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While I cannot diagnose or provide medical advice, I can share some general information that might help you understand the situation better.
When someone exhibits controlling, aggressive, or threatening behavior in response to disagreements or challenges, it could be indicative of various underlying issues. Some possibilities include:
If you or someone else is concerned about So and So's behavior, it may be helpful to encourage seeking support from mental health professionals. However, it's important to prioritize your own safety and well-being in any interactions.
If the behavior continues to affect you or others negatively, taking steps to report and distance yourself from the situation is a prudent approach.
ChatGPT discussion about a bully
Rick Garofolo
June 26, 2024
https://www.facebook.com/groups/2012782952332195
Good morning, everybody. It is Wednesday, June 26, and this is our morning drive live. There have been a couple of posts in both our group and other dental groups questioning exams, exam types, frequencies, and what they are tied to. I wanted to take a few minutes to clear up the differences with exams because these are codes that we use every day, all day.
One of the questions popped up about limited exams. When a patient comes in and they are in pain, and you decide they need two extractions, do you bill out a limited exam on the day you diagnose the need for the extractions? Do you bill out additional limited exams on the day you perform the extractions? What if those extractions are split over two visits? Would you bill out an exam every single time the patient comes into the office? The answer is no. You bill out the exam when you diagnose.
A limited exam isn't specifically limited to one tooth but could be limited to one issue or complaint. In that limited exam you perform on the patient's first visit, you are addressing the complaint of pain, not specifically pain on one tooth, but the overall complaint of pain. That's why we can bill it out when the doctor diagnoses the need for a full-mouth debridement. You're not just limiting that exam to prescribe the full-mouth debridement to one tooth but addressing the condition of calculus buildup that prevents further diagnosis. You're not able to perio chart or get a good look at the rest of the teeth because of the buildup. That's why we bill out a limited exam with a full-mouth debridement instead of a comprehensive exam.
So, understand that a limited exam isn't just limited to a tooth, but to a complaint or overall issue. You don't need to perform it every time the patient comes in for further care once you've already diagnosed the need for those services or treatments.
Another big topic is comprehensive evaluations, whether it's a D0150 or a D0180. The question was, how often are you doing those? According to the ADEA definitions and guidelines for billing a comprehensive evaluation, whether it's a comprehensive oral evaluation or a comprehensive periodontal evaluation, it's done in three scenarios: when you have a new patient, when an existing patient has been absent from the practice for three or more years, or when an existing patient has had a significant change in health history. A significant change in health history could be a recent diagnosis of diabetes, cancer, starting oncology treatments, a heart attack, or bypass surgery. It’s not something minor like having a cold or the flu last month.
When performing a comprehensive evaluation on an existing patient, document the reason for the comprehensive exam and include a narrative in the chart notes stating the significant change. Send that along with the claim to the insurance company. Some may downgrade the exam to a D0120 due to frequency or limitations in the contract or provider manual. If you're in-network and they downgrade it, then that's what you accept. However, you should still bill it out as a comprehensive evaluation because that’s what you're actually performing.
Make sure you are actually doing a comprehensive evaluation and not just a quick two-minute recall exam. Document why you are performing the comprehensive evaluation. The timing for both the D0150 and D0180 is the same: new patient, significant change in health history, or existing patient absent for three or more years. The difference between the two codes is that a D0180 is for a patient with periodontal disease or risk factors for periodontal disease.
If you're performing a periodontal evaluation, use the D0180 code rather than the D0150. Even if the insurance company only allows a few dollars more for the D0180, it adds up over time. Proper coding ensures you are appropriately compensated for the work you are doing.
Another point of confusion is billing a D0150 every time an FMX or a pano is taken. The X-rays have nothing to do with the exam code you bill out. The interpretation of the X-rays is included in the X-ray code, not the exam code. If it's an existing patient and you take an FMX, you would bill a D0120 unless the patient meets the criteria for a D0150. The X-rays do not dictate the exam code.
I hope this helps clarify some of the confusion around exam codes and billing. Have a fantastic Wednesday and a great rest of your week. I will see you all on Friday morning for our next drive live.
Rick Garofolo
June 24, 2024
https://www.facebook.com/groups/2012782952332195
Good morning, everybody. It is Monday, June 24th, and this is our morning drive live.
I’m just heading back into the office this morning after a few days of being out speaking in Lansing, Michigan. It was a wonderful trip, and everybody had a great time at the two-day business-building weekend workshop.
One of the things we talked about in Michigan over the weekend, and I really wanted to bring it up today here, is why insurance companies are asking for all of this documentation all of a sudden.
One of the things we talked about in the class over the weekend was documentation requirements. A lot of the people in the class said they were having issues with insurance companies requesting start and end times for SRPs, requesting the length of appointments for SRPs.
You know, Aetna has been doing that for quite a while now; it’s been a few years that Aetna has been wanting start and finish times for SRPs. But now, all of a sudden this year, we’re starting to see a lot of the Delta Dental companies requesting that information as well.
