Risk Management and Your Patients

Posted February 14, 2017 by Danielle H

Girl Screaming

One of the biggest fears a dentist has in his or her career is being confronted with a lawsuit or going before the dental board. Statistics say a dentist will likely face 3 to 5 law suits or dental board cases in their lifetime. How can you prepare for or prevent a malpractice lawsuit? Today’s post will look at 4 ways to minimize the risk of malpractice lawsuits against your practice.



Maintaining open communication with your patients is one of the most important aspects to managing malpractice risk. Inform patients of your office policies regarding after-hours care, prescription refills and expectations for conduct in the practice. Patients who request to speak with the doctor outside of their scheduled appointments should be told when to expect a response from the dentist. The dentist should always follow up with any patient who is expressing dissatisfaction rather than defer to a staff member.

Get it in writing

Even though everyone knows that proper documentation is the best defense in a malpractice lawsuit, many practices continue to fall short. Document your facts, impressions, clinical judgement and treatment objectively. Refrain from using words that contain bias towards patients or previous providers in your documentation. Also, be sure to note when patients report both positive or negative comments.

No chairside manner

Patients who like their providers are far less likely to file a lawsuit. It is the entire team’s job to provide a great patient experience. Basic things like greeting every patient you come in contact with should be the expectation. Your clinical team members bear an even greater responsibility to ask questions and listen to the patient. Patient needs or concerns should be shared with everyone on your team to ensure everyone is on the same page. If a patient has treatment concerns, minimizing or dismissing those concerns will likely lead to dissatisfaction. Taking the time now to explain procedures and complications thoroughly will reduce an opportunity for disappointment later.

No formal discharge process

There may come a time when a patient becomes a problem for your practice and termination of the doctor/patient relationship must occur. A formal discharge process should be followed to ensure there is no additional liability for the dentist. Outline a process for your practice that helps your team follow the same steps every time. All communications (phone and written) with the patient should be documented. Written termination should include an end date and make it clear that the patient will not be seen by the dentist after that date has passed.

Every practice faces challenges when it comes to managing patients and minimizing risk. Keep in mind that taking steps to listen and communicate properly, identifying dissatisfaction, having adequate documentation, and understanding the legal consequences involved are just some of the important factors in managing risk with your patients.

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Payer Audits: What you need to know

Posted February 7, 2017 by Danielle H

Payer Audits factsWith tens of billions in financial losses due to health care fraud annually (according to the National Health Care Anti-Fraud Association), third party payers are taking action. In an attempt to prevent abuse of the payment system, payers are now routinely conducting audits of health care providers. This article will help you understand how payers choose providers to audit and how you can prepare your practice.

Why me?

For insurance payers, the audit process often begins by looking at a specific dental plan. Payers analyze procedures submitted across all providers and look for inconsistencies. Auditors look for unusual charges and/or providers that submit a particular charge at an atypical frequency. As the payer looks closer into a particular provider, they will examine data relating to average cost per claim and average cost per person. Once the auditor has identified providers with the greatest discrepancies, they choose to audit one or multiple providers.

I’m being audited. What now?

Most dental practices will be notified of an audit by telephone or mail. In many cases, the third-party payer will arrange a day and time for the audit. Upon receiving a call like this, ask the payer representative why you are being audited. Likely, they won’t share details, but any information you obtain could help you prepare.

Plan to clear your schedule or significantly reduce your number of patients on the day the payer representative arrives. Meet with your entire team ahead of time to inform them of what is going on and what is expected of them. A primary focus of an auditor is to review patient files that support claims that were submitted. The auditor will request information from specific patient records and should be permitted only to view the records of the patients covered under their plans. HIPAA privacy laws do not allow payers to view the patient information for those that are nonmembers of their plans (or former members). Participating providers are typically left without recourse when the story told by the patient record doesn’t support the necessity of the treatment provided.

Preventative Measures

With dental payer audits becoming more routine, preparing your practice for a potential audit is increasingly important. For each insurance company that a practice participates with, the dentist and insurance coordinator should review the payer contracts annually. Designate a safe place to keep these items so they are easy to reference when needed. Next, review a report of the most commonly used procedure codes in your practice. Use Practice Booster to review these codes for accuracy. Are you submitting these codes under the proper circumstances? A Practice Booster subscription can help you stay on top of the latest information related to coding and insurance. Lastly, examine the documentation processes you have in place. Do your progress notes tell the entire story? What documents help support your necessity for treatment in any situation? Take time to review your processes with your team regularly. If you want to see what Practice Booster can do to help reduce your risk, contact XLDent for a special offer today.

