Business Administration for a Dental Office

Making filing efficient

1. Separate the files into their appropriate groupings. For instance, gather all the dental records together, client education handouts together, and so on. 2. Be sure that all the pertinent and updated information is in each of the files. Also ensure that all appropriate entries have been made in the medical records before they're returned to their shelves. 3. Begin the filing process. If you're filing dental records folders, arrange them in the appropriate order, either numerically or alphabetically, before filing them.

Managing distractions and interruptions

If it's an exceptionally busy day at the office, explain this to the caller. If you need to be off the phone for more than 30 seconds, offer to call him or her back within a few minutes. If the person prefers to wait, put the call on hold rather than just placing the receiver on your desk or the counter. Remember, too, to thank the caller for his or her patience.

Daily plans

If you use your calendar as discussed previously, many of your activities already will be recorded for you to complete. The items on your calendar would then become your list of things to do for the day. A daily prioritized list is the best way to focus your attention on your most important goals. Work from the top of your list. If unexpected demands come up, assess their priority and handle them accordingly. Don't use something unexpected as an excuse to distract you. At the end of each day, review what was accomplished and carry forward any items on your list that need completion. Reprioritize these with tomorrow's new items. A format for your list isn't important; any format that's comfortable will work.

Registered mail

Important papers such as deeds, wills, negotiable bonds, contracts, and valuable merchandise are often sent by registered mail, as this is the most secure option the United States Postal Service (USPS) offers. Registration involves declaring the value of the items being sent for security and insurance purposes. The valuables receive special handling through the entire mailing process. There's a registration fee for insurance protection that covers items worth up to $25,000. If a return receipt is required, this can be obtained for a small additional fee.

Telephone techniques

In a typical PBX system, an operator or receptionist handles the incoming calls. On a PBX system telephone, you dial an extension number to reach another person within the company (Figure 4). To call another company, you dial "9" to gain access to an outside line and then dial the telephone number you want. Many PBX systems offer features to control and lower the costs of long-distance calls. Long-distance calls may be available from any outside line or may require a special access code. Some systems keep a log of long-distance calls so that telephone usage can be analyzed.

Answering calls

Answer the phone promptly. Try to answer the telephone by the second ring. You can build a reputation for efficiency by providing fast telephone service.

time management

As a dental administrative assistant, often you'll be called on to behave as a juggler. Constant demands will be placed on you to perform multiple tasks, possibly from several individuals. You'll answer the phone, process mail, make copies, respond to emails, grab coffee, and arrange a meeting—all in the first hour of a given day. This section will show you how to handle your workflow, how to use some helpful tools to plan your work schedule, and how to accomplish your goals and objectives in the most efficient and effective way.

Basic bookkeeping

As a dental administrative assistant, you may be asked to complete some light bookkeeping tasks, such as keeping track of financial transactions, maintaining the petty cash fund, or reconciling a monthly bank statement. This section will teach you how to accomplish those tasks as well as the meanings to a few introductory accounting terms.

Refrigerated shipments

Certain items that are ordered for a dental practice must be refriger- ated or frozen during shipping. Vaccines, many laboratory supplies, and some medications may fall into this category. Upon arrival, these boxes will usually be marked with labels such as "Perishable," "Refrigerate upon Arrival," or "Keep Frozen".

Answering and placing calls

Identify yourself. When you answer outside calls on the office telephone, identify the office or organization as well as yourself. For example, you might say, "East Coast Dental, Ms. Simmons speaking," or, "Good afternoon, this is Mr. Carlton at Happy Smiles Dental Office. How may I help you?" Mentioning the business or organiza- tion in the greeting lets the caller know if he or she has dialed the correct number. Saying your name lets the person know who has been reached.

Telephone techniques

A more modern style of phone system in offices today is called Voice over Internet Protocol, or VoIP. This system allows telephone calls to be routed over the Internet rather than traditional telephone lines. For some businesses, this cuts long-distance costs significantly.

Accounting terminology

Accounts payable bookkeeping is the management, verification, and prompt payment of expenses for payroll, supplies, rent, and other costs of the dental office. Also known as overhead, it's the dentist's cost of doing business, and it involves paying for expenses and services such as taxes, insurance, salaries, payroll deductions, utilities, and supplies and equipment.

Accounting terminology

Accounts receivable bookkeeping is the recording and managing of all patient account transactions within the dental office. It concerns financial transactions, which are financial entries made to an account record. There are three types of transactions: charge, payment, and adjustment. The charge increases the account balance, the payment decreases the balance, and the adjustment either increases or decreases the balance.

