The Dental Billing Podcast

Hygiene Performance & Billing Part 2 with Jennifer Lyman RDH

• Ericka Aguilar • Season 8 • Episode 4

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Ever wondered how to elevate your dental practice's perio performance percentages? This episode promises actionable strategies that can transform your approach to periodontal care. We begin by breaking down the concept of perio performance percentage and its critical role as a key performance indicator. This isn't about singling out individual hygienists but about rallying the entire dental team towards a common goal. We'll tackle the importance of self-assessment to understand where you currently stand and how proper diagnosis, patient communication, and financial discussions can collectively enhance your practice's performance and patient outcomes.

Dental hygienists face enormous challenges, from overwhelming demands to time constraints that make optimal patient care a struggle. We delve into the emotional and professional strain this pressure can create, and how crucial support from the front office team can help. Effective communication, better scheduling protocols, and a deeper mutual understanding are essential. By empowering hygienists to manage their time for complex cases and educating the front office to support these needs, we can significantly improve patient care and practice efficiency.

We wrap up with a focus on effective patient follow-up and communication. Tools like the Gum Health Tool from Colgate can revolutionize patient education, but it's the collaborative effort between clinical and front office staff that truly makes the difference. Introducing the "Reason for Return" (RFR) in clinical notes ensures everyone is on the same page about patient follow-ups and recalls. Plus, we examine the importance of hygienists managing their own schedules with robust systems in place, emphasizing that systemic improvements and teamwork are essential for a smoothly running dental office. Tune in to learn how these strategies can drive continuous improvement in your practice.

Want to learn Dental Coding and Billing? Join here:

https://tr.ee/efzYrY7mp-

Would you like to set-up a billing consultation with Ericka or Jen? We would love the opportunity to discuss your billing questions!

Email Ericka:
ericka@dentalbillingdoneright.com

Email Jen:
jen@dentalbillingdoneright.com

Perio performance formula:

(D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)


Want to know what your fee should be for D4346? Send Ericka an email to ericka@dentalbillingdoneright.com


Speaker 1:

Okay, jen, you're back and we are going to have another conversation about aerial performance and hygiene and all of those topics. You know, we had this quick conversation before I call it the real show, before the show. It's like that behind the scenes conversation and I really want to emphasize, like this series, to allow our listeners to be like a fly on the wall, and I really want to emphasize that we're not trying to add more to a hygienist plate, right? This is not to add more, it is to document for what we're actually doing one and then improving our perioperformance percentage. So, just as a recap, really quick, we talked about what is perioperformance percentage, what does it represent, what are those procedures involved, all of that and in this episode we want to talk about why it's important for our offices to self-diagnose, right? So we want them to understand what their current perio performance percentage is and why do you think that we should do?

Speaker 2:

that Well, you don't know what you don't know. So everybody is going to be, you know, going to work, we do our job, we take care of our patients, we go home. We don't really think about the ramifications of our day-to-day diagnosing in patients and if you don't know your periopercentage, how can you get better one and how can you have a measurement to see where you're at? So you know, we can always get better.

Speaker 2:

I feel like in the dental industry especially, we're always doing continuing education, we're always trying to get better, we're learning new material, we're getting new equipment. This is the same thing. You have to know your perio percentage to know where you can go and where you're at. This is one of the most important things I feel like in a practice, in the health of a practice, one of our key performing indicators right, like how is your hygiene performing? And in this episode, we know we're talking from a hygiene perspective. So, hygienists, we're talking to you in this. This is not a berate on hygienists episode. This is going to be you know, where can we find out where you're at right now? How can you improve as a clinician and take care of our patients? And that's really what it comes down to.

Speaker 1:

Yeah yeah. I think we've seen plenty of stereo performance percentages and in fact, I screenshotted one to you this morning because I think I said this can't be right. And what was that? I think it was 0%. It was zero.

Speaker 2:

They had done 12 SRPs, 12 quads, I should say 12 quads, so three patients in the last 18 months.

Speaker 1:

Yeah, 4,000.

Speaker 2:

And that's an extreme example.

