Dental Training Notes PDF

**[Exams]** - Comprehensive Exam is every 3 years for all insurances - [PPO] periodic exams are every 6 months - [Medi-Cal] covers periodic exams every 6 months (0-20yr old) and every year for 21+ - Periodic exam can be scheduled up to 3 years. If more than 3 years, schedule a co...

**[Exams]** - Comprehensive Exam is every 3 years for all insurances - [PPO] periodic exams are every 6 months - [Medi-Cal] covers periodic exams every 6 months (0-20yr old) and every year for 21+ - Periodic exam can be scheduled up to 3 years. If more than 3 years, schedule a comprehensive exam - Comprehensive Exam will be covered if ***NEW*** patient comes from another practice (Even if exam at other practice was less than 6 months) - Once an exam is completed, patient will be scheduled for hygiene & treatment with the **same dentist** (*The exception being Saturday Dental Services*) - Exams are 60 min appts because the patient will have exam & prophy on same visit. Children can be scheduled for 45 min exams, only on designated slots. **[TYKE]** - Reason for encounter: Child Recall/TYKE - TYKE is a supplemental program with Medi-Cal. If you receive a call from Medi-Cal patients requesting to **reschedule** for periodic exams and patients are 0-6 years old, you may see a TYKE note in the patient\'s appointment. Transfer these calls to the dental front office so they may assist patient with scheduling. - If patient is calling to schedule a Comprehensive Exam for patients 0-6, you may schedule accordingly. **[Initial Appointments vs. Treatment Planned Appointments]** - Initial appointments are appointments that can be scheduled without needing to be on a treatment plan. The initial appointment reasons are: Comprehensive exam, Consultation, Denture/Partial Reline, Emergency Limited Exam, Pediatric Evaluation 0-2, Periodic Exam. - Treatment planned appointments are recommended by the dentist & added to the patient's treatment plan. They can be viewed under the *[Charting Tab]*. These appointment reasons would be any appointments not listed above. Ex: restorative, prophy, extraction, etc.). When scheduling treatment planned appointments, make sure they were placed on a treatment plan within the last 12 months. [ ] **[Dental Billing]** - **Dental billing calls are transferred to ext. 7076(cold transfer). Advise patient if no one answers, leave voicemail & someone will call back in 24 hrs.** **[Saturday Services]** - Saturday Service hours are 8:45AM-1:00PM. - Saturday locations: Fresno-Bullard, Kerman, Reedley *only*. - Only patients with Medi-Cal, Sliding Fee, Self-Pay - ***NO*** private insurance - Patients seen on Saturdays will remain scheduled on Saturdays. If patient wants an appointment during the week, schedule a consultation appointment to transfer care. - Dental providers rotate for Saturday services, so patient will see a different provider at each visit **[Transfer to site]** - Any Majors- Partials, dentures, crowns, plates, bridges - If referral needs to be refaxed or rerouted - Requesting info regarding prescription or referral - Specialty office/county worker/insurance rep calling - If patient wants to be added to cancelation list - If patient is running late to appointment - Any patient's requesting to reschedule appointments with the note "TYKE" - Dental labs calling regarding dentures, partials, crowns, etc. **[FYI, they do not have patient DOB, but they have patient name, MRN, and dentist/location info.]** **[Escalation Calls]** - If you need to get ahold of a supervisor/manager, contact the Dental/Medical Receptionist Supervisor. - If you are unable to reach the MRS, contact the Health Center Manager. - The Dental Assistant managers will **no longer be contacted** **[Consultations]** - AthenaOne Dental appt reason is Consultation. Add a note: "Consult for \_\_\_\_\_." - Medi-Cal does not cover consults for adults, only for children 0-20. **[When to schedule consults:]** - When patient is requesting to transfer care to a different dentist or clinic & is ***NOT*** due for an exam - When a patient is requesting a treatment that is not on current treatment plan. Ex: *"the dentist recommended a root canal, but I would rather have my tooth extracted."