I really think that’s only going to increase; it's just going to get worse. More and more companies will request that additional information, that additional documentation.
The question over the weekend was why. Why is it getting worse? Why are more companies asking for all of this documentation? Why do we need IO pics? Why do we need start and end times? There are a lot of layers to that question, and what I will say is, first and foremost, I do believe it is a stall tactic.
But I don’t believe that is the big reason why. The big reason why, and we see this in the group on almost a daily basis, is somebody will post, "I just started at a new office. They had jet build-out for quads of debridement, scaling, and root planing for four or more teeth per quad, and the patient was only in the chair for half an hour.
I'm not a clinical person; can somebody tell me if that's even possible? Because at my old office, they never did that." Those kinds of posts come in really, truly almost on a daily basis.
Those are the reason we’re getting all of these documentation requirements. Because of those offices that bill out a 4341 on all four quads in the same day, and the patient is in the chair for 30 minutes total, we all know that’s not possible.
If you figure out what they say is an average of 10 minutes per tooth, that appointment for four teeth per quad should be 40 minutes per quad, plus a little time for numbing, cleanup, and so on and so forth.
So really, you’re looking at a minimum for two quads of a 90-minute appointment, using a laser maybe a little less to do what you need to do a little quicker potentially.
This is the reason insurance companies are requesting this additional documentation. A lot of the information they are requesting, we think, "Why do they need that all of a sudden?" We also have to remember that when the AAP updated their staging and grading guidelines, that is something you’re supposed to be doing as part of your periodontal diagnosis.
So just diagnosing that a patient has periodontal disease, staging and grading should automatically be part of your clinical note; it should be in there every single time. Even if you’re doing a 4346, you know, the scaling in the presence of moderate to severe gingivitis should be part of your clinical chart note.
Because remember, the clinical note is the legal documentation. So it definitely should be in there; it should be part of the standard across the board.
I know we’ve talked about this before, but when one insurance company has a documentation requirement like that, like Aetna a few years ago started wanting start time and end time for those appointments.
Sometimes they want to actually see a copy or a screenshot of the day’s schedule so they can verify how long that patient was scheduled to be in the office. When that becomes a requirement by one insurance company, I make it a standard part of my documentation requirements for all patients.
I don’t care if they are a fee-for-service patient who is totally uninsured and pays in ten-dollar bills every time they walk into the office. That is our documentation requirement for one company; it’s going to be our documentation requirement for every patient that we diagnose as needing that service.
So if it’s a patient that we diagnose as needing SRP, the staging and grading is going to be part of that patient’s clinical note every time, whether that is a cash patient, Medicaid, Medicare, commercial insurance, whether they have NO, Delta, United Concordia, MetLife, or whoever. It doesn’t matter to me.
The documentation is the same across all patients, because then nobody in the back has to question, "Should we do this? Do we have to do this? Should this be part of our documentation? Oh, what insurance do they have? We’re doing a crown buildup; do we have to do the intra-oral pictures, the pre-op and post-op IO pics? Does this patient have Aetna, who requires it, or not?"
I make it a standard part of my documentation requirements, and that’s just the way it works. That way, no matter what, across the board, the documentation requirements are the same for every single patient, regardless of insurance status. That way, I know I never miss one.
Because if you have a system where, "Oh, we have to check, and we only do the pre-op and post-op buildup IO pics for Aetna patients because they’re the ones that require it," somebody’s going to miss one somewhere.
Nobody likes working for free. The thing people forget is, when you’re in-network, if something is denied because you didn’t provide the proper documentation requirements per the insurance company requirements, per the provider manual, you aren’t able to charge the patient for that service either. So you end up doing it for free.
One of the other things we talked about over the weekend in Michigan was nobody likes working for free. We say, "Oh well, we missed it; we didn’t do the pre-op IO pic; it got missed, so we’ll just write it off." But "just write it off" is somebody working for free, and it’s usually not the assistant who was told to take it and forgot or who didn’t because it’s not a standard thing across the board.
Who ends up having to work for free? It’s the dentist, who not only has to work for free but has now spent money on the supplies, on the buildup materials, on all the chair time, all the expenses that go along with an appointment. It’s the dentist that ends up doing that for free.
I want everybody to understand the importance of having a system across the board for getting that documentation done, for having those documentation requirements set, understanding what they are for each different insurance company, and then all you have to do is make a list.
I always adhere to the strictest of the requirements. So whatever requirement is the strictest, whichever insurance company requires more documentation, different documentation, something out of the norm, that is the documentation requirement that we follow for all patients, regardless of insurance status, regardless of who their insurance company is.
That is the documentation requirement that we follow for that service for every single patient across the board throughout the entire practice, forever, until those documentation requirements change again.
I want everybody to understand and make sure they know, and I know we’ve talked about provider manuals a lot in the group, but make sure you are reading those provider manuals because they give you the documentation requirements.