Organizing contact info and call logs

After locating a number, it's best practice to keep a list of commonly called numbers and extensions in an address database, Word document, and/or Excel-type spreadsheet. Frequently called numbers can also be stored on speed dial in certain telephones, such that you only have to push the appropriate button and don't need to dial the entire number. If you place telephone calls on behalf of your business, your employer may require you to keep either a written or comput- erized daily log of your telephone calls. Sometimes it becomes important to have a record of an individual's call. Also, the telephone log becomes useful to the accounting department in reconciling the phone bills each month. The log also becomes useful in helping management measure client-communication effectiveness as well as scheduling future appointments.

Logbook

All details of controlled substances must be recorded in the controlled substance logbook. First, the delivery of an unopened order to the practice's central supply is recorded in one part of the log. Then, when a container is opened to dispense medication to a patient, that action is recorded on a different page of the log. Every tablet or capsule of every controlled substance must be accounted for in the logbook. Every milliliter of a controlled injectable medication must also be recorded. The controlled substance logbook should include the: Patient's name Date Amount dispensed Amount remaining Name(s) of individual(s) authorizing the use of the medication Name of the individual actually handling the medication.

The purpose of dental records

Because of the legal nature of dental records, all pertinent information should be recorded completely, accurately, in a timely fashion, and written legibly and in ink—never in pencil. If a mistake is made, a single line should be drawn through a mistake and initialed. Then, the correct information should be entered and initialed next to the mistake. Don't erase, scratch out, or blot out mistakes. Dental records should be maintained continually so that they may be reviewed at any time. Yet another purpose of dental records is to provide the means to track certain data within the patient population. Dentists can collect statistical information about certain issues. For instance, how many cavities were detected in the practice within a certain time period? How many root canals have been performed by the practice? A dentist can also gather information about the makeup of his or her overall patient base by referring to dental records. It's possible to determine the average age range, location, and more of those in the patient pool.

Refrigerated shipments

Refrigerated and frozen items must be processed and stored in a refrigerator or freezer immediately upon arrival to prevent the con- tents from warming. When you receive such a package, check for the following important things: 1.The shipping date on the package. Ensure that no more than 48 hours have passed since the package was shipped. If more than 48 hours have passed, there's a danger that the items may have been exposed to extreme heat or cold and are therefore unsuitable for use. 2.The frozen state of the ice packs. Packaged items should be in sealed plastic bags to prevent them from getting wet from condensation or melting ice.

Action planning worksheet

These worksheets can vary in complexity. The simpler worksheets show only those steps required to complete a project. Additional information such as beginning dates, targeted completion dates, cost estimates, and who's responsible can be added to the basic worksheet

Capital equipment

equipment that has a fairly long life expectancy and contributes to the income of the practice. Examples of capital equipment include an anesthesia machine, an X-ray machine, equipment for performing dental procedures, and an autoclave (for sterilizing surgical instruments).

Telephone techniques

A Private Branch Exchange (PBX) system is a switching system that connects all of the telephones in a company through a central switching mechanism. The telephones also share access to outside telephone lines. Switching is activated by dialing specific numbers instead of first pushing a key for an open line, which lights up when in use (key system). A PBX system can be used with a much larger number of telephones than is possible with a key system.

Balance sheet

A balance sheet is a picture of a business in financial terms. Comparing balance sheets for two consecutive accounting periods enables you to determine what's happening financially in the business. Assets include anything of value that's owned by the company, including cash, inventory, land, and equipment. Liabilities are what the business owes to creditors. The owner's equity is the total amount of a business's assets, minus its total liabilities.

Handling calls

A caller should never be transferred more than once unless business must be conducted with two or more individuals or departments within the business. By knowing precisely which person can handle specific telephone requests, you eliminate 99 percent of the problem calls. If you're absolutely stumped about whom the caller should contact, ask the person's name, number, and purpose of the call. Tell the caller that someone will call back in a few minutes. Then, you and your coworkers can solve the problem together. This way, the caller won't be left on hold for long or shifted from extension to extension. By showing interest and determination to find an answer for the caller, you're demonstrating that you care and are taking the issue seriously.

The purpose of dental records

A dental record also provides continuity if multiple dentists are involved in a single patient's care. It allows any other dentist to understand, simply by reading it, what the dental history is, what the current problems are, and what's planned for the patient. Another purpose of dental records is to provide documentation of all dental decision making from a legal perspective. Dental records are legal documents, and in the event of any dispute, they protect a dentist and his or her staff by clarifying what was done and why.

Maintaining the petty cash fund

A petty cash fund is cash and change, usually kept in a lockbox in an administrative area, that's used for small, unexpected expenses that usually need to be made in a hurry. As cash is required, money from the petty cash fund is used, and all receipts and any change left over from the purchase goes into the box. Keeping a transaction log to record any deposits and withdrawals in the lockbox is also a good idea. On a regular basis, perhaps once a month, the receipts in the lockbox need to be totaled. The total of the receipts and any cash remaining in the box needs to be compared with the transaction log and equal the original starting amount of the petty cash fund. If you're in charge of the petty cash fund, you'll follow the company's procedure for replenishing the fund, which will likely involve using the business's checkbook to write a check out to "Cash." This cash will go back into the fund.

