Dentists face numerous regulatory and liability issues. Keep up with the issues can be daunting and best, career ending at worst. Host Duane Tinker (AKA the Toothcop) discusses the issues and helps make them easy to understand and apply in your dental practice.
HIPAA: The Treatment, Payment, and Healthcare Operations (TPO) Exception
A lot of people get the Treatment, Payment, and Healthcare Operations (TPO) Exception wrong. So in this episode of Talking with the Toothcop, Andrea and I dissect what it is. We also talk about what to do if you need patient authorization and the importance of informed consent for treatment. Don’t miss it!
Outline of This Episode [0:21] Coffee + Rom-Coms [4:07] Learn more about ProEdge Dental! [5:24] The treatment exception [10:00] The payment exception [11:01] The operations exception [12:14] If you NEED authorization [13:25] Informed consent for treatment [17:49] Learn more about protectit dental! The treatment exception You can communicate with other healthcare providers (i.e. dentists/specialists) to care for a patient (consults, discussions, coordination of care, etc.). Under HIPPA you don’t need authorization from your patient to communicate with healthcare providers regarding treatment. Some state laws are more restrictive. For example, in Minnesota, this does not apply and you are required to get authorization. Federal HIPPA laws allow communication if your state does not have more restrictive requirements.
The payment exception If Grandma stops by to pay a patient's bill, you may have to follow the minimum necessary principle (that a legal guardian is the only one allowed access to patient information). So you may not be able to close the date of service or the procedure but you sure can take payment. If it’s necessary to state a balance to get paid, it’s perfectly fine.
The operations exception The operations exception allows dental offices to access and use/disclose their patient‘s information. You don’t need authorization from the patient or legal guardian. How does that look in practice? Duane is allowed to access a patient’s records without them being notified because it’s for compliance purposes.
If you NEED authorization If you need authorization from a patient to disclose PHI to a third party, there is a form you need them to complete with specific elements that need to be on it. Most information release forms don’t have the necessary information. So what’s needed?
It must clearly identify your entity and who you’re allowed to release information to What part of the patient’s record you’re authorized to use or disclose The explicit purpose for the disclosure A notice that informs the patient they have the right to revoke the authorization at any time (this is what most dental offices are missing) A signature on the form by the patient or legal guardian NOTE: Get familiar with your state's recommendations to make sure they don’t have specific requirements for authorizations. If you’re from MN hit me up at toothcop(at)dentalcompliance.com for a template for the form you need!
Informed consent for treatment This seems like an ongoing issue I encounter regularly. Different states have different requirements for informed consent. Common sense dictates—to protect yourself and your practice—you should obtain informed consent from your patients. They should know the potential risks of a procedure and alternative treatments that could be appropriate (including no treatment). They should also be informed of the potential consequences if they choose not to have a procedure done.
If you practice in multiple states, follow the most stringent standard in all of your locations. Then you’ll never run the risk of being out of compliance. In Texas, you need consent for everything that comes with a risk. In Texas, Medicare requires consent for every procedure on the date of service it’s being completed. If you don’t get consent, the insurance companies can recoup what they paid for the services.
Have any good coffee bean recommendations? Send me an email with your suggestions!
Resources & People Mentioned Learn more about protectIt dental a
The Lowdown on Hepatitis B Vaccinations + Post-Vaccination Testing
Recently, I’ve dealt with some level of confusion surrounding the Hepatitis B vaccinations (HBV) and post-vaccination testing requirements. So in this episode of Talking with the Toothcop, I’m going to cover what both OSHA and the CDC require for the HBV and post-vaccination testing.
Outline of This Episode [2:03] Hepatitis B vaccination requirements in dentistry [5:08] OSHA requirements for post-vaccination testing [10:22] Hepatitis B vaccination recap Hepatitis B Vaccination Requirements When a dental office hires a new person, they need to determine if that person will have exposure to bloodborne pathogens. Front office staff may have exposure in one dental office and others won’t, whereas a clinical staff will have ongoing exposure. It all depends on the activities of your staff and whether or not they’re cross-trained. But it’s not like a bloodborne pathogen follows the rules and won’t cross into an area they’re not supposed to.
If a new staff member will likely face exposure throughout their employment, they need to be offered the Hepatitis B vaccination. The employer must:
Get a copy of the employee’s vaccination record If the employee declines the vaccination, they must sign a declination form. (i.e. they may have already had the vaccination). Dentists, you must show you offered the vaccination within 10 days of hiring the new staff member. Document your attempt to get the vaccination records. Include all of this in your new hire paperwork.
The vaccination is a three-shot series given over six months. At the conclusion, your staff member’s blood needs to be tested to ensure they’ve developed antibodies for Hepatitis B.