* - When a patient would like to begin process for dentures, implants, crowns, partials, etc. - If patient is requesting treatment that has not been discussed with dentist - For patients requesting consult for implants, schedule with Dr. Leung at Bullard location. He is the only dentist who does implants at UHC. - If the provider has left UHC or has transferred to a different location & patient will now be seeing another dentist. (If patient is following the same dentist to new location, schedule treatment as normal & add a note to appointment) - If patient is usually seen on Saturdays & is requesting to transfer care to be seen during the week. - If patient is usually seen during the week & is requesting to transfer care to be seen on Saturdays. **[Referrals]** - **[Dental referrals are good for 6 months]** - When a patient is referred out, the provider will usually add a note to the visit on dismissal. You can find the information there if needed. - Referral information can also be found on AthenaOne. - If referral needs to be refaxed or rerouted, transfer to health center. **[Urgent Appts]** - For urgent or emergency, patient doesn't need a comprehensive or periodic exam - Schedule appointment as **[Emergency Limited Exam]** - Can be scheduled for: pain, swelling, abscess, bleeding, broken teeth, **any problem with or without pain** - At the appointment, dentist will assess area/pain and advise patient of recommended treatment - We ***CANNOT*** guarantee any treatment during appointment - **FOR PAIN/DISCOMFORT:** - **OFFER SAME DAY APPT: ANY SLOT/TIME. IF THEIR PROVIDER IS NOT AVAILABLE, OFFER ANY PROVIDER/ANOTHER LOCATION** - **IF NOTHING AVAILABLE, OFFER WALK-IN & TRANSFER TO HEALTH CENTER FOR ASSISTANCE** - **HAVE PATIENT CALL BACK IF THEY ARE UNABLE TO GET ASSISTANCE FROM HEALTH CENTER. IN THIS CASE WE WILL REACH OUT TO SITE SUPERVISOR, GRETA & ANY OTHER SUPERVISOR IN THAT ORDER.** - **IF YOU NEED TO SCHEDULE ON A MAJOR CHAIR, REACH OUT TO YOUR SUPERVISOR FOR APPROVAL** - **EXTENDED HOURS: OFFER URGENT CARE IF CLINIC IS CLOSED (URGENT CARE: PT MUST HAVE MEDICAL INS ASSIGNED TO UHC OR PPO)** - **IF AFTER HOURS: OFFER ANY SLOT ON THE NEXT BUSINESS DAY** - **LIBERTY EPO: CONTACT SITE OR SEND YOUR SUPERVISOR PATIENT'S INFORMATION IF YOU SCHEDULE** - **FOR URGENT/EMEREGENCIES: ANY PROVIDER CAN STILL SEE PATIENT EVEN IF THEY ARE NOT CONTRACTED WITH INSURANCE, OR IF THEY HAVE AN OUT-OF-COUNTY INSURANCE PLAN.** - If patient does not want a Same Day Appointment, follow the dental template to schedule the urgent/emergency appointment. Schedule with the usual dental provider, if they are in the middle of treatment. - Schedule urgent/emergencies patients within **1 week**, if patient is requesting outside of this time frame, advise them to walk-in or call back when they want to come in. You can also offer a dental exam if they are due for one. **[Need to Know]** - When registering patient for Dental services ***ONLY***, usual provider is *SPECIALTY\_ONLY* - After exam, schedule Hygiene if not done (SRP, PROPHY, PM) or look at notes/ Treatment Plans Tab for next visit recommended - When you're looking at the Treatment Plans Tab, the treatment plan will be phased out. This is the order the dentist would like the appointments. - Ask ***NEW*** patient to come in 30 min prior to appt - Ask ***EST*** patients to come in 15-20 min prior to appt - Ask patients to bring in ID, insurance card, and medication for appts - Patients cannot change dentist in the middle of treatment/no hopping around unless they want to transfer care. In this case schedule a consultation appointment. - OB patients need dental clearance from their OB provider before they are seen (1 clearance per pregnancy) - If patient has cold/cough symptoms, reschedule appt - **Never promise or guarantee any treatment, it will be up to the provider** - When patient has braces, they need to have wires removed by their ortho before they come for appointments - We do not offer braces - Dental appts have no grace period. If running late, connect to the site. - **[For minors- parent or guardian must bring in patient for exam]** - If parent wants another adult to bring patient in, they need to have a consent form signed in office **FIRST** - Schedule follow up appointments on any exam slot or chair 1, 1^st^ appt of the day or 1^st^ after lunch - If you are scheduling a follow up from a specialty office, advise patient to bring in any paperwork given from specialty office appt length should be 45 min. Add note: "follow up from specialty visit for\_\_\_" - We will try to schedule the follow up visit in 2 weeks (OR when provider wants to see patient) if there is no availability, transfer to site queue. - Follow up/Post-Op visits are NO charge visits - If patient has emergency Medi-Cal & is pregnant, they automatically qualify for Denti-Cal - Patients can see Dental & Medical (or another specialty) on the same day - *FYI: Root canals- when they are done in house they will be done in 2-3 visits. When referred out to specialty office, they are usually done in 1-2 visits.* - **FYI: Sealants are scheduled for 45 min on restorative slots** - *You can find notes left by the health center regarding dentures, crowns, etc. on the Charting Tab under Patient Notes section.* **[Insurance]** - We accept PPO, Medi-Cal, Self-Pay, Sliding Fee - We are not contracted/in network with ***most*** HMO(DHMO)\*\*see Dental Insurance Cheat Sheet. - If primary insurance is an HMO plan we are ***not*** in contract with & secondary is Medi-Cal, Medi-Cal will not cover their visits. Patient can be seen under sliding fee, or self-pay - If we're not in contract with patient's insurance, they can still pay out of pocket/sliding fee if want to be seen at UHC. - Medi-Cal patients ***do not*** have to be assigned to UHC, we will bill Denti-Cal (Medi-Cal) - Most insurance plans are unable to be verified online, the site will call to verify eligibility and benefits before patient's appt. ***Encourage the patient to call their insurance carrier to verify their eligibility & benefits.*** - For patients with HMO plans we ***DO*** accept, patient *must be assigned to provider & clinic* they will be seen at. - If Patient has a Liberty Dental EPO plan & states they were told the provider is in network, you may schedule without transferring to health center. **[Emergency Medi-Cal]** - Emergency Medi-Cal covers Urgent & Emergency visits - Extractions will only be covered if last visit was emergency visit **[Medi-Cal]** - Consultations for Adult Patients (21+) are not are not covered (Offer self-pay or sliding fee) - Consultations for children (20 & under) are covered - Restoratives are covered (look for Oral Exam within a year/Emergency visit OK) - Oral Exams are covered (Adult 1 every year/Child 1 every 6 months) - Extractions are covered (look for Oral Exam within a year/Emergency visit OK) - Denture/Partial Relines are covered - Final Impressions are covered - Prophy (Adult 1 every year/Child 1 every 6 months) Check for OE - SRPs are covered by Medi-Cal (1 session every 2 years) (1 session= 4 visits) - Endo/RCT covered (look for Oral Exam within a year/Emergency visit OK) - Sealant covered (look for Oral Exam within a year) **[Medicare]** - Medicare **does not** cover dental services; the patient will have a separate dental plan. - If patient has a Managed Care Medicare Plan, they might have dental benefits under that plan. - For example: A patient has a Humana Medicare Advantage Plan. The patient may have dental benefits with their Humana plan. - If a patient only has straight Medicare, they will not have dental coverage with them. - There are exceptions to this: if a patient needs dental services due to an underlying medical condition or due to a medical procedure they need to have, Medicare can cover the visit. For example: Patient needs a dental exam before they have a kidney transplant. - If the patient does not have dental benefits, they can be seen under Self-Pay or they can apply for the Sliding Fee Program. **[Sliding Fee]** - - Oral Exam - Restorative/Sealant - Prophy - Periodontal Maintenance - SRP - Extractions **[Self-Pay]** - If a patient chooses to pay out of pocket for their visits, they can. - We cannot provide them with pricing, it depends on what will be done during the visit. - The health center staff will let the patient know of the amount due during the visit. - If patient insists on a price, transfer to the health center staff.