Equipment and Supplies

A third category of supplies necessary for the smooth functioning of a dental practice is medical supplies. This category includes items like bandaging materials, sutures, needles, syringes, X-ray film, and chemicals used in the laboratory. These items, used in the everyday functioning of the practice, help the dentists and dental hygienists do their jobs. Equally as important as medical supplies are the pharmaceuticals that are used in the practice facility, including anesthesia, sedatives, and so on.

Sorting and handling paperwork

Although much of what you deal with in the office will be electronic, you'll still have a fair amount of paper to deal with on a daily basis. There isn't room to keep every sheet of paper, so you have to determine what's most valuable and what type of action it requires from you. One source of paper is the daily mail. Organizing it is easier if you sort and place it in three piles: 1. Critical—Requires action, has a deadline 2. Medium—Important but not time-critical 3. Low—Eliminated or postponed, or items such as maga- zines, journals, advertisements, and so on Next, discard all junk mail. Look at each piece of mail and decide its worth. Ask yourself what would happen if you threw it away. Do copies of it exist elsewhere? If you can answer nothing and yes to those questions, you're probably safe in discarding it.

Filing system

As an example, a practice using numerical filing of dental records might use end-tab folders and apply the colored numbers to the end or bottom of the folder. Usually a single sticker with the last two digits of the year is applied somewhere on the same tab. Then the dental records are filed on open shelves with the end tabs, complete with numbers, visible to the receptionist. It's easy to see at a glance if there are files out of sequence. Tabbed dividers are very helpful in clustering records with similar number sequences together. For dental records filed alphabetically, the concept is very similar to numerically sequenced dental records. Each letter of the alphabet is assigned a color, and the first two or three letters of the last name are attached to the end tab of the medical record folder. Thus, it's easy to identify if a chart is out of sequence on the file shelf.

How to reconcile a bank statement

At the end of each month, the practice should receive a bank statement, a document that lists all the deposits and withdrawals made from the practice's checking account in the past month. You may be asked to help reconcile bank statements, which means comparing bank statements to other recorded amounts and ensuring that the statement is correct and there are no discrepancies. To do this, 1. Compare each deposit and each withdrawal listed on the bank statement to those noted in your records. 2. Note which checks the bank has cleared, as per the statement, and put checkmarks next to each cleared check in the practice's check register to keep track. 3. Keep track of which checks haven't yet cleared the bank. 4. Review any miscellaneous debits and credits, such as account fees, listed on the bank statement and add them to the practice's accounting records. 5. Note and investigate any differences in amounts. These discrepancies will need to be researched to determine if they're errors in the practice's accounting records that need to be adjusted. If the bank made the error, contact the bank with this information. 6. Compare the statement's ending cash balance with the balance of the accounting records, being sure to add or subtract any reconciling items from the total. (For exam- ple, a check that hasn't cleared yet won't be listed on the bank statement but it might be listed in your records. When reconciling, subtract that check's total from the accounting records' balance.) If the two balances don't match, double-check your work and look for a not-yet-identified item that needs to be reconciled, and, if necessary, reconcile the previous month's statement to ensure that there were no errors previously. 7. Staple all reconciling items to the bank statement upon finishing the reconciliation and file it in the appropriate location.

Telephone techniques

Automatic PBX systems, in which code numbers are used instead of outside-line operators, are commonly used in business today. These automatic systems are specifically known as Private Automatic Branch Exchanges (PABXs). Most automatic systems used today are computerized and may also be called Computerized Automatic Branch Exchanges (CABXs).

Collect on delivery (COD) mail

COD means that the post office will take responsibility for collecting both the postage and the fee for the package's contents. Some companies ship products such as books, records, and tapes COD, and the money is returned to the company upon delivery. Naturally, the postal service charges a higher rate for this service. COD can be used for sending materials by first-class, express, priority, registered, and third- and fourth-class.

Call forwarding

Call forwarding allows you to forward any incoming calls to another extension. For example, if you go to lunch, you can have calls forwarded to another phone so that another employee can take messages for you. Or, if you're going to be away from your desk and don't want to miss an important call, you can temporarily have calls forwarded to the extension where you're going to be. However, don't forget to cancel the forwarding command upon returning to your desk!

Call waiting

Call waiting is used when there's a single line, and it alerts you that another call is waiting. When you hear the call- waiting tone, you can choose to ignore it or briefly put your caller on hold while you attend to the waiting call. This feature is available on regular phone systems as well as voicemail systems. When a call is camped on your line, the caller is waiting while you're on the line with another person. As soon as you hang up, that call rings on your extension. This feature is available on both regular phone systems and voicemail systems.