Now that we’ve explored risk management as it pertains to your clinical practices, infrastructure, and insurance, stay tuned next week as we look at malpractice and how to handle risky patients.

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Strengthen your Risk Management Plan Today

Posted January 31, 2017 by Alexa S.

Risk Management Quote

As individuals, society, and organizations, we take risks regularly as a necessary step to grow and develop. Forecasting and evaluating what is needed to manage risk and minimize negative impact is not something that everyone or every organization takes time to focus on. It is important to make sure that your dental practice has adequate tools to combat threats and ensure security. Your business must evolve and adapt to ensure it is minimizing risks while maximizing growth potential. However, risk management is not always a one size fits all solution.

As we continue through our risk management series, there are three important areas where XLDent can help you strengthen your risk management plan today.

Offsite Backup Storage

How frequently are you backing up your patient and practice data? Are you making sure your backup system is secure and HIPAA compliant? With XLBackup, you have a managed, fully automated, online, off-site, data protection service that can help you keep a potentially serious business risk under control. By using XLBackup, you enable your dental practice to quickly restore lost files, images and critical data to get your practice up and running in a disaster recovery situation. Let’s break down the important considerations in a backup solution.

  • Managed service: The XLBackup service includes professional management of your back up solution. This includes storage management and optimization, data integrity and verification checks, and annual disaster recovery fire drills.
  • HIPAA Secure: Incorporates critical secure elements such as HIPAA compliant encryption technology, storage in multiple data centers and Federal Information Processing Standards.
  • Automatic Data Healing: This automated process runs in the remote data center, performs in the background, and scans the entire storage to ensure data integrity by checking data blocks and comparing digital signatures for inconsistencies.
  • Data De-Duplication: Essentially, you won’t have multiple copies of everything causing a headache in a recovery situation. Data is compared based on its content to the appropriate repository and a pointer is used to point from the data’s original location to the library location.
  • Local Storage: Backup on a local device so immediate restoration at LAN speed can occur.

XLBackup is compatible with all Dental Practice Management and Image Management solutions. It is an absolutely necessary component of your electronic dental records risk management.

SecureMail – HIPAA Compliant Email

Need to send sensitive patient information via email? Don’t risk PHI by sending with just any email client or service. With SecureMail, you’ll be able to send information and file attachments that are protected from accidental exposure and data theft. At the same time, SecureMail ensures compliance, guards your reputation, builds customer trust, and reduces business process cost. It also includes the added security of being able to track and confirm sent, received and open emails. SecureMail is a cost effective, cloud-based service that is available to any practice, regardless of dental practice management system.

Credit Card Processing

Credit and debit transactions that use EMV technology are an important milestone in managing risk in card payment transactions. Point-to-point encryption (P2PE) combines secure devices, applications and processes to encrypt data throughout the transaction, making it an integral part of your card payment solution. XLCharge not only makes it easy with integrated payment processes right inside the XLDent practice management software, but also offers you a level of security you can depend on.

These are just a handful of ways your technology choices guide you in developing a viable risk management plan. Let XLDent take some of the stress out of your risk management.

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Understanding Risk from a Clinical Perspective

Posted January 24, 2017 by Dawn

Whether you’re just getting started or a seasoned vet, every dentist has heard the phrase “If it’s not in the chart, it didn’t happen.” And, even though we’ve all heard it before, many dentists continue to repeat the bad habits of their predecessors, leaving themselves at risk for malpractice lawsuits and fraud. In today’s blog, we’ll explore the clinical aspects to risk management in the dental office.

The Dental Chart

In order for the dental chart, or electronic dental record, to be defensible in a court of law, it needs to provide a consistent and detailed account of events. Let’s look more closely at some of the key components to the dental chart and ways to safeguard your practice.

Health History

While most practices are good about obtaining health history information at the time of a patient’s initial visit, many fail to maintain consistency when it comes to updating information. With a lot of dentists counting on hygienists and assistants to update health history information, it’s easy to get lazy with your review of this information. Never assume that your hygienist or assistant will tell you about important changes. Make it a habit to review the information in your electronic dental record prior to each patient encounter and document this in your clinical progress note. The recent addition of the Medical Tab in the XLDent chart helps clinicians view and update medical conditions and medications easily.

