By Dayna JohnsonIf you have read my February article, you understand that treatment planning and case presentation play a huge role in your efforts to collect money at the time of service. Providing your patient with a written estimate outlining the treatment plan and estimated costs is an absolute must in the dental practice. But did you realize that lack of treatment planning is the No. 1 record-keeping error among dental offices, according to a 2005 survey conducted by the ADA Council on Member Insurance? This survey determined the severity, frequency, and causes of dental malpractice claims reported between 1999 and 2003. If you would like a copy of the results of the survey, please click here to be directed to the Links & Internet Resources page of my website and look for the ADA Dental Records guide page 13. With this in mind, treatment planning in the dental practice becomes not only a necessity for collections, but a legal issue if the chart is ever subpoenaed in a malpractice case. Now, you might be asking yourself, How does this apply to the front office? It is the doctor’s and hygienist’s responsibility to make the treatment plan and document it in the chart, not mine. Yes, I do agree with you that they are creating the treatment plan and discussing the clinical aspects of it with the patient; however, after the treatment plan is entered into your patient’s chart, it then becomes your responsibility to manage it ... and that is my focus in this article. In this day of electronic record keeping, managing the patient’s treatment plan takes on a few new details to which the office manager and treatment coordinators need to adhere. You play a key role in keeping your doctor’s head above water in the case of a patient complaint or malpractice case.There are three key elements that you, as treatment coordinators, need to be aware of when managing your patient’s treatment plan:1. Keeping track of patient referrals — If your doctor refers a patient to a specialist for anything, it must be documented in the patient’s clinical record. Yes, it would be noted in the clinical notes for the day, but I also recommend that it be included in the treatment plan as well. The reason I recommend this is because the treatment coordinators will be working off of Unscheduled Treatment Reports and Referral Reports to follow up with their patients — not searching through clinical notes. When the procedure that is being referred out is added to the treatment plan and you note on the procedure code where the patient is being referred, the treatment coordinators now have a way of following up with the patient. Depending on your practice-management software, you can track this treatment either from a treatment plan report or a referral report.For example, if you are using Dentrix software, you can attach a referral directly to the procedure code so it will print out on the patient’s estimate without the fee, link it to the referral section on the Family File for easy tracking on the Referral Report, and then the procedure will show as completed at another office when marked complete. The final step is to make sure you store the letter from the specialist in your patient’s electronic record either by scanning it or importing it directly from an email.2. Managing treatment options — Have you ever had a patient call up years later after having treatment in your office and say something like this: “I was talking to my neighbor the other day and his dentist gave him the choice of either having a root canal or having his tooth pulled. My doctor never told me I could have had a root canal done; he just extracted it!” One of the major mistakes in clinical charting is the lack of documentation when giving the patient treatment options. When the doctor is consulting with a patient and discussing the options — for example, a bridge, implant, or partial — this not only needs to be documented in the clinical note but also laid out in the patient’s treatment plan options. This is where the treatment coordinators need to be careful. All too often, when a patient decides on one course of treatment, then the other options get deleted forever. Once something is deleted from the electronic record, it is gone. If you need to retrieve these treatment options for future use, this could pose a huge problem. If your practice-management software does not allow you to keep track of “rejected” treatment plans, at the very least make sure you print an extra copy of the estimate you give to the patient or scan an extra copy in the patient’s electronic chart. If you are fortunate enough to be using Dentrix G2 or higher software, you have the ability to create alternate treatment options in the patient’s treatment plan, attach a consent form to it, have the patient sign it, and keep a record of those alternate plans forever; you can just hide them from view. If you are working with different software, find out what steps you need to take to store the rejected treatment and not delete it. 3. Documenting the status of treatment — How many times do you have a patient come in with a toothache and needing a root canal when your doctor had treatment planned a small occlusal filling only a year ago? Then the patient says, “Well, nobody told me. If I knew I needed a filling, I would have scheduled it. Now I need a root canal!” This could potentially lead to a patient complaint or legal situation if there is no documentation to show follow-up with the patient. Part of your weekly management routine as the treatment coordinator is patient follow-up and keeping your doctor’s schedule full. But it doesn’t stop there. You must document your conversations with patients somewhere in their clinical record. If you are using an electronic health record, there needs to be a consistent place where you keep notes that everyone in the office can retrieve easily. Remember, if it didn’t get written down, it didn’t happen.The treatment coordinators have a very important role in keeping our patients’ clinical records accurate, well documented, and safe from potential legal problems. If a patient files a complaint and the patient’s record is subpoenaed — but you have a good record-keeping system — the potential that legal action will go any further is greatly decreased. To see the complete list of the top record-keeping errors, click here to be directed to the Links & Internet Resources page of my website, click on the ADA Dental Records guide, and go to page 13.Author bioDayna Johnson, founder and principal consultant of Rae Dental Management, helps dental offices improve patient care, increase collections, and reduce staff headaches by implementing efficient management systems. With 18 years’ experience in the business and technical side of dental offices, Dayna’s passion for efficient systems is grounded in both personal understanding and professional expertise. She can be reached at [email protected] or visit her website at www.raedentalmanagement.com. If you’re a Dentrix user, you can also check out her blog with front office tips and ideas at http://thedentrixofficemanager.blogspot.com/.