Talking with the Toothcop

Join Duane Tinker, "The Toothcop," as he engages in a compelling conversation with Michael Gonzalez, an expert in maximizing dental practice potential by leveraging existing leads. Gain valuable insights into effectively converting your current dental practice leads into loyal, long-term patients! Michael shares his proven strategies and tactics to optimize your practice's performance, ensuring sustained growth and success. This insightful dialogue between Michael Gonzalez and The Toothcop can revolutionize your approach to lead management in dentistry. Connect with Duane Tinker on LinkedIn and explore Dental Compliance Specialists, your trusted partners in navigating the complexities of dental regulations and compliance. Schedule your consultation today by calling (817) 755-0035. Learn more: Dental Compliance Specialists: https://dentalcompliance.com/ Duane Tinker on LinkedIn: https://www.linkedin.com/in/duanetinker/ Resources mentioned in this episode: All On 4 Liaison: https://allon4liaison.com/ Connect with Michael Gonzalez on LinkedIn: https://www.linkedin.com/in/michael-gonzalezjr/ Thanks for tuning in to Talking with the Toothcop! Don't forget to follow and enable notifications for future episodes. *** Disclaimer: Duane Tinker is not an attorney and does not offer binding legal advice concerning regulatory compliance. The information in this podcast should not be relied upon or construed as legal advice in any way. Consult your attorney for legal advice concerning compliance matters as they pertain to your dental practice.

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...

Clinical Recordkeeping for Dental Assistants for Nifty Thrifty Dentists Group 🦷 The importance of proper documentation and compliance in dental practices: Learn from Dwayne Tinker, former police officer for the Texas Dental Board, as he shares insights on #DentalCompliance and record-keeping. Key Takeaways: 1️⃣ Proper notations for medications and doctor's instructions are crucial. 2️⃣ #HIPAA compliance is a must, especially for patient record access. 3️⃣ Respect patient privacy and obtain consent during conversations. 4️⃣ Ensure accuracy and reliability through thorough documentation. 5️⃣ Fix problems in advance to maintain credibility and avoid audits. 6️⃣ Comprehensive clinical notes are essential, including medical history, x-ray findings, and perio charts. Join us to stay informed about the legal implications of dental records! 📋🔒 #DentalDocumentation #ComplianceMatters #PatientPrivacy #DentalRecords #HealthcareCompliance Connect With Duane https://www.dentalcompliance.com/FacebookLinkedIn

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 Resources & People Mentioned FacebookInstagramLinkedInWebsiteDeanna Otts-Whitfield, RDH, BSDH, MSHQSBluTube Dental Unit Water Purification CartridgeDental procedures during pandemic are no riskier than a drink of waterPreventing Airborne Diseases in Dentistry with Michelle StrangeCDC warns of bacteria in dental waterlines after children are infected Connect With Duane https://www.dentalcompliance.com/FacebookTwitterLinkedInYoutube

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 Resources & People Mentioned MCSPaul SaueressigHygiena Connect With Duane https://www.dentalcompliance.com/FacebookTwitterLinkedInYoutube

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 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? 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 OUR SPONSORS: ProEdge Dental Water Labs: https://ProEdgeDental.com/Toothcop Protective Dental: https://DentalCompliance.com/DrugKit Resources & People Mentioned implementation guide and toolkit Connect With Duane https://www.dentalcompliance.com/FacebookTwitterLinkedInYoutube

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...

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...

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 Resources & People Mentioned https://dentalcompliance.com/drugkitwww.ProEdgeDental.com/ToothcopMichigan Dentist busted by the DEASelf Disclosure Protocols renamedCIA's are back!Justice Department's criminal fraud “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/FacebookTwitterLinkedInYoutube

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 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 ThimmesThe 7 Elements of Dental Compliance ProgramsHow a Compliance Program can Save Your BaconSedation Inspections + EPCS + Continuing EducationThe 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 https://proedgedental.com/toothcophttps://dentalcompliance.com/drugkit Connect With Duane https://www.dentalcompliance.com/FacebookTwitterLinkedInYoutube

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 https://proedgedental.com/toothcophttps://dentalcompliance.com/drugkit 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? 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 75 Hard ProgramUltrasonic Cleaning Monitor2021 Dental Compliance...

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 https://proedgedental.com/toothcophttps://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: 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 https://proedgedental.com/toothcophttps://dentalcompliance.com/drugkitDental Compliance Bootcamp 2021 Connect With Duane https://www.dentalcompliance.com/FacebookTwitterLinkedInYoutube

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 Quick tips for emergency preparedness What are some easy things you can do to prepare your practice for emergencies? 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 https://proedgedental.com/toothcophttps://dentalcompliance.com/drugkitDental Compliance Bootcamp 2021 Connect With Duane https://www.dentalcompliance.com/FacebookTwitterLinkedInYoutube

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 https://proedgedental.com/toothcophttps://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. pain management courseTonya BurnsLaura Diamond 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: 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 https://dentalcompliance.com/drugkitDental Compliance Bootcamp 2021Hurst Conference CenterHilton Garden Inn Hurst Connect With Duane https://www.dentalcompliance.com/FacebookTwitterLinkedInYoutube

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 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: Dental providers cannot do that 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...

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 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...

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 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 https://dentalcompliance.com/drugkitProEdge3-year-old Boy Dies During Dental ProcedureThe Texas State Board of Dental Examiners NewsletterElectronic Prescribing of Controlled SubstancesTexas administrative code Rule 108.7 sub-section 16https://tsbde.texas.gov/The Professional Recovery Network Connect With Duane https://www.dentalcompliance.com/FacebookTwitterLinkedInYoutube

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 ProEdge Dentalprotectit 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? 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 https://dentalcompliance.com/drugkitNew in TownHHS Guidance on TPO Connect With Duane https://www.dentalcompliance.com/FacebookTwitterLinkedInYoutube

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 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: 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? Resources & People Mentioned https://dentalcompliance.com/drugkitProEdge DentalOSHA response to Richard L. Raimondo, Jr., D.D.SOSHA 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/FacebookTwitterLinkedInYoutube

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 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 https://dentalcompliance.com/drugkitOver the Topsedation inspections Connect With Duane https://www.dentalcompliance.com/FacebookTwitterLinkedInYoutube