Clinic Organization and Business Protocols December 5, 2005 Nader A. Nadershahi, DDS, MBA

Second Year Clinic -- A System Overview -- The Clinics Main Clinic Main Clinic Located on Level C Located on Level C Clinical Practice Breakdown Clinical Practice Breakdown Senior (Third) Year Clinic -Groups I, II, III, IV) Senior (Third) Year Clinic -Groups I, II, III, IV) Junior (Second Year Clinic) Junior (Second Year Clinic)

Clinic Organization Four Group Practices with their own GPA and Administrative Assistant (I, II, III, IV) Four Group Practices with their own GPA and Administrative Assistant (I, II, III, IV) Second year faculty are in format that you are familiar with in ½ of the alphabet Second year faculty are in format that you are familiar with in ½ of the alphabet Third year students will work with mentor groups and specialty faculty as needed Third year students will work with mentor groups and specialty faculty as needed All rotations and other programs still apply All rotations and other programs still apply

Patient Transfers Patient transfers will be made in group practices. (Students in 2 nd ¼ of senior class will transfer patients to students in 2 nd ¼ of junior class.) Patient transfers will be made in group practices. (Students in 2 nd ¼ of senior class will transfer patients to students in 2 nd ¼ of junior class.)

The People Students Students Senior Students + AEGD, OMFS, & Senior Students + AEGD, OMFS, & Junior Students Ortho residents Junior Students Ortho residents Patients Patients Senior Cases Senior Cases Junior Cases Junior Cases Sharing -- Referrals within the group practices and between Seniors and Juniors Sharing -- Referrals within the group practices and between Seniors and Juniors

The People (continued) Faculty: from all clinical departments Faculty: from all clinical departments Staff: receptionists, sterilization, cashier, patient care coordinators (PCC) Staff: receptionists, sterilization, cashier, patient care coordinators (PCC) Clinic Administration: ADCS, Group Practice Administrators (GPAs) & assistants Clinic Administration: ADCS, Group Practice Administrators (GPAs) & assistants

Associate Dean for Clinical Services GPA Group I GPA Group IV Restorativ e Chair Perio Chair Removabl e Chair Endo Chair 2 nd year clinical faculty GPM Coordinato r Group I GPMs and 3 rd year faculty Group II GPMs and 3 rd year faculty Group III GPMs and 3 rd year faculty Group IV GPMs and 3 rd year faculty Admin Asst. Group I 3 rd Years and Patients Group II 3 rd Years and Patients Group III 3 rd Years and Patients Group IV 3 rd Years and Patients Clinic Managers PSLGPA GroupII GPA Group III Receptionists PCCs Sterilization Admin Asst. Group I 2 nd Years and Patients Group II 2 nd Years and Patients Group III 2 nd Years and Patients Group IV 2 nd Years and Patients

The Clinics Oral Surgery (Level C) Oral Surgery (Level C) Radiology (Level C) Radiology (Level C) Emergency (Level C) Emergency (Level C) Pediatric Dentistry Clinic (1st Floor) Pediatric Dentistry Clinic (1st Floor) Orthodontic Clinic (1st Floor) Orthodontic Clinic (1st Floor) Oral Medicine and Facial Pain (6th Floor) Oral Medicine and Facial Pain (6th Floor) Faculty Dental Service Group (1st Floor) Faculty Dental Service Group (1st Floor) Advanced Education in General Dentistry (Level B) Advanced Education in General Dentistry (Level B) Perio Surgery (Level C) Perio Surgery (Level C)

The Year Quarter Quarter Fifth (Mon.-Thurs.) Fifth (Mon.-Thurs.) Sixth, Seventh and Eighth Quarters (Mon.-Fri.) Sixth, Seventh and Eighth Quarters (Mon.-Fri.) Time Spent in Blocks 40 Percent Blocks Percent Blocks

Second Year Clinic Goal To develop the fundamental clinical patient care skills in all dental disciplines for comprehensive patient care. To develop the fundamental clinical patient care skills in all dental disciplines for comprehensive patient care. To provide close faculty interaction to carefully guide student learning experiences. To provide close faculty interaction to carefully guide student learning experiences. To provide quality patient care. To provide quality patient care.

How do we do it? -- The Year as a Transition Designed to introduce students to comprehensive patient care with an emphasis on diagnostic skills. Designed to introduce students to comprehensive patient care with an emphasis on diagnostic skills. Teach students to manage dental cases. Teach students to manage dental cases. Prepare students for more complex patient care cases. Prepare students for more complex patient care cases.

