download_pdf_buttonBulletin, July 2013

The Latest in Area Economic and Technical Trends
Exclusively to Clients and Friend of Advanced Practice Management

Bill Rossi
Bill Rossi

Our Dental Dow Jones: First Half 2013

Comparing the averages from January through June 2013 to the same period in 2012, we find that practice production is up 2.9% andcollections are even with the previous year. Patient flow, as measured by exams, is up 1.3%. Crown and bridge production is up 6.6%. New patients are down 6.2%.

 (first half)
 2009  2010  2011  2012  2013
Prod. Increase  .5%  1.4%  2.5%  3.3%  2.9%
Coll. Increase  .4%  0.4%  1.6%  3.5%  0%

A Big Second Quarter:

As you may remember, the first quarter of 2013 was disappointing. Practice production wasdown 1.6% and collections were down 4.2%. Comparing the second quarter of 2013 to the second quarter of 2012, we see the numbers perking up. Production was up 7% andcollections were up 4%. Patient flow was up 2.7%. Crown and bridge was up 12% with the overall production per exam up 3.7%.

So maybe the recovery we were starting to see in 2012 has recovered!

Some Facts To Consider:

Insurance Alternatives:

Given that much of the population has no dental insurance, it certainly makes sense that alternatives to insurance are making headway (as discussed in my previous April 2013 Bulletin).

These programs typically involve a membership fee which then entitles the patient to a discount on dental services. This encourages the patients to come back for their check-ups and to go ahead with treatment (one of the main benefits of this type of program, by the way). It certainly bonds them to your office. You are the only “provider” of your own plan!

We can help get this rolling in your practice. Just call!

Kelly Larson
Kelly Larson

Why Online Reviews Matter To Your Practice:

According to a Nielsen Study:

Make it easier to get reviews:

1) Collect patients’ email addresses: Many of you are moving to digital communication software and this is necessary in any case. When talking with patients, ask for their email if you don’t already have it. Everyone on staff can help with this. Tell patients that you appreciate their business and that you are always looking for feedback in areas to improve.

If for example, their email is a gmail, their reviews can be especially useful because it will show on Google’s Place Page.

patientreview2) Email patients after their visit: This can be done manually with an email template that we created.

3) Use your website to collect and showcase your reviews:Make sure that you have “buttons” on your website that make it easier for patients to see reviews or leave reviews.


4) Send eBlasts: An occasional email is a good way to keep in touch with patients. You don’t want to overdo it. We feel that quarterly is appropriate. This can be done around seasonal events such as Dental Health Month, Back to School, the Insurance/Flex Plan Year End letter and so on. Include a mention of reviews and a means (link) for them to submit their feedback.

Put one team member in charge of this and monitoring online reviews. Have him/her report to you each month.

This person should be in charge of keeping everyone on your team excited about getting patient reviews.

There used to be a time (Bill Rossi refers to it as “the good old days”) when Dentists could just put a shingle up and forget about it. But nowadays, unless you want to be overly dependent on PPOs, you and your staff need to put in the effort to get patient reviews.

Shelly Ryan, RDA
Shelly Ryan, RDA

Smart Coding Can Add $1,000s to Your Bottom Line! When to use Palliative Treatment (D9110) vs. Limited Exam (D0140) and/or Open & Drain (D3221)

D9110 is an under-utilized code*
1) D9110 is often reimbursed at a higher rate (usually $100-$137) than D0140 Limited Exam (usually $55-$70). So, $30 to $50 more.

2) It is not a “take back code” [which means if you complete the restoration, insurance will not subtract the payment they made on the initial service, i.e., D3221 (Open & Drain) or D2940 (Sedative Filling)].

3) It is generally benefited 3 times per year and does not affect the frequency limitations of exams, such as D0140 does.

Example Situations/Narratives:

The following are possible palliative situations where you would want to use D9110 in place of D0140 to relieve acute and spontaneous pain, discomfort, or sensitivity.

1) Fractured tooth: “Mesio-buccal cusp of tooth #3 was fractured. Area was smoothed for patient comfort.” D0140 could be used but D9110 will reimburse higher and doesn’t affect the D0140 limitations (2 per year).

2) Fractured tooth: “Gluma was applied to mesiobuccal cusp area to relieve discomfort, tooth #19.” D0140 could be used but D9110 will reimburse higher and doesn’t affect the D0140 limitations (2 per year).

3) Temporary placement of IRM for discomfort associated with heat and/or cold: “Patient had sensitivity with tooth #3. Caries was excavated and IRM placed.” Formerly called a sedative filling, D2940 could be used but the insurance
company may “take back” any reimbursement when the final restoration is placed by the same dentist.

4) “Acute pain with Tooth #3: #3 was opened only (partial pulpal debridement) for drainage and patient relief. D3221 may have a higher UCR Shelly Ryan, RDA than palliative (D9110). (Note: D3221 may be a “take back” if the same office does the subsequent endodontic treatment with some carriers.) So, it is best to use palliative D9110 in this situation when the same provider will be completing the root canal. It is best to use D3221 when you are referring to an Endodontist.

NOTE: Palliative (D9110) can be reported in conjunction with an office visit—after regularly scheduled hours (D9440). The patient would generally be responsible for payment of the afterhours visit (D9440) out-of-pocket (usually $75-

The average Doctor sees approximately 10 emergencies/mo. – if half of those are Palliative and coded such – profits increase by at least $300/mo. or $3,600/yr. just from using the appropriate code!

Share this information with your administrative staff!

* Our thanks to Dr. Charles Blair, D.D.S., for parts of this article from his book, Coding with Confidence: The “Go To” Dental Insurance Guide, CDT-2013 Edition.

Matt Lahn, RDH
Matt Lahn, RDH

We Don’t Recommend Using D0180: “Comprehensive Periodontal Evaluation New
Or Established Patient”:

This code is often “downgraded” to a periodic oral evaluation. A comprehensive exam should involve a detailed perio assessment in any case and it is going to be reimbursed at a higher rate from insurance companies.

So this code doesn’t really define anything you’re not already doing in a comprehensive exam and it doesn’t help (and can hurt) reimbursement. We say “pass.”

Fluoride Codes:

We recommend you use 1206 for “Adult Fluoride Varnishes” and 1208 for fluorides for kids (whether varnish or not, the code isn’t specific as to the method of fluoride).

This way, your insurance reimbursements will be whatever they will be and you and your staff can more accurately track the fluorides you do for adults and children.



November 1st
Embassy Suites, Bloomington, MN

A Must for Your Team – Collections Made Comfortable is coming soon – Friday, November 1st: This seminar is almost always a sellout. Clients get first dibs! So CALL TODAYto reserve your space. $198 first person and $148 each additional. $20 discount per attendee if registered by September 15th.

FRIDAY, NOV. 1, 9:00–1:00
CALL 952-921-3360
Limited to 120 Spaces

Bill Rossi, Robyn Kain, Shelly Ryan, Kelly Larson and Matt Lahn
Bill Rossi , Robyn Kain, Shelly Ryan, Kelly Larson and Matt Lahn

Telephone: 952-921-3360

Yours truly,


Shelly Ryan, RDA
Shelly Ryan, RDA

“Profit Masters of Dentistry”
In San Diego, California
October 4th & 5th   


My team is on your team. Other teams watch out!


THANKS! We are honored to be part of your practice.