Speaker 1:

Yeah, that's an extreme example, but you know we have seen a lot of offices that are. I mean, most of our offices are 10%, 12%. You know some are below, but for the most part I think we see offices that have a perio performance percentage that they think is going to be higher and it's much lower and it's not like you said. It's not a reflection of a hygienist performance. Can you expand on that? Because I really want to make sure that we really drive home that this is not anyone's performance. This is the department's performance overall. That's why we broke down what perio performance percentage is in the last episode. So can you talk about how this is not the hygienist individual performance?

Speaker 2:

When it comes to the perio performance. We're talking about, you know, SRPs. We're talking about the gingivitis code 4346, we're talking about perio maintenance. If we're not, you know, diagnosing, then we can't treat it. But in this sense, it's not the hygienist responsibility necessarily to get that number to where it's at, it's the whole office as a whole and we need to know what the patient's benefits are before we can diagnose. We need to be comfortable having that conversation first with the patient, Then the front office needs to be comfortable having that conversation financial conversation with the patient too, and insurance companies need to start paying what it's worth.

Speaker 1:

And.

Speaker 2:

I think that it's like a whole, you know symbiotic system that we need to improve. And when it comes down to, it's not just the hygienist, because we are so spent for time. You know, some offices we only have an hour, maybe even less, maybe even 45 minutes to do a full period of chart, to talk to the patient, to do the treatment and then to walk them out and like have you know that relationship with them, and it's just not enough time. I mean, there is so much that hygienists are asked to do in a timeframe and it's completely overwhelming. And if a dentist comes in and they're like, hey, you need to diagnose more SRP, like what do you think that hygienist is going to feel? They're just going to feel exhausted, run down and not motivated whatsoever to diagnose more. Because why, what does it do to benefit them or their patients at this point? So I think what we need to get down to is how can we encourage and support the hygienist to where now they have the support, the front office support, to have these conversations so they don't have to and be embarrassed or feel weird about those conversations. Because we're clinicians, like we should not be focusing on financial conversations, although that's important.

Speaker 2:

Sometimes it's not the time or place when we're diagnosing SRP. Yeah, we need to have time to schedule these patients for SRP. I think that's another thing that when we're doing all these bloody pro-females, you know that you talk about all the time. Erica, we're diagnosing gingivitis, okay, but maybe we're treating it, maybe we're not, or documenting for it, but we're just pumping people through and we're not. We don't even have the space. Even if you did diagnose SRP, do you have the space in the next three months to put them on the schedule within two weeks for SRP? And I don't think anyone thinks about that. But from a hygienist perspective, we're like well, I don't want to diagnose SRP because I can't get them in for another three months.

Speaker 2:

And you're not doing the patient any favors by putting off treatment, but we're already like we don't have any time.

Speaker 2:

We don't have any time in our schedule and so we just treat without really documenting for it or billing for it, but we're still doing right by our patients and I think that's what is important to note. We're not doing SRPs, we're not not doing gingivitis cleaning. We are doing them, we're not documenting for them and we're not billing for them because we don't have time and we're not supported by the staff in a lot of ways. I'm going to stop you there because oh, no, no, no, no.

Speaker 1:

We definitely hear the passion coming through Like it's, I mean you're a hygienist, you day and we speak to hygienists all the time with low perio performance percentages.

Speaker 1:

Where I wanted to stop you is I do believe that as a front office team member myself you know I'm a biller, I've been an office manager I think we can do better. I think part of what we do when we're training our clients' teams, the front office, really needs to be educated on how they can better support the hygiene department. And understanding, you know, hygiene department and understanding you know scheduling timeframes, understanding when a patient should come back. So if the patient has a gingivitis cleaning, we have a standard protocol as to how much time the next appointment is going to be, what the next appointment is going to be, you know, and all of those things. So I don't think that that's emphasized.

Speaker 1:

I know myself as an office manager. I'm thinking back to, you know, the old days when I used to manage offices. I never took that into consideration. I was always production driven, collections, goal driven, because that's my job. My job was to drive collections, was to make sure that case acceptance was up. But nobody ever taught me as an office manager. Nobody ever taught me how can I support my hygienist in a way that she can hit goals Right.

