The NEW Normal in the Dental Office (Covid19 Ideas)

We’re facing a new world with new challenges. We all need to be educated on new guidelines and procedures for dental offices in order to best use Dentrix Ascend to implement these changes. This article shares solutions to create new workflows and necessary documentation. 

Welcome Letter 

For those in the beginning stages of returning to the office, a welcome letter/updated patient form may help to both welcome back patients and assure them the dental office is a safe place for treatment. This letter may include:

• New policies, protocol & procedures that will include pre-screening and taking of temperatures.
• How they will be scheduling & rescheduling cancelled appointments. 
• This content can be created/shared through digital patient forms. 
• If an office would like to send a printed letter to their patients, power reporting (Patients Seen report) will allow you to pull a patient list with email addresses, filter it by last visit date to gather active patients and export to a csv file for import to an email service.  
• If an office chooses to mail letters they can create a custom letter in the Letters module and print & mail or send to a mail service.
• If you are utilizing Teledentistry, provide information on how and when to use this option.

There is no better time than now to utilize Online booking – the staff is going to be overtaxed trying to catch up while ensuring the safety of the patients and the staff.  If the welcome letter is shared as an email - include the online booking link and ask patients to watch for their recare email/text with a link to book their appointment online. Also direct patients to your website or Facebook for the link.  

Bringing patients back to the office 

Offices have patients in need of treatment, patients overdue for recare and cancelled appointments to reschedule. Building custom lists will assist them in finding those patients and filling their schedule. 

• Unscheduled Treatment – by patient all procedures for all patients that are not scheduled 
• Treatment Tracker – cases by provider and, scheduled and unscheduled treatment 
• Recare Management – Patients overdue/not scheduled, last contacted, filtered by type & date 
• Scheduled Production by Month – to find patients during the shutdown that were seen as emergency patients that need follow-up 
• Patient List – all active patients filtered by last visit date, no future appointment and insurance benefits remaining 
• Missed appointments – patients who have broken appointments that need to be rescheduled  
• Lab Case appointments – Lab cases received that need to be delivered 

You also can use our appointment communications to send text/email messaging to patients who missed appointments so you do not have to call each individual person: How to Send Text and Email Invitations to Patients with Missed Appointments.  

Patient Forms 

Protect your patients and team members by screening patients in advance of coming to your practice using ADA-approved questions. Send a link to this new form in advance using text or email to support your “safety first” plan. You could add/update consent forms: 

“Office Policy for Patient Safety” form to inform patients of new policies, protocols and safety measures. Digital signature to consent.   

“Covid 19 Pre-screening form” Informing patients that a staff member will contact them 1 day prior to their appointment for a pre-screening to determine if they are able to be seen or need to be rescheduled. 

Patient Communications 

Suggestions for customizing patient communications by email/text: 

• Appointment Start 5 days prior to appointment – Continue every day until appointment is confirmed. Notify patients of Pre-screening policy one day prior to appointment. 
• Appointment Start 1 hour prior to appointment – Per our Social Distancing Policy, Reply HERE when you arrive at the office 
• Include link for forms on both communications to insure patients have the filled out & signed all forms including the new Office Policy & Pre-screening information forms. 

Scheduling Patients 

Dental procedures generate aerosols that hang in the air. COVID is a small virus which according to the National Institute of Health (NIH) is highly contagious because of those small particles that can remain on surfaces or fabrics for days. New protocols (can vary by state) may require Dentists to see only one patient at a time, stagger patients and allow operatories to “rest” for at least 30 minutes after cleaning. 

Setting up the appointment book to follow protocols, maximize efficiency and enhance workflow is critical. Adding schedule events to stagger starts, to allow operatory clean/rest time will help to manage schedules. Schedule templates will help build a safe and efficient schedule and updating templates for online booking may be helpful.

Communications have confirmed our appointments and provided patients with their pre-screening message as well as a link to their forms. We can use the unconfirmed appointment list to make calls to patients that haven’t been confirmed and do a pre-screening at the same time. You’ll also be able to see who hasn’t filled out their forms and re-send those links to both confirmed and unconfirmed patients.  

Pre-Screening 

You may want to add 2 new Clinical Note templates: Pre-appointment screening & Day of Appointment Screening. These are standard questions taken from the ADA recommendations. The patient is either cleared for appointment or referred to their primary care physician for evaluation. 