Fifth Quarter -- The Blocks 2 nd Year Clinic Blocks 2 nd Year Clinic Blocks Perio Recall Perio Recall Perio Surgery Assisting Perio Surgery Assisting Oral Surgery Oral Surgery Radiology Radiology Other Blocks Local Anesthesia Endo Block Implantology

Fifth Quarter -- The Operation Staff Staff Some Patient Scheduling Some Patient Scheduling Financial Contracts Financial Contracts Patients Patients Recall Patients “check up & cleaning” Recall Patients “check up & cleaning” Simple New Patient Cases Simple New Patient Cases Faculty Manage Patient Care Same Students with Same Faculty Students Patient Exposure (Be there and be prepared) 1st Impressions are Important Pay Attention Patient Scheduling

Sixth Quarter -- The Blocks Percent Block Percent Block 2 nd Year Clinic Blocks 2 nd Year Clinic Blocks Perio Recall Perio Recall Perio Surgery Assisting Perio Surgery Assisting Others: Same as Last Quarter Others: Same as Last Quarter Other Clinic Blocks Same as Last Quarter Pedo Block students scheduled for 10 consecutive clinic sessions

Sixth Quarter -- The Transition Staff Staff Some Patient Scheduling Some Patient Scheduling Financial Contracts Financial Contracts Patients Patients Increased flow of new patients Increased flow of new patients Encourage students to bring in their own patients Encourage students to bring in their own patients Faculty Increase Student/ Faculty Ratio Assisting in procedures, less patient management Students Increased Independence Comprehensive Patient Care Patient Scheduling

Seventh and Eighth Quarters -- Turning It Over 40 – 50 Percent Blocks 40 – 50 Percent Blocks Perio Blocks Perio Blocks 50 – 60 Percent Open Clinic Time 50 – 60 Percent Open Clinic Time See your own patients See your own patients Other Main Clinic Blocks Same as Last Quarter Other Blocks Same as Last Quarter

Clinical Services in the Second Year Clinic Comprehensive Patient Care Comprehensive Patient Care Relatively Simple Restorative Cases Relatively Simple Restorative Cases Clinical Experience Clinical Experience

Clinical Services in the Second Year Clinic -- (continued) Fifth Quarter Fifth Quarter Mostly ODTP & Perio Mostly ODTP & Perio Almost Any Operative Almost Any Operative Almost Any Endo Almost Any Endo Almost Any Single Crown Almost Any Single Crown No Removable No Removable Sixth Quarter ODTP & Perio Almost Any Operative Almost Any Endo Almost Any Single Crown Still No Removable

Clinical Services in the Second Year Clinic -- (continued) Seventh Quarter Seventh Quarter ODTP & Perio ODTP & Perio Almost Any Operative Almost Any Operative Almost Any Endo Almost Any Endo Almost Any Single Crown Almost Any Single Crown Maybe Posterior Bridge Maybe Posterior Bridge Full Denture Cases Full Denture Cases No Partial Dentures No Partial Dentures Eighth Quarter ODTP & Perio Any Operative Any Endo Any Single Crown Maybe Posterior or Anterior Bridge Any Removable Case

Clinical Services -- Most Common CDT5 Codes D Initial Oral Exam (ODTP) D Initial Oral Exam (ODTP) D Periodic Oral Exam (Recall) D Periodic Oral Exam (Recall) D Full Mouth Series (FMX) D Full Mouth Series (FMX) D Four Bitewing Films D Four Bitewing Films D Prophylaxis, Adult D Prophylaxis, Adult D Root Planing (per quadrant) D Root Planing (per quadrant) D Supportive Periodontal Therapy (SPT) D One Surface Amalgam D Anterior Root Canal Therapy D Full Cast Crown (FVC) D PFM Crown

New Patient Intake Service Screenings are done on a first-come, first-served basis. Sign up starting at 8:30 and 12:30. Screenings are done on a first-come, first-served basis. Sign up starting at 8:30 and 12:30. Done by Faculty Done by Faculty Monday-Friday Monday-Friday 9:00 a.m. to 12:30 a.m. and 1:00 p.m. to 4:30 p.m. 9:00 a.m. to 12:30 a.m. and 1:00 p.m. to 4:30 p.m.