Speaker 1:

So I think that when we talk about overall perio performance percentage, this also does not represent it doesn't represent that individual hygienist, because you know that that hygienist wants the time to spend with their patient. We have to emphasize that it is so important that as you diagnose your current perio performance percentage, we also take a look at all of the things that can support. You know, are we do we have protocols like for a class two, class three, srp and maybe I'm not stating this right, but you know, if it's a, you know, a newly, a new perio patient versus somebody who's had perio for quite some time and never treated it, so it's going to be a little more tenacious than the other patients Like, do we have protocols for things like that? You know, are we giving the hygienist one hour across the board, regardless of the type of perio that they have? Should they have an hour or 15 minutes more? Let's be.

Speaker 2:

Well, that's one of the things. Is we really need to give the hygienist the room to say this patient's really hard, I'm going to need two hours, or I'm going to need two and a half hours, and they tell the front desk that. And the front desk? I mean, I've been front office, I've been office manager myself too, as well as hygiene, and sometimes at the same time.

Speaker 2:

And it's like we have to give our hygienist that space and that autonomy to say this is a really hard patient, I'm going to need two hours. And then the front desk is like okay, jen wants to see you for two hours. When can you schedule? Instead of like this oh, you really need two hours. Or, like you know, like fighting us on that because, honestly, we can't do our best if we're not given that time and all the protocols that support us doing that treatment. So you know, we're talking about laser, we're talking about good instruments, we're talking about time to sharpen, we're talking about you know, a lot of us are moms and some of us need time to pump.

Speaker 2:

I mean, who knows what does that mean? Yes, and so I just, I guess, from a whole office view man I've worked in some wonderful offices where, like, the front desk supports theienist, they're like what do you need? What do you need?

Speaker 2:

And they're just like there you know for them, and that is where we see the best period performances, is where everyone's supportive the hygienist, will you know, doctor comes in for an exam and the hygienist is like I, you know, I treatment plan for a quadruped SRP where you have some scheduled for this date and this date, where you have them scheduled for this date and this date, and the doctor's like great, I think that's really great, jen has you down for that. And it's that supportive environment that supports the hygienist and ultimately takes care of the patient.

Speaker 1:

Yeah, I agree with you. That's why I'm saying when you're looking at your perio performance percentage and we will put the formula for you to diagnose your office in the show notes and we will also put our email addresses in case you have any questions we will also tell you which reports to pull so that you know how to get an accurate perio performance percentage. When you do this, to get an accurate perio performance percentage, when you do this, don't look at this just from a hygiene department perspective. Really, take a look at A what is your hygiene goal? B, you know, are we giving our hygienists enough time to accomplish the things that they need to, enough time to accomplish the things that they need to? And let's list those options. So walk us through the perfect hygiene appointment from a hygienist right. So like what would that look like.

Speaker 2:

Ultimately, front desk patient comes in, we have all of their updated insurance information, benefits and eligibility have been checked and we have a benefit breakdown of what their plan allows. Moving back, we want to make sure we go over medical history, ask if they have any issues, any complaints that's been bothering them, anything like that. If so, we may need to redirect and take you know if they're planned for four bite wings, because that's what they're you know. Quote unquote, due for I don't like due for x-rays, but if they're due for x-rays, then maybe we need to add a PA in there.

Speaker 2:

Or they have a root canal that was done a year ago. Maybe we need to add a PA in there. Ask them if there's any updates to their dental history. Are they getting ortho? Have they done any surgeries? Anything like that's super important. Any new medications I always, always, always go over medical history at each appointment.

Speaker 2:

You know by this point in the appointment we're already 50 minutes in. So think about that when you're thinking about you know, time wise. Then we sit them back. If it's been more than six months for perio charting, I'll do a full perio chart. I love having an assistant to do that for me. It goes, you know, very, very quick if they're able to come in and help. If they're not, that does take quite a bit of time. So if you can support your hygienist and have an assistant dedicated for hygiene especially if you have multiple hygienists, that's super important Then after perio charting, we'll kind of talk through that while we're doing it as far as oral health care, where we're seeing bleeding points, those types of things, and then we'll go into diagnosing.

