Dentist blog from Delta Dental

Category: Reminders (Page 1 of 8)

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Reminder: Complete your annual General Compliance and FWA training

Are you a Medicare Advantage dentist? If so, remember to complete your annual General Compliance and Fraud, Waste and Abuse (FWA) training. This training is a Centers for Medicare and Medicaid Services requirement that allows you to participate in the Medicare Advantage network.

Who needs to complete this training?

You need to complete this training if you’re a Medicare Advantage contracted dentist with any of the following companies:

  • Delta Dental of California – CA
  • Delta Dental of the District of Columbia – DC
  • Delta Dental of Pennsylvania – PA & MD
  • Delta Dental of West Virginia, Inc. – WV
  • Delta Dental of Delaware, Inc. – DE
  • Delta Dental of New York, Inc. – NY
  • Delta Dental Insurance Company – AL, DC, FL, GA, LA, MS, MT, NV, TX and UT

Your training must be completed within 90 days of joining the network and then once annually.

What do I need to do to be compliant?

In addition to completing the FWA training, you’re required to have a written ethics guide and code of business conduct in place for your practice. To meet this requirement, you can incorporate a copy of Delta Dental’s Ethics Guide (PDF) into your practice guidelines.

If you still need to complete the FWA training, don’t forget to also incorporate Delta Dental’s Fraud in Federal Health Care Programs guide into your training.

For additional Medicare Advantage compliance and training information, see Delta Dental’s trainings and events for dentists.

On-site quality assessment review checklist for 2022

In California, the Department of Managed Health Care (DMHC) requires that all dentists receive yearly on-site quality assessment (QA) reviews. These reviews evaluate how the many components of your practice compare to the expectations of dental professionals, regulatory agencies, dental educators and Delta Dental.

Your QA review will focus on two parts of your practice:

  1. free iliad papers term cialis generico sin receta john glenn speech essay drugs in sport can taking too much cialis click click watch thesis first person md pharmacy discounts cialas follow site power elite essays disney dreamer and doer essay examples sugril 5mg cialis source site causes of smoking cigarettes-essay follow link book thesis statement examples follow url drug interactions with lexapro cheap essays editor websites online go to site writing your thesis fuesmide but wo prescription my daily programme essay go to site go to site how to write an essay intro Structural (about 20 minutes). Review of your facility and equipment, as well as emergency, sterilization and infection control protocols.
  2. Records (about an hour and 45 minutes). Review of patient treatment documentation for relevance and acceptability under current standards of patient care.

The easiest way to prepare for an on-site assessment is by getting acquainted with the aspects of a QA review. Follow the checklist below to understand what will be checked during your assessment.

Structural review

The structural review involves an assessment of the facility and equipment, as well as sterilization protocols.

Facility and equipment

  • Facility is clean and well maintained.
  • Dentist name and office hours are posted.
  • Procedure manual includes protocols for appointments, complaints, broken appointments and specialty referrals.
  • Accommodations exist for patients with disabilities, such as wheelchair access and a grab bar in the restroom.
  • Waterlines have anti-retraction valves installed and are maintained with properly flushed handpieces.


Sterilization and infection control

  • Staff is trained in infection control standards, and procedural logs are kept.
  • Gloves, masks, protective attire and eyewear are used appropriately.
  • Weekly biologic monitoring is conducted and records are kept.
  • Instruments and handpieces are properly sterilized, stored and labeled.

Safety and emergency procedures/equipment

  • Drugs, syringes and needles are properly stored, and a log is kept of drugs dispensed on site.
  • Required certifications are up to date.
  • A modern evacuation system exists for nitrous oxide.
  • Written office protocol includes staff responsibilities for evacuating patients in emergencies or natural disasters. The evacuation plan with clearly marked exits is displayed.
  • An active contact system can reach the dentist 24/7.
  • A portable emergency oxygen is available, full and there is a positive pressure valve and/or Ambu bag; staff are trained in its use.
  • Mercury hygiene and safety requirements are observed.
  • Medical emergency kit is up to date.

Records review

The records review involves a review of your patient care documentation.