Patient Intake Flow Patient registers at Front Desk Patient registers at Front Desk Fills out paperwork Fills out paperwork Demographic Form Demographic Form Preliminary Evaluation Preliminary Evaluation Health History Health History Patient Rights & Responsibilities Patient Rights & Responsibilities Dental Materials Fact Sheet Dental Materials Fact Sheet HIPPA Acknowledgement HIPPA Acknowledgement Patient returns forms to Front Desk Patient directed to Radiology for Pano and 2 Bite-Wings ($25) Radiology technicians give forms and radiographs to Screening Faculty

Patient Intake Flow Chart -- (continued) Faculty member: Faculty member: discusses patient’s chief concern/desire/ expectations discusses patient’s chief concern/desire/ expectations explains clinical protocols explains clinical protocols briefly reviews patient’s medical status briefly reviews patient’s medical status medical consult form, if needed medical consult form, if needed determine patient’s dental needs determine patient’s dental needs determine teaching case status determine teaching case status provides patient with very rough cost estimates provides patient with very rough cost estimates

Patient Intake Flow Chart -- (continued) If faculty member and patient agree to make patient a teaching case, then: If faculty member and patient agree to make patient a teaching case, then: faculty member suggests Junior or Senior Clinic faculty member suggests Junior or Senior Clinic faculty member prescribes remaining films to have FMX (for an additional $70) faculty member prescribes remaining films to have FMX (for an additional $70) FMX taken or appointment made FMX taken or appointment made If patient brings in FMX, Radiology Faculty determine acceptability of films If patient brings in FMX, Radiology Faculty determine acceptability of films

Patient Intake Flow Chart -- (continued) After FMX: After FMX: Patient Intake Manager, Mr. Robert Trezia, brings cases to Group Practices on a rotating basis. Patient Intake Manager, Mr. Robert Trezia, brings cases to Group Practices on a rotating basis. GPA and AA’s assign based on needs list and procedure tracking. GPA and AA’s assign based on needs list and procedure tracking. Students check patient lists regularly for new pts. Students check patient lists regularly for new pts. Student makes first phone call and appoints ODTP. Student makes first phone call and appoints ODTP.

Screening Goals To Determine: To Determine: Chief Concern Chief Concern Expectations Expectations Needs Needs Medical Status Medical Status To Discuss: Introduce Clinic Comprehensive Care! Finance Fees Payment Plans

Screening Goals -- (continued) Is this patient a teaching case? Is this patient a teaching case? Based on patient needs and expectations Based on patient needs and expectations Based on faculty assessment Based on faculty assessment If patient is a teaching case, then: If patient is a teaching case, then: Order FMX ($70) Order FMX ($70) GPA assigns to appropriate student GPA assigns to appropriate student If patient is not a teaching case, then give patient referral advice and films If patient is not a teaching case, then give patient referral advice and films

How to bring in your own patient Patient must fill out patient information form. Patient must fill out patient information form. Chart must be made for patient Chart must be made for patient Information Desk Information Desk Complete ODTP steps 1 & 2 on clinic floor Complete ODTP steps 1 & 2 on clinic floor Faculty determines appropriateness of case for 2 nd year student Faculty determines appropriateness of case for 2 nd year student Radiograph Rx from faculty Radiograph Rx from faculty

Main Clinic Business Protocols

Clinic Business Protocol – Prelude ODTP -- Step 7 ODTP -- Step 7 Prioritize Treatment Plan Prioritize Treatment Plan Entered into Computer in Proper Sequence Entered into Computer in Proper Sequence Clinical Approval Clinical Approval ODTP – Step 8 ODTP – Step 8 Signed Treatment Printout in Chart Signed Treatment Printout in Chart All Charting in Computer All Charting in Computer All Forms Signed and Organized in Chart All Forms Signed and Organized in Chart

Discussing Treatment Alternatives Explain clinical importance of preferred procedure Respect patient’s ability to pay for services Patient Autonomy and Standard of Care Practices

CARE and Denti-Cal CARE office CARE office Luis Rodriguez Luis Rodriguez Denti-Cal Approval from GPAs or Department Chairs Denti-Cal Approval from GPAs or Department Chairs After approval, chart taken to PCC for final financial approval After approval, chart taken to PCC for final financial approval

Clinical and Financial Approval Type accepted treatment plan into computer Type accepted treatment plan into computer Get instructor to give clinical approval Get instructor to give clinical approval Print out treatment plan Print out treatment plan Have patient sign treatment plan Have patient sign treatment plan Patient fills out Patient Credit Information Form Preauthorization done Sign up to see Patient Care Coordinator (PCC) Wait for PCC to page See PCC for financial arrangements and approval

Road to Clinical Approval Discuss Treatment Options & Costs with Patient Discuss Treatment Options & Costs with Patient Treatment Plan Acceptance Treatment Plan Acceptance Enter Accepted Treatment Plan into Computer in Planned Delivery Sequence Enter Accepted Treatment Plan into Computer in Planned Delivery Sequence Have Faculty Member give Clinical Approval Have Faculty Member give Clinical Approval Hint: Ask for clinical approval from the faculty member you worked with during the ODTP process.

