An insightful and informative newsletter from the Art of Practice Management. A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.

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Hygiene Department
Analysis
Yesterday was a wakeup call for me. I received in my email a
LinkedIn discussion about a case of embezzlement and I
decided to chime in with my thoughts about the controls that
need to be in place in dental practices to avoid embezzlement.
When I hit the send button I thought that I might actually be
helping dental practices better safeguard themselves by
reminding them that controls need to be in place in dental
practices.
I stated that dentists/owners need to take a more active part day to day by reviewing
practice management adjustment reports and deposit slips/reports. I also indicated
that one staff member should never be responsible for all revenue duties. Even for
practices that electronically deposit the checks, cash should always be taken to the
bank by the dentist or practice owner.
Shortly thereafter I noticed a new comment had been posted. This was a comment
from David Harris, CFE addressing my post. David is the president and CEO of
Prosperident, the only company in North America specializing in the detection,
investigation and remediation of embezzlements committed against dentists. This is
what David told me – “Marianne -- I agree that controls are necessary (predominantly
reasons not relating to embezzlement), but most of the embezzlers who I see are
completely capable of overcoming all of the procedures you are suggesting. The
ingenuity that these folks apply to this issue is sometimes breathtaking. As you know,
Marianne, we will not discuss specifics in a publicly-accessible forum like this (I have
recurrent nightmares about educating thieves), but I'm happy to have a private chat
sometime about some of the stuff we see. What we need to understand about
thieves is that they are pushed by some pretty powerful forces and, as my learned
friend Paul suggests, they tend to view controls as simply a “speed bump on the
embezzlement highway”. It helps that they know the doctor pretty well, and are also
very aware of what controls are in place. I'll go one step further. There is a subset of
dental embezzlers who get some kind of pleasure from stealing. Making it harder for
them to steal INCREASES the jolt they get when they embezzle. So you are actually
playing right into the hands of this group when you try to tighten things down. This
cohort is certainly in the minority of embezzlers, but this factor is often overlooked.”
So don’t let this just be my wakeup call. David Harris is definitely the man to contact
if you have any concerns about embezzlement in your practice. He can be reached
at david@dentalembezzlement.com.
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Articles
Embezzlement Wakeup Call
Marianne Harper

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Uncovering the Evidence During a Periodontal Screening
Colleen Rutledge, RDH
This summer I was visiting my friend in the hospital after a double mastectomy. She
also had regional lymph nodes removed under her arm bilaterally as part of her
mastectomy (this is not the case for everyone who has had a mastectomy).
The nurse came in to check on her and subsequently advised her that from now on
she is to never let anyone take her blood pressure on her arm. This perked my
interest as I routinely take blood pressure on my patients. She explained that lymph
nodes filter or catch foreign matter and bacteria. If the nodes are removed, as was
the case for my friend, the normal drainage has a reduced capacity to carry the
lymph fluid.
During a blood pressure reading, pressure is exerted and the fluid backs up and can
cause swelling in the arm. The accumulation of lymphatic fluid is called
lymphedema. This condition is painful and puts the patient at high risk for infection.
Future protocol is to have her blood pressure taken on her leg. Patients with lymph
nodes removed from only one side could have their blood pressure taken on the
unaffected arm.
There are other precautions to consider:
1. Injections, IVs, or blood drawing should never be done in the affected arm
2. Avoid strenuous movements with the affected arm such as pulling, pushing
or scrubbing
3. Avoid heavy lifting or carrying heavy objects (usually to 5 lbs. or less)
4. Avoid tight jewelry or elastic bands around affected fingers or arm
5. Wear gloves for housework and gardening
6. Avoid cutting cuticles of the affected hand.
Reference: http://www.netwellness.org/question.cfm/22423.htm
10% OFF SALE on every product in our store until September 15, 2013! Use
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Dental – Starting in 2013, dental code revisions occur annually. The changes in
2014 will include 29 new codes, 3 new code categories, 18 revised codes, 4 revised
subcategories, and 4 deleted codes. Make your insurance system as efficient as
possible by obtaining the 2014 codes. My recommendation for the BEST source of
codes and coding help is both “Coding with Confidence” and a subscription to
“Insurance Solutions Newsletter”. To order “Coding with Confidence” download the
Coding with Confidence Manual Order Form. To subscribe to the “Insurance
Solutions Newsletter” download the Insurance Solutions Newsletter Order Form.
Medical – As announced in the last newsletter, the CMS1500 claim form has been
updated to the 02/12 version. For all of the details on the changes, go to
http://www.nucc.org. One of the significant changes is in box 21 because it provides
a way to indicate which version of the diagnosis codes is being used (ICD-9 or ICD-
10). This is necessary during the implementation period prior to the mandatory
timeline of October 1, 2014 for ICD-10 only. Also, the form has expanded to provide
for the reporting of up to twelve diagnosis codes as opposed to four on the prior
form.
Insurance Alert

3. October 1, 2013 – This is the date for medical diagnosis codes to update. However,
due to the impending change to ICD-10 in 2014, the only changes to the diagnosis
code set deal with new technologies and diseases. Therefore, for purchasers of
“CrossWalking – A Guide Through the CrossWalk of Dental to Medical Coding”,
there will be no update this year. I will notify you in December about the CPT code
update.
September 23, 2013 - HIPAA Omnibus Final Rule – The updates to this rule were
published on January 25, 2013. The compliance date is September 23, 2013.
January 1, 2013 – Updated CDT and CPT code sets
October 1, 2014 – The new date for ICD-10 implementation
Favorite Quotes:
“The average Joe should be just as concerned about embezzlement, even more so,
because it’s so easy to do. All you have to be is trustworthy to do it.”
Peter Henning, http://www.quotesea.com
Tips – For our Patients:
The high numbers of embezzlement in dental practices gives even more reason for
incorporating background checks into your hiring protocols.
Points of Interest:
According to a report recently published by Marquet International,
“although the economy has been slowly recovering over the last several
years, Marquet said what they found in the report is that a lot of
embezzlement schemes that were hatched during the recession are now
finally starting to see the light of day. However, while many people who
were allegedly involved in these thefts did so out of financial need, others
merely stole to create and maintain an extravagant lifestyle. While the motivating
factor among perpetrators was hard to ascertain in a majority of the cases examined
in the study, those that were discovered varied widely, ranging from supporting
gambling addictions to problems with substance abuse, a floundering family business
or even providing for a loved one. Marquet said the average duration for one of these
major embezzlement schemes is nearly five years and some have even lasted as
long as 20 years before they are uncovered.
http://www.securityinfowatch.com/article/10946366/major-embezzlement-cases-on-the-rise
Is there someone you think would be interested in this newsletter?
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The Art of Practice Management
2217 Fox Horn Road • New Bern, NC 28562 • Phone: 1-252-637-6259
www.artofpracticemanagement.com • a.p.m.1@suddenlink.net
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