Medical and dental history

  • Medical history forms include yes/no questions, identify patient’s existing conditions and contain comprehensive health information.
  • Dental history includes baseline information, TMJ/occlusion status, appliances, periodontal condition and results of soft tissue/oral cancer exam.

Treatment notes

  • Progress and treatment notes are legible and in ink.
  • Included, as appropriate, are: 
    • Referrals to specialists
    • Records forwarded or received
    • Anesthetic used (type, amount and concentration of any vasoconstrictor)
    • Medications prescribed
    • Laboratory instructions

Quality of care

  • Professionally acceptable standards of care are observed for: 
    • X-rays — adequate number, appropriate frequency, of diagnostic value, mounted and labeled
    • Treatment plan — in ink, consistent with diagnosis and exam findings, alternative and elective treatment documented with the patient’s choice and reason
    • Treatment sequence — in order of need
    • Informed consent — documentation that treatment plan was reviewed and patient understands risks, benefits, alternatives and costs; any refusal of recommended care is documented

Outcomes of care

  • Patient records demonstrate effectiveness of preventive care.
  • Overall comprehensive documentation demonstrates that treatment was provided as appropriate, including: 
    • Good prognosis for appropriate longevity
    • Evidence of need (x-rays, pocket charting, etc.)
    • Minimal unplanned treatment or retreatment
    • Referral to a specialist in a timely manner
    • Post-operative instruction given
    • Follow-up (pocket charting, x-rays, etc.)

After your review, you’ll be notified of the findings by mail. If you fail any part of the inspection, you’ll be asked to respond to show that you’ve corrected the error. Outstanding errors or repeated failures on follow up inspections may result in a referral to Delta Dental’s Peer Review Committee (PRC).

This list highlights just a few aspects of a QA review and is a useful tool to help you review your practice through the eyes of the QA examiner. Please refer to the Quality Management section of the Delta Dental Dentist Handbook for information on the Quality Assessment process and a list of all requirements. Together with your staff, you can evaluate your office policies and procedures and be even better prepared for a future on-site QA review. For more posts about QA reviews, check out the quality assessment category.

Let us know when there are changes at your practice

Running a practice can be hectic, and it’s easy for details to slip through the crack. However, it’s essential to let us know about changes like a retirement, a practice name change or new dentists on staff.

What changes does Delta Dental need to know about?

Per the terms of your contract, please make sure to notify Delta Dental of any changes to the following information, ideally 30 days prior to the change if possible:

  • New practice name
  • New office location or primary phone number
  • Change of address
  • Tax ID changes (your W-9 is required for us to process any tax ID changes)
  • Sale or closure of practice
  • Dentists joining or leaving a practice location (contact us to request an application for network participation)

How do I let Delta Dental know about these changes?

Forms for reporting these changes are available at our website. Once you’ve submitted the necessary forms, we may contact you to verify the information before we update our records.

What else do I need to know?

Once you’ve submitted an administrative form, you generally don’t have to take any extra steps. However, there are a few things to know about the process.

  • It takes about four weeks processing time from the date we receive your form for the changes to be reflected in our system. You’ll receive confirmation of the effective date from the Provider File Maintenance department.
  • Until our systems are updated, claims will continue to be processed with the information on record.
  • The processing time for dentists in Maryland is no more than 15 working days after we receive your administrative form.

Thank you for helping us keep our records up to date! We’re proud to be your partners in ensuring that your patients get great care and that you get paid quickly and effortlessly for the work you do.

Help patients find you by updating your directory listing

Your listing in Delta Dental’s online directory is a free and easy way to attract new patients. But it works only if your information is current and accurate.

Millions of Delta Dental patients rely on the directory to find a dentist who meets their needs. To ensure that you’re getting the full potential out of your directory listing, take a few minutes to review it. Especially in light of the current pandemic, make sure you’ve noted any changes to your contact information or hours. Have any staff who speak another language? Add it to your listing.

Are you ready to review your listing? Relax, it’s easy! Here’s what to do:

  1. Log in to Provider Tools and select My account.
  2. Click on Directory profile.
  3. Go to Actions and click Open.
  4. Update your information as needed.
  5. Choose Save as draft if you’re not yet ready to publish your updates, and select Publish when you’re ready to go live.