Dental Records

Dental records, also referred to as patient charts, are the heart and soul of every dental practice. They're dynamic documents that contain pertinent information on each patient and record the sequence of events each time the patient is seen by the dentist. Each dental record must contain a certain minimum amount of information, including the patient's: Name, address, and telephone number Medical and dental history Examination and treatment records Correspondence related to the patient's care Prescriptions and laboratory work orders Radiographs

Ledgers

Each business transaction needs to be recorded twice: once by the date (or chronologically) and once by individual account and classification. Books of original entry, such as the journal, are arranged by date. You'll enter each transaction into the journal in the order it happens. This method of recording business transactions provides an excellent reference for someone who needs information about a certain transaction that happened on a certain date. However, recording by date is an extremely awkward system if you need information about one account that has many transactions throughout the month. Therefore, another book of entry that's arranged by account number and account title is necessary for a good accounting system. That's where the ledger comes into play.

Logbook

Every dental practice also has a controlled substance logbook. The controlled substance logbook is important from the perspective of preventing drug abuse and requiring accountability of drug use. Some medications used by dental practices have the potential to be abused and are therefore regulated by the Drug Enforcement Agency (DEA), a branch of the federal government. The DEA has the authority to perform random inspections and examinations of the controlled substance log.

Express mail

Express mail is the fastest service offered by the USPS, which also provides mailing envelopes, boxes, and tubes for this service at no charge. It guarantees next-day delivery, including weekends and holidays. Important documents that must reach their destination the following day are sent express mail. If it doesn't reach the destination within 24 hours, the sender receives a full refund. If an item is lost or dam- aged, the document is automatically insured. The post office will pay up to $50,000 per piece for lost, nonne- gotiable documents, such as commercial papers and documents relating to bank transactions. The item or package should be at the post office prior to a certain hour for it to arrive at the destination by the following day. There's also a weight limit. You can take the ship- ment to any express mail drop location and deposit it into their specially marked collection boxes, or you can get on-demand pickup or simply hand it to your regu- lar letter carrier. For mail that needs to go quickly to an international address, the USPS offers Global Express Mail to 200 countries, and Express Mail Military Service delivers packages and mail to select Army Post Office and Fleet Post Office addresses.

Filing records

Filing in a dentist's office is much like filing in any other office setting. The details vary slightly from practice to practice, but the concepts are universal. Related materials (dental records, for example) are filed in the same location. The invoices for products and materials purchased by the practice, as well as other expenditures, are filed in a different location than the medical records—most likely in the practice's business office. The bookkeeping records from client transactions also are filed together for easy access in case they need to be reviewed. Client information and handouts are usually filed in a different location. Imprint cards for radiographs are typically found in card files near the X-ray darkroom.

First class mail

First-class mail is the standard route for sending postcards, personal notes, business letters, checks, money orders, and greeting cards. There's a limit on the number of ounces each piece can weigh. Additional weight requires extra postage. Also, there are size limitations for first class. Each piece can't exceed certain dimensions without an additional surcharge. This mail can be sent insured, certified, registered, COD, and restricted delivery. Typically, local mail will arrive in one day and all other locations in three days.

Incoming mail

For most mail, opening all envelopes with a letter opener is the best first step. It's a courtesy to have the envelopes cut open before they end up in the individual mail slots or boxes within the practice. Simply open the envelopes and set them aside to be sorted. Don't sift through the contents. Leave unopened any envelopes or packages marked "personal" or "confidential."

Handling calls when dealing w. someone

Generally, any individual who is physically in your presence should receive priority treatment over the person who's calling. Exceptions would be if the telephone conversation is urgent or if the person on the line is a high-level official. For all other occasions, answer the phone, greet the caller, and then say, "I'm helping someone else at the moment. May I return your call in a few minutes?" Write down the person's telephone number, and then make sure you return the call. If the telephone rings while you're speaking to someone else on the other line, excuse yourself politely, ask the first caller to wait, and immediately answer the second call. Then, get back to the original caller as soon as possible.

Handling mail problems

Handling different types of problems with letters, packages, and carrier services can vary. You'll be required to become familiar with the procedures followed at the practice where you work. For instance, if a letter or a reminder postcard to a client is returned because the address is no longer correct, you'll need to know how to track down the new address. Sometimes the forwarding order has expired and the postal service is no longer delivering mail to the new address after it has been sent to the previous address. Very often, however, there's a sticker on the front of the card or envelope that lists the new address. It's easy to update the dental record and client file at that time. Sometimes a client receives mail at a post office box rather than at a physical address. This problem is relatively easy to avoid by carefully filling out the client information form or computer screen when the client first comes into the practice. Most new clients distinguish between the physical address and the mailing address. If clients ask the practice to send a product or medication to them because it's inconvenient to pick it up, you need to know how to handle the details. Whose responsibility is it to decide what can be sent through the mail and what can't? How are medicines packaged? How are the clients charged?