They tell you what the documentation requirements are for each service, for each insurance company, and so on. Then you know beyond a shadow of a doubt what documentation you need. Please remember, yes, insurance companies absolutely a lot of the time request this additional information as just a stall tactic. Because the longer they can keep your money, the more money they make.
They also know that 50% of denied claims are never followed up on. If they deny a hundred claims an hour, they know 50 of them are never going to be followed up on; nobody’s ever going to provide the additional documentation requested. Nobody’s ever going to call and say, "You did get the documentation; here’s the NEA attachment ID number; here’s this, here’s that." They know that’s not going to happen 50% of the time.
So really, from an insurance company standpoint, it’s in their best interest to deny as many claims as they can. I want to make sure that’s not happening, that we’re not getting those instant denials by making sure we provide all the documentation required to get a service paid the first time.
Now, there are many times we have to fight with the insurance company, and we hear them say, "Oh well, we never got any of the attachments." Yes, you did. Let me give you a call with the NEA attachment ID number so that you can now magically find that attachment because you did get it, and we know you did get it.
I want to make sure I’m providing that, but the big thing is, you have to be sure you are sending
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If you tilt your head to the right, you're actually going to come off more trustworthy. Now, I might be looking to the left, but I'm probably a mirrored image of you right now. However, if I look the left, which I'm probably looking, looks like I'm looking to the right because I'm a mirrored image of you. Then, I'm actually more mysterious and more sexy. So, if you really want a gal that really like you, or if you're in a meeting, and you really want them to know that you're really there for them, and very trustworthy as you're talking to them, slightly lean your head to the right. It'll show them that you're very trustworthy and easy to deal with.
When presenting, actually pay attention to where the patient's feet are pointing. If the feet are pointing towards the door or towards the exit of the operatory, it actually means that they want out - that they're simply just sitting there and listening to you. If the hands are crossed and their feet are pointing in the direction of, getting a like out, from away from you, they want to get away. On the other hand, if their feet, if you guys are facing towards each other, and your feet are actually pointing towards one another, that's actually a good sign. So, really, basically, wherever the patient's feet are, or whoever you're talking to, in general, wherever their feet are pointing, that's actually, exactly, kind of a subconscious idea of where they want to go.
... so we really want to make sure that we're using the body language to kind of get ahead of the game. The eyebrow raise the eyebrow raise is actually like this - simply like that, it just gives you the idea, gives the the patient that you're talking to on a primal subconscious level that you are a friend and not a foe...
For example... The more that I show my palms to you, my open palms, the more subconsciously I'm telling you that I have nothing to hide. So, if you've kind of been noticing throughout this presentation I use my hands a lot. I'm showing you my palms a lot. I'm actually communicating to you on a subconscious level that you, there's nothing to worry about, I'm your friend.
1. The Compliment Sandwich, Hold the Compliments: Start and end with vague, non-committal noises that might be construed as agreement, but ensure the filling is a well-timed, "Actually, Dr. Smith usually recommends the other brand of toothpaste," ensuring your doubt in their recommendation is clear but sandwiched in ambiguity.
2. The Art of Selective Hearing: Perfect the art of misunderstanding directions in such a way that it requires the doctor to repeat themselves several times, preferably in an increasingly loud voice, in front of the patient. This not only questions their communication skills but also their patience.
3. The Prodigal Student: Casually drop into conversation how, at the last conference you attended, the leading experts presented findings that directly contradict the doctor's current approach. Phrase it as a question to feign innocence.
4. Unsolicited Second Opinions: After the doctor has given their diagnosis, chime in with, "Oh, interesting choice of treatment. I read an article just last night arguing that's an outdated approach. But what do I know, right?" Smile sweetly.
5. The Concerned Confidante: Express your concerns to the patient about the doctor's decisions when they step out of the room, but insist, "Don't tell them I said anything. I'm just looking out for you."
6. The Expert By Association: Frequently reference how your previous place of employment did things differently, implying it was the superior method. Bonus points if you can name-drop a well-known practitioner as your mentor.
7. The Public Reminder: In a room full of patients, loudly remind the doctor of basic tasks or checklists. "Don't forget to wash your hands, Doctor!" As if it's a novel idea they hadn't considered.
8. The Passive-Aggressive Professional: Perfect your ability to offer help in a way that insinuates the doctor can't manage without you. "Would you like me to explain the procedure to the patient, or do you think you've got it this time?"
9. The Social Media Savant: Take to social media to share articles that subtly undermine the doctor's methods, tagging the office in every post. Ensure your privacy settings allow for "colleagues" to see these educational posts.
10. The Master of Misquotes: "Oh, I could have sworn you said to schedule them for a root canal, not a regular cleaning. My bad!" Ensure this mix-up happens in front of a packed waiting room for maximum impact.
- mouthJanitor, SP, PTS
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