Ways to Lose Clinical Approval Change the sequence of the clinically approved treatment plan Change the sequence of the clinically approved treatment plan Add anything to the clinically approved treatment plan Add anything to the clinically approved treatment plan Delete anything from the clinically approved treatment plan Delete anything from the clinically approved treatment plan

First Steps to Financial Approval Patient signs clinically approved treatment plan printout Patient signs clinically approved treatment plan printout Patient fills out Patient Credit Information Form Patient fills out Patient Credit Information Form Complete pre-authorizations as needed Complete pre-authorizations as needed Go to Patient Services Go to Patient Services Student signs up to see Patient Care Coordinator (PCC) Student signs up to see Patient Care Coordinator (PCC)

Patient Services (PCCs) Located directly behind the Front (Information) Desk on Level C Located directly behind the Front (Information) Desk on Level C Patient Care Coordinators Patient Care Coordinators Irene Vargas Irene Vargas Maria Bran Maria Bran Jerilyn Thompson Jerilyn Thompson

Patient Care Coordinators Answer patient account questions. Answer patient account questions. Send out and monitor insurance pre- authorizations. Send out and monitor insurance pre- authorizations. Send out and monitor insurance claims. Send out and monitor insurance claims. Give financial approval to ALL patients. Give financial approval to ALL patients.

Patient Care Coordinators -- (continued) See a PCC if you need information or assistance with: See a PCC if you need information or assistance with: Financial Approval Financial Approval Private Insurance Private Insurance Denti-Cal (Public Insurance) Denti-Cal (Public Insurance) Contracts (Financial Arrangements) Contracts (Financial Arrangements) Patient Accounts Patient Accounts

Payment Options Full Payment in Advance Full Payment in Advance Contracts (Under $500 or Over $500) Contracts (Under $500 or Over $500) Pay for Treatment As They Go Pay for Treatment As They Go (Depending on amount. Can bill under $300)

Full Payment In Advance Advantages: Advantages: To Patient: 5 percent discount To Patient: 5 percent discount To Student: Financial approval every visit (as long as treatment plan does not change) To Student: Financial approval every visit (as long as treatment plan does not change) Disadvantages: To Patient: May not have all the funds at that time. To Student: None

Contracts -- Qualifications Employment or Income Information Employment or Income Information Major Credit Card Major Credit Card Bank Account (Savings or Checking) Bank Account (Savings or Checking) Down payment equal to one month’s payment (Procedures requiring laboratory fabrication need 25% down payment Down payment equal to one month’s payment (Procedures requiring laboratory fabrication need 25% down payment Contracts run no more than 20 months with a $40 per month minimum payment. (Total amount Divided by 20)

Contracts Contract Under $500 Contract Under $500 If patient or co-signer has employment verification plus either a major Credit Card or Bank Account If patient or co-signer has employment verification plus either a major Credit Card or Bank Account Treatment plan can be broken down into ~$500 increments. Treatment plan can be broken down into ~$500 increments. Contract Over $500 Patient or co-signer has all qualifications.

Insurance Private Insurance Private Insurance We accept any dental insurance plan that will accept us. We accept any dental insurance plan that will accept us. Every plan has different rules (see your PCC) Every plan has different rules (see your PCC) Public Insurance Public Insurance Denti-Cal or Medi-Cal Denti-Cal or Medi-Cal Pre-authorizations a MUST Pre-authorizations a MUST Eligibility needs to be checked EACH month. Eligibility needs to be checked EACH month.

Denti-Cal Procedures Requiring Pre-Authorization Root Planing Root Planing Root Canal Therapy Root Canal Therapy Dentures Dentures Relines Relines Crowns (No posteriors unless abutments for RPD) Crowns (No posteriors unless abutments for RPD) Stayplates Stayplates Partial Dentures Partial Dentures They are only a benefit if opposing a full denture. They are only a benefit if opposing a full denture. Failure to wait for pre-authorizations will result in your not receiving credit for the procedure.

Ways to Lose Financial Approval Add or subtract anything to or from the treatment plan. Add or subtract anything to or from the treatment plan. Patient becomes more than 60 days past due (delinquent account). Patient becomes more than 60 days past due (delinquent account). See your PCC See your PCC

Financial Approval Be prepared! Be prepared! Always accompany your patient when making financial arrangements. Always accompany your patient when making financial arrangements. Only a PCC can give financial approval Only a PCC can give financial approval ALL PATIENTS NEED FINANCIAL APPROVAL

Thank You…