Pre-Treatment Diagnosis

Failure to document a definitive diagnosis is a common weakness to the electronic dental record in many practices. The clinical progress note should reflect your diagnosis and the findings that led to your diagnosis. Supporting items, like radiographs and treatment plans, will also help strengthen and validate your progress note. Additionally, your documentation must reflect the treatment options that were recommended and alternatives that were discussed with the patient.

Informed Consent

ink form consentPrior to treatment, the dentist bears the responsibility of obtaining informed consent from the patient to perform the procedures that were diagnosed. For most, the process to obtain consent involves a conversation with the patient that results in patient understanding and acceptance of the treatment that will be provided. When it comes to malpractice claims, lack of consent is frequently cited. At a minimum, the clinical progress note should reference the process used to obtain consent and that the patient consented to the treatment provided. For riskier procedures, consider obtaining consent in writing to help support your clinical note. One such method is clinical consent forms that are signed on the tablet pc when using XLDent’s Ink Forms.


ePrescribeEven in 2017, many prescribers will be the victim of prescription theft or tampering. Sending prescriptions to the pharmacy electronically offers greater protection for the prescriber, reducing the risk of fraud. Additionally, ePrescribing software offers safety measures for the patient. When creating a prescription electronically, ePrescribing software will alert you of drug interactions caused by allergies or other medications.




We hope these recommendations will help you minimize the risk of fraud or error in your clinical settings. If you found this information helpful, be sure to check out Part II of our risk management series next week as we look at the role infrastructure technology plays in managing risk.


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HIPAA: Keep your data and practice protected

Posted January 12, 2017 by Alexa S.

We get it, HIPAA isn’t the most exciting topic out there. However, it is a topic that needs to be a priority to every dental practice. A lack of attention to HIPAA details could cost you. HIPAA (Health Insurance Portability and Accountability Act) was established in 1996 as a way to promote and standardize information stored and exchanged, as well as create a guideline for transaction, security, and privacy standards. A common buzzword associated with HIPAA is PHI (Protected Health Information) which is individually identifiable health information that is held or transmitted by a covered entity or its business associate. There are 3 primary categories in HIPAA that we should first take a look at.

The HIPAA Privacy Rule establishes standards to protect individuals’ medical records and other personal health information. The HIPAA Security Rule deals with electronic Protected Health Information (ePHI). The HIPAA Breach Notification Rule requires covered entities to notify affected individuals, HHS, and in some cases, the media of a breach of unsecured PHI.

Now that we have reviewed the nuts and bolts of HIPAA, what do you think the most common HIPAA violation is? Negligence. Negligence can in the form of either intentional or unintentional. More often than not in a dental office, unintentional negligence is the most common. Human error is the number one offender for unintentional negligence. It cHIPAAan be as simple as an employee who forgets to log out of the computer when leaving, or other violations such as improper data disposal or a lost backup device. A first step in minimizing the unintentional acts is with proper staff training. HIPAA education and processes should be ongoing in your practice. Every team member should participate in HIPAA training and should understand the do’s and don’ts that surround patient data.

So, what are you doing to keep your office HIPAA compliant? For starters, do you feel that you are keeping up with your computer security? The modern practice relies on technology for successful and seamless daily operation, and not having a safe and secure technology system could lead to costly downtime and even violation fines. One way to make sure your practice is doing all that it can to back up data is with XLBackup. This offsite backup storage uses HIPAA compliant encryption technology system that stores your data in multiple data centers. For added security and peace of mind, this solution is consistent with NIST publication 800-11 and follows Federal Information Processing Standards (FIPS) 140-2. Using XLBackup is an easy way to make sure your information is automatically backed up to a secure location, and the more automation surrounding your data, the better.

Another area to consider when making sure you are staying HIPAA compliant is an encrypted email service. XLDent offers SecureMail which is a HIPAA compliant email service that will secure sensitive patient email and file attachments from accidental exposure and data theft. SecureMail ensures compliance, guards your reputation, builds customer trust, and reduces business process costs.

There are many tips you can find surrounding HIPAA compliance and best practices. Here are a few you can start implementing today.

  1. Make sure your team is trained in HIPAA compliance.
  2. Regulate who has access to sensitive information.
  3. Keep an inventory of your office computers and devices.
  4. Wipe down tablet and touchscreen devices to ensure clear entries and to prevent easy guessing for entry to systems.
  5. Do not share passwords.
  6. Keep anti-virus scanning software up to date.

For more information about offsite backup, email security and other services to keep your data safe visit

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