Speaker 2:

So even if they are a preventive type of clean, if they're a pro-P patient, I will still go. You're doing a really great job. There's a couple areas that we want to focus on for next time, but today we're going to do a preventative cleaning for you, and I say what they're doing every single time, like we're doing a prophylactic cleaning for you. Today we're doing a gingivitis cleaning. Today for you, we're doing an SRP Do you have any questions? And that way they know what they're getting and if I say something that doesn't match with what they're doing they'll always

Speaker 2:

ask me, and after that I perform the cleaning, whatever that may be. And then there's x-rays prior to as well, if that's necessary, and then afterwards we go into oral health care instructions in depth, specific to the patient. That is really important. I usually print them off, like a Colgate has a really good tool it's called the Gum Health Tool, I believe and it's all online and it's something you can print off and physically get to the patient and then put in their chart.

Speaker 2:

So when they come back for their next cleaning, at the end of the appointment I always say you know, hey, we're going to work on the upper right bleeding. I want you to really work on that for next time and we'll check to see how you're doing. I always give them homework so it's not like, oh, you're doing a great job, keep doing what you're doing. It's like something specific that's tangible, that I can check next time. And then I put that in the notes at the very end. So the front office knows and wants to check the upper right bleeding next time, and so we have that communication between the office in the clinical notes. So from there then I schedule their next appointment, make sure that they're on the schedule, whatever interval that that is, and then I walk them up and verify everything with the front office so they can walk everything out correctly, and during all of that I update my notes as I'm going.

Speaker 1:

And I love when you're coaching our clients and we have the front office staff. We have the front office and we have the hygiene department hygienist present. I love how you emphasize that collaboration between the front and the back, because it does make the appointment a lot more intentional. Right Like we, every minute that you have with the patient is spent, you know, checking off the next thing. You know check box number one, number two, number three. So I love that you do that. But you also talk about in in your training, is there? There's a part of the clinical notes that you put in there and it's kind of like layman's terms, right, like you will write that out so that the front office can reemphasize or reiterate what it is you want to see the patient back for. Can you talk about that a little bit?

Speaker 2:

Yeah, so I call it the RFR, the reason for return. So this is at the very, very bottom of the note and it's on every single patient. I don't care if they're healthy, if they're three years old, if they're, you know, 55 and needing SRPs, I always have a reason for return because they will always need to return. Right, it's just a matter of why, and so I don't put that in clinical terms because not, um, not always is front office trained on, like hygiene terminology and all of that. So I just put it in a very simple format. I'll say check upper right bleeding. Or I'll say, continue to see improvement in their oral health, or see if they use their water pick. Or, um, you know, make sure, make uh, check to make sure that the four millimeter pockets went down on the upper left or whatever. That is, um, but just like that, make sure the pocketing went down.

Speaker 2:

Yes, just very simple, like four words. And then when I go up front, if I'm running behind and I can't schedule them and they go up front, they can pull up my note. My note's already done, like by the end of my appointment, my note is done and I don't go back. I don't't have to redo my notes. I don't stay late through lunch, I do it throughout the appointment.

Speaker 2:

So at the very end when I'm scheduling their appointment I will say I want to see you back for the upper right bleeding. And then on that RFR line I will put check upper right bleeding. So then when they go up to the front and maybe I didn't schedule or something the front can say hey can say, hey, jen wants to check that upper right bleeding. Without even talking to me. I don't go up there and say, hey, I need to check their upper right bleeding, in front of all the upper patients, all of the patients, you know. But it's a conversation piece for the front. And then if the patient falls off the schedule for whatever reason and we're calling and doing that hygiene recall phone calls we can say, hey, jen saw you in May of 2024, and she wants to check the upper right bleeding. So we really need to get you back for that, and so it gives them a reason to come back.

Speaker 1:

And I think that the RFR is so powerful when it's implemented properly and everybody just kind of gets the flow of things. And this is the final piece in of the checklist that we teach is you know, make sure that everybody and you can do this on the restorative side, on doctor's side too. You know, the RFR it's just a great tool to have for recall. It's a great tool to have for, you know, incomplete treatment, that incomplete treatment report that we have to work. You know, incomplete treatment, uh, that, that incomplete treatment report that we have to work, you know we have to. It's one of those, um, I think they refer to it as a downtime task, but I don't think we have downtime, uh, in the office.

Speaker 2:

There's no downtime now.

Speaker 1:

We're all all under staff.

Speaker 2:

There's no such thing as downtime.