Insured mail

Insurance can be obtained for mailed items valued at any amount up to $5,000. Packages sent third- class, parcel post, and priority mail can be insured for their value. This is particularly important during times when the post offices have peak business, such as late November and December. Risks of loss are greatest at these times.

International mail

It's not unusual for businesses to send mail to all parts of the world. International mail is divided into the following types: Global express mail is the fastest international deliv- ery possible and comes with a money-back guarantee if it doesn't arrive within one to three business days to any of almost 200 countries. Mail can be tracked, and insurance up to $100 is free. Express mail international is an economical choice because it uses flat-rate shipping and can be tracked. Priority mail international is for mail that weighs up to 70 pounds, and delivery goes to almost 200 countries at a flat rate. First-class mail international is designed for mail that weighs less than four pounds; postage can be as low as 75 cents for a letter or postcard. International priority airmail is for volume mailings like catalogs, small merchandise, and so on. International surface air lift is for sending global mailings of more than 50 pounds.

Handling calls

Make sure the person you're talking to knows that you're transferring the call and to whom he or she is being transferred. You should do this before you put that person on hold. Tell the caller, "Mr. Adams, I'll transfer you to Dr. Hutchins. If we're disconnected for some reason, her extension is 4250." Always give the person on your phone the extension of the person to whom you're transferring in case the person is disconnected.

Inventory

Many practices use computer systems to keep track of inventory and assist with purchasing decisions. If the inventory for the practice is entered into the computer system and tied into the invoicing function of the practice program, then any inventory items that are entered on an invoice will automatically be removed from the practice inventory. Periodically, the computer program can then be accessed to generate a report suggesting necessary purchases.

Equipment and Supplies

Most of the supplies—copy paper, computer paper, printer cartridges, adding machine tapes, pens, pencils, markers, message pads, and anything else that's necessary for a smoothly functioning office—likely will be found in the administrative area of the practice.

Filing records

Most practices have a variety of filing equipment available, depending on the items that need to be filed. For instance, if dental records are kept in manila end-tab folders, there will be open shelving to accommodate the files. If the dental records are kept in hanging pocket folders, there will be cabinets with pull-out drawers. To maximize the usable space within a reception area, file cabinets with lateral file drawers are often used. When the drawer of a lateral file is pulled out, it doesn't take up as much room as a standard file cabinet drawer. The files are then arranged from side to side rather than from front to back. If information is kept on index cards, you'll find file cabinets with pull-out drawers of that particular size. The filing supplies in a typical dental practice vary as well, depending on the filing needs of the practice. Most dental records are identified on the outside of the folder or pocket using letters, numbers, or a combination of the two.

Telephone techniques

Multiline phones are common in many small businesses. They allow you to answer calls throughout the office and then route them to wherever they need to go with the touch of a button.

Incoming mail

Next, sort the mail by addressee (recipient), and then place each piece into the appropriate receptacle. Does your practice have trays marked with each staff member's name for depos- iting phone messages and mail, or is it the receptionist's job to see that mail and messages get into the right hands? Who receives envelopes addressed to the practice (the practice owner, the clinic manager, or someone else)?

Dental records

One of the most important aspects of dental record keeping is accuracy. It's critical that each dental record always reflect up-to-the-minute information about a patient. The following are some simple strategies for keeping dental records current: Ask the patient, when he or she is at the practice, if the address and telephone number recorded in the dental record are still correct. Contact any patient whom you haven't seen in a while. ("Mrs. Jones, we haven't seen you at the office since last spring. Have you found another dentist, or would you like to make an appointment with us?") Record information in the dental record in a timely fash- ion. The day a patient comes into the practice, what's observed and what's done, as well as any assessments and plans should be recorded in the patient's chart. Keep written records of telephone conversations with patients in the dental record. Remember to place sheets in the record with the most recent information on top.

Equipment and Supplies

One of your jobs as a dental administrative assistant will be to record, in a timely fashion on the appropriate want list, any items that you notice are running low. A want list is a list posted in a notebook or on a clipboard at a specific location in the practice for all to see and use. When you retrieve a particular medication or supply from the practice inventory and notice that the remaining quantity has dropped to a low level, it's time to enter that item on the want list. At regular intervals, the person in charge of ordering practice materials retrieves the want list and uses it to guide the purchasing for a particular time period. All employees are responsible for placing needed items on the want list.

