices is disturbing.     

A survey of general dentists in Ontario, Part II: Knowledge and use of topical fluoride and dental prophylaxis practices

A mail questionnaire was used to assess variations in the knowledge and practices of Ontario dentists with respect to topical fluoride and prophylaxis procedures. The questionnaire was answered by 1,276 general dentists. A high percentage (72 to 83 per cent) of respondents identified six months as the optimal time interval at which both procedures should be repeated for all patients under 19 years of age. Relatively few dentists (< 10 per cent) indicated that there should be no specific time interval for re-treatment (i.e. that it should be individually selected). The respondents' preventive knowledge was found to be deficient in two areas: few dentists (16 per cent) knew that it is not necessary to provide a prophylaxis prior to topical fluoride application to achieve maximum caries protection; and most dentists overestimated the speed of caries progress from outer enamel to the dentinoenamel junction (DEJ) in both primary (83 per cent) and permanent (82 per cent) approximal tooth surfaces. In bivariate analysis, three variables were found to be consistently and significantly related to optimal time intervals selected for both topical fluoride application and prophylaxis procedures: year of graduation from dental school; level of hygienist employment; and percentage of patients with private insurance. Multivariate analysis also identified three significant variables: year of graduation from dental school; level of dental hygienist employment; and practice business. Continuing education courses are suggested as a means of updating dentists' knowledge regarding preventive services. Studies are needed to determine the extent to which recent recommendations regarding the professional application of topical fluorides have been followed.     

Managing money flow to safeguard your practice

Whether payments for service come in the form of patient cash or checks, or insurer payments, it is paramount that a doctor implement a strong accounting system to disclose all daily financial transactions. It is also essential that a strong audit trail be part of this accounting system. By taking a few minutes at the end of each day to do the necessary review, dentists protect their income and provide one of the best protections an owner can have against embezzlement. Let the staff know you are on top of the books!     

Third party recognition of psychological services.

Investigated reimbursement guidelines for psychological services among 26 insurance companies in Missouri. The most frequently covered services were individual inpatient and outpatient therapy. Group and family therapy were inconsistently covered, biofeedback was reimbursed by fewer insurers, marriage counseling was recognized by only one company, and vocational guidance by none. All companies specified benefit limits for nervous and mental conditions and had selection procedures to determine which providers were eligible for reimbursement. Issues of concern to state and national insurance committees are delineated. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Injury--damages--insurance: legal implications

Belgian dentists are, during their undergraduate studies, not enough informed on court and insurance procedures in case one of their patients gets injured in an accident or assault. This article focuses on the correct interpretation of some widely used, but often misunderstood, principles. The role of the treating dentist and the dental advisor of the insurer is described and a plea is made for a better cooperation between them, based on honest and correct reporting.     

Policy on insurance.

Comments on the position adopted by APA in negotiating with insurance companies on the subject of reimbursement to psychologists for services rendered under health insurance plans. When outpatient psychotherapy is covered by insurance, a psychologist making an independent determination of the need for psychotherapeutic treatment is, according to the APA resolution, being a "judge of illness in the medical sense" and that the "appropriate inter-professional collaborative relationships" between medicine and psychology is for the medical person to make the determination of psychotherapeutic illness and to decide upon the need for psychological services. We are officially concurring that medicine is within its rights in determining the need for and supervising psychological services, when these services are covered by insurance. The APA position on this insurance issue contravenes previously accepted APA policy which states that, within the scope of ethical practice, a psychologist may function autonomously as a psychotherapist. This has been done without sufficient justification, and certainly without sufficient notice to and discussion by the membership. It behooves APA to defer any further negotiation on this issue until it provides for a full reconsideration of the issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Images of your future

Would you buy something without seeing it first, and without any real idea of what it was you were buying, or whether you really wanted it? In the past, that is what dental patients have been expected to do when their dentist has offered them restorative dentistry, but now, using a dental imager, you can show your patients quickly and simply just what you can do to improve their appearance; and they can show you exactly what it is they want.     

Anxious children: coping in dental practice

Treating anxious children is a challenge that many dentists face. Not only do anxious children find it difficult to cope with dental treatment but dentists also find it difficult to cope with anxious children. This article is intended to simplify the management of anxious children in general dental practice. Behavioural management, the coordination of the whole dental team, treatment planning and the use of inhalation sedation will be discussed.     