Speaker 1:

So, um, I think I heard a dentist tell me recently that she went to the front office and this front office team member had her feet up on another chair the radio and was basically just up there singing songs. Um, and I remember the doctor, she called me to talk about this and I think vent a little bit and she said I cannot believe it. She was. We're back here running around and she's in the front singing along with her favorite songs.

Speaker 2:

So I mean, if you're singing along while you're working on recall, sure there is always something to's fine, there is always something to do, always something to do.

Speaker 1:

Let me ask you this. I just want your thoughts on this. This is kind of a random question, but what are your thoughts on hygienists working on their own schedule?

Speaker 2:

I have mixed thoughts on that. So if we have an SRP that cancels or something, and we sharpened our instruments and we're prepared for the day ahead and all of that, then sure, go up and call us, call some patients and try to get them in. But I don't think that should be our primary job, like we need to be focusing on production. You know, we can go get the patient's number for the doctor, you can go help in sterile, you can go help chart for another hygienist. There's clinical things that I think should be priority for hygienists other than filling their schedule.

Speaker 2:

If an office has two front office and they can't fill the schedule, that may be a systems problem. Right, we need to have some systems in place so that that can happen and that's part of that whole. You know, office working together. I man, there was one office I worked at just recently that those front office girls were so on top of it. I mean I would have like a four o'clock opening and be like cool, I get to go home, and it was like still so fast.

Speaker 1:

Oh yeah, well, that's when you have scheduling systems in place. I mean as a front off, a billing coach, and you know, essentially it's billing encompasses all things front office. I mean, let's be honest. So as I go through and I look at different offices and how they utilize, and I look at different offices and how they utilize or either maximize or underutilize their, the power of their practice management software, it's amazing to me how many offices do not use the ASAP list. It's amazing to me many offices don't ask if, if something opens up around the same time as your appointment, would you be willing to come in sooner than your appointment. That is how you can really quickly fill a hole you know in your schedule is by having those conversations.

Speaker 1:

So for every hygiene appointment, I tell my teams make sure that you ask the patients. If something opens up prior to your appointment around the same time, would you like us to give you a call? Some patients will tell you, no, I won't be able to come in sooner than this, and so you're not going to call them, you're not going to put them on the ASAP list. But there are patients that would say, yeah, that would be great. And so now you have four o'clock hole. You have other four o'clock patients scheduled in the future that are willing to come in sooner. The likelihood of you filling that last minute hole is pretty good. You know, it amazes me how we are not having the right conversations um to make sure that our schedules are remaining full um, but I I love how you know. You said that the front office if there's two front office people and the hygienist has holes in her, his or her schedule, we got a front office issue that's not a hygienist issue.

Speaker 2:

right, like that is a front office issue and I think that's really frustrating.

Speaker 1:

And again, I don't believe that this stuff is an individual performance issue.

Speaker 2:

No, not at all.

Speaker 1:

Somebody who doesn't want to know how to do better, like, if we're talking about an individual who does not have the willingness to improve, then we have an individual issue right. Like, then that's just somebody that needs to go right. I don't want anybody on my team that's not willing to learn more or willing to improve. So, but if it's a skill set issue, if it's something we can teach them by giving them the right tools, the right scripts, the right systems to maintain the schedule, then now we've got an ebb and flow that just makes it easy to keep the schedule full. So you know, I 100 percent. That's why I wanted to ask that question. I kind of knew which way you were going to go.

Speaker 2:

100, that's why I wanted to ask that question.

Speaker 1:

I kind of knew which way you were going to go. Um, but yeah, I agree 100. Um. This is an admin challenge. That, um. If you find, if you're an office, you're a hygienist, a dentist listening right now and you find that your hygiene schedule is continues to fall apart, it's a systems issue it's.

Speaker 2:

It's holy, but not in the best way. Yeah.

Speaker 1:

Yeah.

Speaker 2:

We don't want a holy hygiene schedule.

Speaker 1:

We don't want that.