Pert chart

PERT stands for "Program Evaluation and Review Technique." The technique offers a more sophisticated way of depicting the various steps in a project. A PERT chart shows the relationship among various steps in a project and is an easy way to calculate what's called the critical path. The critical path is the longest time path through the network of steps. It identifies essential steps that must be completed on time so as not to delay completion of the total project. To create a PERT chart, you list the steps required to finish a project and estimate the time required to complete each step. Then, you draw a network of relationships among the steps. The number of the step is shown in a circle, and the time to complete the step is shown on the line leading to the next circle. Steps that must be completed in order are shown on one path to clarify proper sequencing. Steps that can be underway at the same time are shown on different paths. You can color each step with a different color marker as it's completed. Actual times can be written above estimated times, so you can readily see the estimated versus actual times of completion for various steps. You then have an idea of which steps might require more or less planning time in future projects.

Logbooks

Part of the business record-keeping system in any dental practice consists of various logbooks—where dentistry and business overlap. One example of a type of logbook that's used in dental practices is the X-ray logbook, which includes the following information: Patient's name Date X-ray case number View(s) taken X-ray machine settings (kVp, MA, and so on) Any comments (quality of the films, diagnosis, abnormalities noted, and so on) Another example of a logbook is the anesthesia/surgery logbook. This volume documents: Patient's name Date Procedure(s) performed All drugs administered (including the exact volumes given and the routes of administration) The length of the anesthetic event The length of the procedure The identities of the surgeon(s) and anesthetist

Dental records

Periodically, it's useful for the practice to purge, or eliminate, the records of individuals who are no longer active patients of the practice. This purging process reduces the clutter of a dental records file filled with the charts of individuals who have died or moved or are no longer served by your practice. When a dental record has been eliminated from the active patient files, it will be either inactivated or deleted. Every practice has its own policy on purging, but it's generally done at least once a year. Each practice also defines which records are to be considered active. For some practices, any patient that has been seen within three years is considered an active patient. Sometimes the time frame is as short as 18 months. If a patient has died or moved away, his or her file can be deleted from the active records. The hard copy of the medical chart should then be stored by the practice in case there's ever any reason to retrieve information about the patient. If the patient simply hasn't been seen for a long time but isn't dead, the dental record shouldn't be deleted but considered inactive. Inactive files are best stored where they can easily be retrieved if the patient wishes to return to the practice for dental care.

Answering calls

Position the telephone correctly. If you're using a tradi- tional handset, place the telephone firmly against your ear with the center of the mouthpiece about three- fourths of an inch from your lips. Never talk with the mouthpiece nestled under your chin. Many administra- tive assistants now use headsets when they answer the phone (Figure 5). If you find yourself using a headset, make sure the mouthpiece is properly positioned.

Dental records

Prior to inactivating a dental record, most practices contact a patient who hasn't been seen for a certain period of time by phone or in writing. A letter like this gives a patient a chance to respond. The patient may have died, be living in a different household, or be going to a different dentist. Or, perhaps he or she is simply unaware that so much time has passed since he or she was in for dental care. The standard time for storage of purged dental records, whether they're inactive or deleted, is seven years. After that time, the charts may be discarded. A dental record is considered a confidential document. The record is owned by the dental practice, not the patient. Most practices require a signed authorization form from the patient before any information from the dental record is released to him or her, to another dentist, or to an insurance company. The attending dentist is usually the only person authorized to release information from the dental record. If the patient requests that a dental record be transferred to a new dentist, it should be sent directly to the new dentist. The original dental record is never released—only copies. If the transfer of a dental record is requested, that request should be recorded in the original patient chart.

Second class mail

Second-class mail costs less than first-class mail and is used primarily for sending news- papers and periodicals. Naturally, this class is also slower. Second class is limited to publications that are produced and mailed at least four times a year. However, a magazine or catalog that's issued only once per year is an exception. In this case, a second-class permit can be obtained.

Inventory Control

The process of maintaining enough supplies on hand to run the practice efficiently, reduce waste, and control office costs.

Fourth class mail

Sending packages fourth class is the most economical means of getting invoices, reply enve- lopes, order forms, circulars, and advertising sheets across the country. There are minimum and maximum weight and size requirements. The postage rate for fourth class depends on weight and destination. The farther away the destination, the higher the rate.

Handling callers who are waiting

Some callers prefer to wait to be put through, even if the wait is long. He or she might be anxious because information is needed urgently. If this is so, you should come to the phone every few minutes and speak to the caller so he or she doesn't think you've forgotten him or her. Always remain courteous and use expressions such as, "Thank you for waiting, Mr. Stengel," or "It will be just a few more minutes."

Certified mail

Sometimes it's essential to know that mail has been received. Payment of a bill or an offer to purchase something can be sent by certified mail, but materials sent under this method shouldn't have an actual money value. The mail goes through regular chan- nels of processing. The important feature of certified mail is that it provides the sender with a mailing receipt and a record of delivery to the addressee's post office. There's an additional charge for this service beyond the required postage. If the sender wants to know when the addressee receives the mail, a Return Delivery Form is required. In addition to the two fees already paid, another fee is required. Delivery is made to the addressee only or to an authorized person indicated in writing. The certified mail receipt is proof that an envelope or package has been mailed. The post office doesn't keep a certificate of mail- ing on record. The fee for this service doesn't provide any insurance on the article sent.