Impact of MR imaging on nationwide health care costs and comparison with other imaging procedures

OBJECTIVE: We wished to determine the extent to which MR imaging contributes to the overall costs of imaging in the United States and to compare MR imaging costs with other imaging techniques. MATERIALS AND METHODS: All 23 current procedural terminology, version 4 (CPT-4) codes for MR imaging were extracted from the national 1993 Part B Medicare annual data reimbursement file. For each code, we calculated total Medicare physician reimbursements. Aggregate reimbursement for all MR imaging was compared with aggregate reimbursement for all 659 imaging-related current procedural terminology, version 4 codes and also with comparable figures for echocardiography and other categories of cardiovascular imaging. RESULTS: Within the 23 MR imaging codes, 1,449,911 examinations were performed on Medicare patients in 1993, for which physicians were reimbursed $370 million. Medicare reimbursement of physicians for all 659 imaging-related procedures was $5.3 billion. Thus, MR imaging accounted for only 7% of all imaging costs. By comparison, a group of just 10 imaging codes, which are primarily cardiovascular in nature, accounted for $1.67 billion, or 32% of the entire Part B costs for imaging. Reimbursements for echocardiography alone are more than twice those for MR imaging. CONCLUSION: From the national perspective, MR imaging does not appear to warrant its reputation as a costly procedure. The costs of echocardiography and other imaging related to the cardiovascular system are considerably higher.     

The incentive effects of malpractice liability rules on dental practice behavior

OBJECTIVES: The impact of malpractice liability rules on dental practice behavior was estimated using data from a 1992 nationwide survey of US general dentists. The study examined the premise that malpractice liability rules can affect quality of care and related resource allocation decisions by dentists, but that market features, such as relatively complete and "non-experience rated" malpractice insurance, are likely to weaken the incentive effects of malpractice liability. METHODS: General practice dentists in the United States were selected randomly, and 3,048 dentists were studied by mail survey. Secondary data on county-level characteristics were used to measure market area factors. Quality-of-care measures were derived from the survey about self-reported practice policies and behavior and participation in continuing education. Legal measures were assembled from state statutes and appellate court decisions. Ordinary least squares was used to assess the relation between legal variables and dependent variables of quality of care, continuing education, and the rate of dental output. RESULTS: Hypotheses about the effects of malpractice law on practice quality and participation in continuing education were not supported. The relation between pro-dentist law and output was supported. A number of legal provisions related to differences in practice behavior, but often in ways opposite to the expected direction. CONCLUSIONS: The direct effects of specific malpractice liability rules on dentist practice behavior often failed to point in the direction predicted by theory and were economically insignificant. It is possible that relatively complete malpractice liability insurance, coupled with "noisy" liability rules, substantially dulls the deterrent effect of malpractice liability. Other forces, such as the dentist's past malpractice claims experience, were more significant in shaping dentist behavior.     

Trend analysis of dental expenditures by selected dentist and practice characteristics, 1985-1995

Using the reported gross billings from the annual ADA "Survey of Dental Practice," the authors estimated the total national dental expenditures according to various dentist characteristics for the period of 1985-1995. These selected characteristics are specialty, office time, number of dentists in the practice, sex, length of experience and U.S. region. As government agencies do not report dental expenditures by such dentist characteristics, the data presented in this article may be the first of their kind to be estimated and published.     

The role of the central nervous system in realizing the action of UHF electromagnetic oscillations in the centimeter range on the function of the excited tissues in cold-blooded animals

Marketing is a system. While it is key and the scope of this article to offer 40 internal/customer service, external/community marketing strategies, this is your goal. The combination of programs consistently applied, analyzed and modified makes a difference. Start with your internal/customer service program. Once that is in place you can expand to external/community marketing programs. Creativity and persistence are how strong dental practices are built!     

Impact of HIV on the practice of dentistry in Houston, Texas

Texas ranks fourth in the nation in the number of documented HIV-infected and AIDS cases. The city of Houston has the highest prevalence of HIV-infected and AIDS cases in Texas. Dental health personnel have an ethical and legal obligation to provide dental services for HIV-infected persons. The purpose of this study was to assess the impact of HIV on the practice of dentistry in Houston. The study population was all dentists with a current Houston practice address registered with the Texas State Dental Board. A 41-item questionnaire was mailed to a stratified random sample of 500 dentists in Houston. The questionnaire covered four main areas: demographics, knowledge, attitudes, and behavior. About three-quarters of the dentists said they had treated an AIDS or HIV+ patient. Sixty percent of the dentists were not aware that breastmilk is a mode of transmission of HIV. There was a significant correlation between "ever treated" an HIV+ patients and "willingness to treat" an AIDS or HIV+ patient (p < 0.01). The experience of treating HIV-infected patients has a greater impact than knowledge alone in influencing dentists' behavior towards AIDS/HIV+ patients.     