Speaker 2:

No, I think sometimes we do have an inside perspective of like who could come in, and in that sense I will go up to the front and be like hey, you know, jane Smith wanted to come in this day, you can call her. Or if I have a patient the next day that I know will want to come in earlier, I'll give them a heads up. But I don't typically make those phone calls because my time can be utilized elsewhere in the back. But if everything's been done and everybody's up to date and everyone's taken care of and the doctors are numb doctors, everything's been done and everybody's up to date and everyone's taken care of and the doctors are numb their doctors, patients are numb and everything's good to go, then I'll go up front. And I think sometimes it can be powerful for a hygienist to call a patient if they're especially difficult to get in if they're particular to youth especially.

Speaker 2:

you know, if they're like prefers Jen, then if you call that patient, they're going to be like oh yeah, jen, I'll be right there, you know. So there is instances where I feel like that can be useful, but I'm and honestly, pay is better spent in the back for hygienists, where we can maximize production.

Speaker 1:

Oh, absolutely, absolutely Okay. So we've talked to everybody about you know why it's important to do your own diagnosis. I want to challenge the listeners to diagnose their own office. We're going to give you the formula, the tools, the list of reports you need to pull. I think it's only going to be one report. I could be wrong. Regardless, it's going to be in the show notes In our next episode on this perioperformance hygiene performance series. We're not talking about supplemental as, in addition to we're talking about, you're already doing these supplemental procedures. You're just not documenting in a way that we can bill for them. Give us an example of one supplemental procedure that hygienists are doing but they're not getting credit for.

Speaker 2:

I would say the number one is the desensitization. From what I've seen in all the practices that we work with, that is one that they do as a courtesy. They usually call it a courtesy for the patient, helping them not be sensitive on that cervical surge during a cleaning. But that is a billable service, so that is something that we can maximize the insurance for. If a patient is paying for this insurance, we should also be getting paid for what we do, because that is something that the office pays for too. So it's an expense that the office has that we should be getting reimbursed for at some point. So desensitization is my number one for sure.

Speaker 1:

Yeah, I've heard you talk about that a lot and I've also seen the hygienists agree with you, like I've also seen them go. You're right, I do that. I know when I go and get a cleaning, I think it's number 13 is always sensitive and I always get some type of desensitization around that area. So I know for a fact, I have had it.

Speaker 2:

Yeah, I have too, and I never see it on my EOB.

Speaker 1:

I don't either. I don't. My hygienist has done that and I've never seen it in the clinical note. So it was something that I had to teach him how to do Mental note. The first time he did my cleaning I was like he just put desensitizer on 12 or 13. I wasn't sure back then. And then I went back and I read the note and I was partnering this office with friends, so I was able to go back and read his clinical note and there was no mention of desensitization around that area and I showed him and I said how am I supposed to bill for this?

Speaker 1:

I know you did it. He goes no, you're right, I did. I didn't know I was supposed to document it. And I said well, how am I supposed to bill for it if you don't document it? That's that I mean. And your patients aren't going to come back to you and say, hey, you know, you didn't document everything you did. They're just going to go. But I was. I'm a different kind of patient, jen.

Speaker 1:

I'm going to put our contact info into the show notes and I'm also going to get that formula in there for them so that they can diagnose their own office. And if anybody wants to email us and let us know, we have yet to find an office that is over the. Jen has her benchmarks. Jen, your benchmark is a minimum of 60% perio performance percentage and I don't think we've ever seen an office that is above your bare minimum performance. We've had one office that was at 56% when they did their initial diagnosis, but we want to be closer to 80. And the reality is we want to be like at 80% or higher if we can, but 60 is what you say is the bare bare minimum.

Speaker 2:

Yeah, and I think we talked about this on the last one too, but it's because of a statistic from the CDC like this isn't a number that we just pulled out of our hats and said no percent of your office needs to be. You know this is based on statistics that show how many Americans have periodontal disease. So you know, if we're taking care of our patients, billing and documenting correctly, then that number should easily be at that 60%. So that's where that number comes from.

Speaker 1:

And if anybody has any questions, feel free to reach out to us Now. You have no excuse not to know where your perio performance is, and if you want to know how to improve that number, then you want to tune into the next episode. We're going to talk about how to improve your perio performance percentage, so make sure you know your number before you listen to the next episode.

Speaker 2:

All right, Well then we'll see everybody in the next episode.

Speaker 1:

Bye for now, friends.

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Ericka Aguilar

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