Sorting and handling paperwork

Sometimes you'll want to save materials for a few days only, such as regularly updated sales reports and personnel information. You might want to assign a special place to keep these temporary papers until the next update comes out. Along with the incoming mailbox, you should also have an outgoing mailbox, so you can drop these pieces of paper in it that need to be delivered to others with a note from you. You might also develop file folders for people with whom you deal on a regular basis, such as the dentist and others in the practice. Drop items for them into their folders in your outgoing mailbox. You might also create folders for regular meetings you have, and place all pieces of paper that deal with these in the appropriate folders. You can keep these in your desk or in the front of your file drawer. Then you can pull them out at a later date and create an agenda for any meetings in which you might be involved based on items in the folders.

Sorting and handling paperwork

Sometimes, you won't know what to do with a piece of paper. If this happens, you should place the paper into a special file folder. This is your "problem" or "pending" file. You'll probably have to ask your manager how to handle anything in this file. You should also have a folder named "To Be Filed." Remember, you'll place files that will be filed as part of the company files in your outbox. This "To Be Filed" folder is for papers you wish to remain in your office. At the top of each piece of paper, mark the words under which the document is to be filed. You might also write how long you think this document will have to be retained, so that you can easily go through your files at a later date and throw away outdated materials. You shouldn't waste your time filing each piece of paper during the day as you decide it needs to be kept. Keep all new papers for your files in a separate folder, and do your filing once, or at the most twice, each day. Some individuals wait and do their filing once at the end of the week. A number of these files and their associated papers may exist electronically in your word processing system. Remember to keep a close eye on what's there and to continue putting documents where they belong when you're finished with them.

Gantt chart

The Gantt chart graphically displays the relationship of the steps in a project (Figure 13). First, you list all the steps required to finish the project and estimate the time required for each one. The steps are listed down the left side of the chart, with dates shown along the top. A line is drawn across the chart for each step, starting at the planned beginning date and ending on the completion date of that step. Once you complete the milestone chart, you can see the flow of the action steps and their sequence. Several steps can overlap and be in progress at the same time. As the project progresses, you can chart its progress by drawing lines in another color beneath the original target lines. These new lines will indicate the actual dates as opposed to targeted dates of completion for each step in the project.

Logbook

The amount remaining in the logbook must agree with the amount in the controlled substance cabinet. Record entries should also agree exactly with the information in the controlled substance log. Falsifying the information in the controlled substance log or improperly using any controlled substance is a federal offense. Controlled substances are to remain locked up at all times in their cabinet, which should be mounted permanently somewhere in the practice. The only staff members of the practice who should have a key to the controlled substance cabinet are the dentists involved in the practice.

Journals

The journal keeps a chronological record of the daily transactions of a business. Sometimes called the book of original entry, the journal is where original transactions of the business are first recorded. It's very much like a diary in that it tells a story about a business. Each recorded business transaction—called an entry—is documented in the order it happened (chronologically), and every entry must have a source (or beginning)—it must come from somewhere. Usually, this is some kind of business paper called a source document, which is proof that the transaction occurred. For example, a source document for cash would be a check stub. Other examples of source documents are calculator tapes and receipts.

Making filing efficient

The key to organizing and filing records efficiently is to learn the format used in the practice where you work, become familiar with the details of the record-keeping system that's in place, and do all you can to help maintain that system. Being consistent ensures that patients receive the best care by keeping all pertinent information about them readily available for review.

Ledgers

The ledger is a record of the transactions of a business arranged by individual accounts in numerical order according to the account numbers. It provides the information needed for the financial statements at the end of the month. The chart of accounts is a chart or list on the first page of a ledger that shows the name or title of each account and its account number. This setup makes it easier to find an individual account quickly.

master list

The master list is a long list that you maintain either in a notebook or on your computer. On this list, you write down what needs to be done when you're made aware of it. This way, you get a big picture of all the activities and tasks that must be done. Your purpose isn't to put this list in any kind of priority order or to categorize information. Also, the master list isn't a daily list, so there are no restrictions in terms of the activities you can place on it. It's simply a comprehensive reminder of what you must do.

Filing system

The practice where you work may also use color coding to signal records that are to be inactivated, records for clients that are to pay cash only, records for patients that are returning for a follow-up visit, and so on. A color-coding system can be as simple or complex as the practice wishes and can be used to communicate many different types of information to others on the staff. The practice where you work will probably have filing systems in place for more than just the dental records. For instance, the practice may have client education handouts that are commonly distributed. There must be a single, simple way to access information like that. There will also be various forms and certificates used throughout the practice that must be organized and easy to find. One strategy is to have hanging files that are organized by topic, and then, within the hanging files, to have manila-tabbed folders that are organized alpha- betically. This system allows related information or paperwork to be stored in the same place and to be organized and accessed easily.