Computer-assisted learning in dentistry. A view from the UK

OBJECTIVES: The objectives of this paper are to review the development and impact of computer assisted learning (CAL) in dentistry with emphasis on the UK. DATA SOURCES: This is a wide ranging review of dental, medical and technical literature. STUDY SELECTION: An attempt has been made to evaluate present knowledge in an objective manner and to make some prediction as to the future development and use of computer-based teaching methods in dentistry. CONCLUSIONS: The introduction of computers as an educational tool in dentistry and the provision of CAL is having an impact not only on how dentists are trained but also on the skills they will need to acquire in the future to keep pace with this new technology. It is suggested that there is a great potential for computer-based continuing professional education for dental practitioners, and that the Internet will provide access to such material.     

The role of intraoperative transesophageal echocardiography during ventricular septation

PURPOSE: To determine whether teaching medical students has concurrent economic effects on physicians and their practices. METHOD: The authors reviewed 869 patient-encounter forms completed in April 1994 and July 1995 by four family medicine physicians who were clinical faculty at the State University of New York Health Science Center at Syracuse. The authors compared those forms that were completed when a third-year medical student was present for the patient encounter with those completed when a student was not present. The authors looked for differences in the distributions of billing codes and in the frequencies of in-office procedures performed and diagnostic tests ordered. RESULTS: The presence or absence of a third-year medical student had no significant effect on the variables studied. CONCLUSION: In the clinical settings studied, concurrent medical student teaching did not appear to affect the distribution of billing codes or the frequency of in-office procedures performed or diagnostic tests ordered.     

Ender nailing for ipsilateral femoral shaft fractures after Austin-Moore hemiarthroplasty

Some dentists have voluntarily chosen to leave the dental profession despite the considerable time, effort, and financial expenditures involved in their educations. The purpose of this study was to survey the entire population of dentists who had identified themselves as being principally employed in a career outside of clinical practice in the American Dental Association's 1991 Census. A four-page survey was mailed to 654 former dentists, with a total of 237 usable responses (36%). Analysis of major demographic variables showed no significant difference between the survey respondents and the 1992 ADA Survey of Dentists. Major reasons cited by respondents for entering dentistry included professional, financial, and independence factors. Respondents as a group rated their dental school experience as average in degree of difficulty. Clinical dental experience was varied, with a substantially smaller percentage (37%) choosing solo clinical positions than the 1992 ADA Survey of Dentists reported (69%). Reasons for leaving practice included financial, stress, and external regulation concerns. Current careers varied widely, with business, teaching, medicine, and investing being the most common. Respondents ranked their current careers as considerably more favorable on measures of perceived creativity, freedom, belonging, and whether they would choose the same career again. These findings indicate that there was a difference between the perception of a dental career and the reality of clinical practice for the study sample.     

Statute of limitations. Key to understanding dental malpractice cases

Many dentists ask about the process followed in a dental malpractice case. Often, the actions of the insurance carrier handling the matter mystify the dentist who is the defendant. What follows is the first of a series of articles outlining what happens in a typical malpractice case. It concerns the malpractice statute of limitations, a vital component to understanding the process of commencing a dental malpractice case.     

Practicing implant dentistry profitably

The success of dental implants has opened up countless treatment possibilities for restorative dentists to offer to their patients. Just as our clinical paradigms have had to change because of this new technology, so too must our paradigms concerning the way we communicate with our patients change if we are to get them to say "yes" to treatment that we know that they need. Success in clinical treatment using implants requires a systematic approach. A systematic approach to communicating with your patients will allow you to have the same high degree of success with treatment acceptance that is possible with dental implants. The key to the systems we have discussed is Relationship Centered Care. A relationship is fostered and enhanced through a Comprehensive Examination Process, a structured Consultation Process utilizing the influencing process and Financial Arrangements that allow the patient to receive what they want while the office maintains the profitability that it needs. A system for calculating rational fees can be utilized that allows the practice to have control over an area that traditionally was controlled by anecdotal factors. The Pride Institute has developed this material and is presenting it to the profession so that restorative dentists can truly practice implant dentistry profitably.     

Genomic organization of the mouse adrenocorticotropin receptor

PURPOSE: This paper describes the perceived risk of occupationally contracting HIV and reported compliance with universal precaution guidelines among Australian dental hygienists and dentists. METHODS: This examination is based upon responses to a mailed questionnaire from all registered dental hygienists (63% response rate, n = 208) and dentists (76% response rate, n = 550) in Western Australia. RESULTS: Results indicate that: 1) oral healthcare providers who perceive a high risk of occupationally contracting HIV report a more conservative, cautious approach to HIV infection than do providers who perceive less risk of contracting the virus; 2) dental hygienists are more likely than dentists to report a higher degree of perceived risk of occupationally contracting HIV; and 3) dentists are more likely than dental hygienists to report compliance with universal precaution guidelines in the dental practices where they work. CONCLUSION: Educating oral healthcare providers on the realistic risks of occupationally contracting HIV and the value of compliance with universal precaution guidelines may reduce undue stress and hindrances in the provision of safe and effective oral healthcare in this era of AIDS.