If the patient is cleared for the next day appointment, from a custom code added to Procedure codes, add “PSC” (Pre-screen complete) to the appointment procedures box. To view which patients are pre-screened visually in the schedule, use the new appointment color layout set to provider color on the large box and set the side panel as the procedure color. Then set-up a procedure category, with the #1 priority as Patient Pre-Screen and a green color. The appointment book will now show green (for screened and ready) on the side of the appointment. This will provide good visibility for the staff to assure all patients have been pre-screened. They can choose if they want the code posted to the ledger for additional record-keeping. 

If after the screening, the patient is showing symptoms, break the appointment & use COVID as a reason. (You could also enter a new custom procedure code of “RPC” (Referred to Primary Care) on their ledger. However, keep in mind that this would update the patient's last visit date in the ledger and they have not in fact been seen. For tracking purposes, you may want to use a scheduled power report rather than a procedure code.) Create a letter to the patient advising them to seek advice from their physician and call to reschedule after they have been cleared, or per the office protocol. Add a medical Alert of COVID symptoms to warn staff when the patient tries to reschedule. You can expire that alert if the patient tests negative or has no additional symptoms. If they test positive, add the COVID positive alert and follow protocol. If they develop COVID and recover, add that medical alert.  

Day of appointment 

Per our communications, patients are asked to reply HERE when they arrive at the office. From the Inbox you can see all of the responses and patients that have responded that they have arrived. Once you confirm that the patient has been pre-screened and cleared, change the patient status to HERE. When you are ready to have the patient enter the office, you can call them or use whatever method you have set-up. Once they enter the office you will need to follow new procedures for safety such as providing masks and hand sanitizer, taking temperatures and same day screening to insure the safety of staff and other patients.  

If the patient is cleared for treatment after Day of Appointment screening, change status to READY. Appointment will now have the Green ready status and the Green pre-screening status. Copy CLEARED FOR TREATMENT to messaging box in appointment tracker, there will also now be a note on the appointment with the same message. Messages can also be viewed in the status tracker. If notifications are turned on you can click on the ready or chair notification, see the screening notes and any messages regarding the patient. 

If the patient is showing symptoms, follow the same procedure for breaking the appointment as day prior to the appointment and refer the patient to their physician per office protocol. 

Set up new PPE code/billing 

This section provides instructions to set up your software if you choose to charge patients for this.* 

As of August 7, 2020 New York's Governor Cuomo has issued guidance against charging for PPE, to read more: Full Letter .

• Edit existing procedure code D1999 and add your fee (let's say $10) and set to submit to insurance – Since this code falls into the preventive code range, covered 100% - set this same $10 UCR in all fee schedules including the PPO plans, then for carriers that do not pay - Create an exception in the coverage table for not covered so the fee defaults to the patient 
• Reimbursement varies by insurance carrier. You could add a multi-code with ADC (Appointment Day Screening) & PPE so both get posted to ledger in a single step saving time and insuring it doesn’t get missed.
• If the carrier does not allow the patient to be charged, then use a patient note that opens in the ledger only and add a write-off adjustment. Tag that adjust PPE write-off so you can track it. 

*Please consult the laws and regulations in your state for guidance on charging for Personal Protective Equipment (PPE) and other COVID-19 related costs and particularities. You should not rely upon the material or information provided by HS1 as a basis of making any decisions without the proper legal or other professional advice specific to your situation as needed.

Electronic Statements 

Send electronic statements after appointment completion. Before sending statements, best practice is to review your Aged Receivables report to look for any patients who may have both an unapplied credit (prepay) and balance, then go into their ledger to apply the unapplied payments. This may eliminate the balance or reduce it, making the statement more accurate. 

Offices may want to ask patients to email them copies of insurance cards (front & back) and/or identification and then upload to the patients Document Manager. Web cams and/or built in computer cameras can be used to capture documents that patients hold up to the cam. (Touchless capture) 

Electronic Prescriptions

To be as digital and touchless as possible, use electronic RX for prescriptions. DoseSpot is working on a new integration with Ascend right now - soon to be released.  

• To check out DoseSpot online: https://www.hseprescribe.com/ 
• To order DoseSpot through Henry Schein One; call 877-244-9347 

(Authored by Laurel Lubin, 2020)