The purpose of dental records

The primary purpose of these records is to serve as a detailed description of the patient's dental history, medical issues, treatment, progress, and resolution. Each record is a benchmark for measuring improvement or deterioration of a patient's dental health. The dental record provides for continuity of care by reminding a dentist what he or she has noticed when evaluating a patient and of the patient's history, the tests that have been done and their results, the diagnosis, the treatment that has been initiated, and all comments and recommendations made to a patient.

Organizing contact info and call logs

There will be very busy days when you'll need to find an individual's or business's phone number as quickly as possible. The secret to locating any person efficiently is to keep telephone numbers accessible and, for frequently called people, to note their schedules, so you know which telephone number to try first. The standard rule for locating a telephone number is to search for it only once. Never get into the habit of having to look up the number again and again. This takes too much time. Make it a rule that each time you have to search for a number, you write it down and place it where you can reach out easily and grab it again.

Third-class mail, or standard-class bulk mail

Third-class mail is even less expensive than second-class mail, but it's also slower. There's an ounce limit with third-class mail. Circulars, booklets, and manuscripts are sent third class. Envelope sizes must meet first-class minimum size requirements, however. Third-class mail won't be returned when delivery is impossible unless the sender writes "Return Postage Guaranteed" below the return address. The sender is willing to pay return postage when the item is of value. On the other hand, the sender is likely to print "If Undeliverable, Do Not Return" on cir- culars in which the value is less than the cost of return postage. Companies that send thousands of circulars each year usually obtain a third-class mailing permit. This permit costs a flat fee per year and allows the com- pany to send several hundred or thousands of identical mailings at a reduced rate. In preparing bulk mail, the post office requires that the sender sort the pieces according to zone, area, and ZIP code. In addition, a form is completed that describes the mailing. The postal service will furnish bags, labels, and complete information about how to prepare a bulk mail shipment. All mailings are paid for in advance.

Daily plans

Use the to-do list to plan your daily schedule. The list should reflect your meetings and appointments, plus time to accomplish other priority items. The to-do list should include sections for both scheduled and unscheduled activities. Scheduled activities include meetings and appointments. Unscheduled activities might include paperwork and planning time. These are activities you want to complete during the day but don't have a specific time during the day when they must occur. If you set time aside for both types of tasks, you're more likely to do them.

Outgoing mail

When sorting through outgoing mail, the first step is to classify it for postage and handling. First-class letters receive different postage than reminder postcards directed to clients. Packages are handled differently as well.

Filing system

You may encounter different filing systems, depending on the practice where you work and what kind of information retrieval systems the practice has developed. Dental records are usually filed in one of two ways: numerically or alphabetically. A numerical system—best suited for practices with thousands of patients—can work in one of two ways: either each client is assigned a number, or each individual patient is assigned a number. Each digit, from 0 through 9, is represented by a different color. The colors on the records then vary, depending on the number that has been assigned to a particular client or patient.

Filing records

You'll find blank folders (usually with end tabs) or hanging pockets, rolls of number stickers, and rolls of letter stickers. In addition, you'll probably find side-tab manila folders for more conventional filing. The manila folders may rest directly in a file drawer, or they may be inserted into hanging files. There will be stickers for identifying the manila folders. You'll also find blank cards for imprinting radiographs.

Incoming mail

You'll need to learn the process for sorting through catalogs and other "junk" mail. Who in the practice decides what's "junk" mail? Is there a central location for catalogs? How are the catalogs separated? Whose responsibility is it to go through the catalogs periodically to purge duplicates and keep only the most current ones from each company? Do catalogs simply go into the internal mailbox of the person to whom they're addressed? Are discarded catalogs and other advertisements recycled? Where are they gathered so that they may be recycled? You must also learn the process for accepting deliveries of medical or office supplies to the practice. Where do the boxes go when they arrive at the practice? Who is responsible for unloading shipments of medical supplies? Is there any way you can assist that person, either by reviewing the packing slip to be sure that everything has arrived or by helping to put things away and rotating the stock? How are packages to be handled that read "Refrigerate upon Arrival"?

Weekly plans

weekly plan describes what you want to get done by the end of the week and the activities required to ensure that happens. Weekly plans can be simple or complex depending on your preference and developed on Friday for the following week, over the weekend, or on Monday morning. After you fill out the weekly plan sheet, you should retain it for frequent referral during the week. You might also wish to save it in a file for future reference. Daily activities recorded on this planning sheet are transferred to your daily calendar and take place according to an assigned priority.