That’s it! To make sure that patients always have your most recent information, we recommend setting up a yearly reminder to check your listing for accuracy. And don’t forget to verify your other online listings, such as YelpFacebookGoogle and Apple.

Remember to discard these one-time use items

Proper use of single-use and disposable items is key to passing QA reviews, but sterilization and infection control procedures are often misunderstood or overlooked.

What do I need to know about single-use items?

Before examining single-use items, it’s important to understand the definitions of critical and semi-critical dental items and instruments.

  • Critical items and instruments are those which penetrate soft tissue or bone or enter into contact with the bloodstream or other normally sterile tissue. Some examples are bone chisels, scalers, forceps and scalpels.
  • Semi-critical items and instruments do not penetrate soft tissue or bone but do come into contact with mucous membranes or non-intact skin. Some examples are mirrors, amalgam condensers and reusable impression trays.

All critical and semi-critical dental items and instruments must be heat sterilized unless doing so would damage or degrade them.

What about critical and semi-critical items that are damaged by heat?

Heat sensitive items are available as single-use disposable items and include (but are not limited to):

  • Foam and plastic impression trays
  • Plastic air and water syringe tips
  • Plastic saliva ejectors and high-speed evacuator tips
  • Plastic mouth mirrors and prophylaxis angles
  • Prophylaxis cups and brushes
  • Pumice used in laboratory lathes
  • Cotton products, such as gauze
  • Patient care gloves, which should be removed and disposed of every time staff steps out of the operatory for any reason

Equipment and instruments labeled as “single-use” or “disposable” must never be sterilized and reused.

How can I store my single-use items?

Acceptable storage for sterile instruments and disposable items includes containers, drawers and cabinets that can be closed off from the external environment.

Unacceptable storage places include under sinks or other spaces where sterile instruments and their packaging might become wet or damaged. You should also take care not to store heat sensitive items in areas where they be exposed to rapidly fluctuating temperatures, such as near vents.

How should I dispose of single-use items?

Contact your local waste management service for instructions about the proper method of disposal in your area. California’s Dental Practice Act specifies: “Contaminated solid waste shall be disposed of according to applicable local, state, and federal environmental standards.”

One way to be sure you’re on the right side of disposal standards is to check with the Occupational Safety and Health Administration (OSHA). Many laws about the proper disposal of items are based on OSHA standards, so they can be a handy reference for broad guidance.

How does using single-use items affect my patients?

For patients with concerns about infection control and prevention, explaining that disposable items are single use items may help put them at ease.

  • Reassure your patients. Tell them that their health and safety are important to you. Let them know about the infection control procedures your office follows, particularly those developed by the Centers for Disease Control and Prevention and any required by state or local authorities.
  • Describe the infection control practices your office takes. Point out the steps you take like hand washing, use of personal protective equipment, decontamination of surfaces, use of disposable items and sterilization of non-disposable items.

Remember, patients will observe firsthand your commitment to their well-being and quality dental care.

Proper usage, storage and disposal of single-use items help you avoid quality assurance issues and protect yourself, your staff and your patients.

Is your directory listing helping patients find you?

When was the last time you confirmed your Find a Dentist directory information is correct? It only takes a few minutes, and by making your directory listing as accurate as possible, you’re setting yourself up for success!

Your directory listing is key to helping patients find you. If you’ve recently changed your hours, hired a staff member who speaks a different language or made any other updates, consider revising your listing. You should also confirm all contact information is correct so patients can schedule an appointment.

Here’s how to update your listing:

  1. Log in to Provider Tools and select My account.
  2. Click on Directory profile.
  3. Go to Actions and click Open.
  4. Update your information as needed.
  5. Choose Save as draft if you’re not yet ready to publish your updates or select Publish if you’re ready to go live.

Remember, your listing can and should be revised anytime changes are made to your business. We recommend setting up a yearly reminder to check your listing for accuracy. While you’re at it, be sure to verify your other heavily searched online listings such as YelpFacebookGoogle and Apple.

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