OSHA requirements for post-vaccination testing In a 2000 OSHA response to Christopher S. Taylor, M.D. (a flight surgeon), OSHA stated that:
“The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure follow-up to all employees who have had an exposure incident." (Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, [CPL 2-2.69])
In short, according to OSHA, the employer must pay for post-vaccination evaluation and follow-up at no cost to the employee (2 months after the vaccination series is complete).
In 2015, Richard L. Raimondo, Jr. D.D.S, posed two questions to OSHA.
Once my employees have completed the 3-dose hepatitis B vaccination series, is there a requirement to obtain a test for hepatitis B antibodies? OSHA responded that, yes, a test is necessary for antibodies (according to the CDC). Dr. Raimondo also asked if anyone hired before this standard was in effect must be tested for antibodies and offered the vaccination series. OSHA responded that at the time, they didn’t recommend further vaccinations or titer testing for anyone vaccinated before December 26, 1997. However, for anyone vaccinated after December 26th, 1997, they did recommend anti-HBs [titer] testing.
Hepatitis B vaccination requirement recap What does this mean for dentists?
Determine who needs to be vaccinated. Offer them the vaccination and prove you’ve made the offer (i.e. declination form and vaccination record). Document, document, document. If it isn’t written, it didn’t happen. Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Check out ProEdge Dental for waterline testing! OSHA response to Richard L. Raimondo, Jr., D.D.S OSHA response to Christopher S. Taylor, M.D. Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtu
Get to Know Duane Tinker + Andrea Baysinger
This episode of Talking with the Toothcop is a two-parter! In the first half, you’ll get a look behind the curtain and get to know me—Duane Tinker—and my co-host, Andrea Baysinger. In the second half of this episode, we share an important reminder about nitrous oxide compliance rules. Don’t miss it!
Outline of This Episode [3:01] How Andrea became my co-host [6:05] I’m an introvert—until I take the stage [8:09] Andrea is an introvert disguised as an extrovert [9:29] Country versus city living (who is who?) [12:22] Raising Australian Shepherds on a ranch [13:05] Dentists that administer nitrous oxide [14:31] How dentists get busted for lack of compliance I’m an introvert—until I take the stage I am an introvert. I’m like Sylvester Stallone (Hawk) in the Movie “Over the Top.” Hawk is a professional arm wrestler preparing for a national event in Las Vegas. At the end of the movie, Hawk is interviewed. He said that before he steps in the ring, he turns his hat backward and it’s like he turns his face and becomes a different person. That’s how I feel when I’m about to walk on a stage and speak. I’m a shy wallflower until I take the stage.
Andrea is very talkative and is a self-proclaimed social butterfly. But she believes it’s just a different version of her. She has a degree in English and loves writing and being introspective. So she’s at her best when she’s chosen to be alone. She feels at peace. She recharges, then gets back out with people.
Country living versus city living My wife and I have a ranch and sometimes I’ll go weeks without leaving it. We’ve got everything we need here (including fast internet). Andrea grew up in the country, too, in a small town of 1,500 people. She thought she was going to stay there for life but she followed her brother to Texas. She packed everything in her Maxima, got a part-time job within two weeks, and has been here for almost 8 years. She’d never in a million years thought she’d end up in a field close to healthcare and now she can’t imagine anything else (including living in the country again).
My wife and I have 6 Australian Shepherds, five of which are related. We have a lot of livestock (sheep, goats, ducks, and geese) because my wife does competition herding with her dogs. Supporting my wife in training the dogs is my extracurricular activity. Plus, there are always things to do around a ranch.
Dentists that administer nitrous Switching gears, I’ve been getting a lot of calls and emails from dentists who are shocked about rules that have been in place for three years now. Many dentists are way out of compliance and don’t know where to start.
How are dentists getting busted for lack of compliance? The state only does inspections for those with level 2, 3, and 4 sedation permits. Those who are administering nitrous will never be inspected for that. But let’s say a new patient comes to see you for a second opinion. You prepare a treatment plan, make your recommendations, and the patient decides to go with you for treatment.
Six months down the road, you get a letter from the state board. They want to copy the patient’s record and the dentist’s emergency plan, and the dentist has no idea what they’re talking about. Nine times out of ten, it’s a complaint against another dentist. That’s how dentists get busted for not having emergency plans. It’s how the conversation starts with me.
Dentists who administer nitrous: What you should be doing What do you need to do? You need to have a written emergency plan in place and train your staff on that plan. You need an AED, stethoscope, blood pressure cuff, backup suction unit, and emergency oxygen unit. Most of the dentists that are calling me had no clue. Luckily, it’s an easy fix.
The takeaway? Be in the know. Get the newsletter from your state li
Diving Deeper into the COVID-19 Rule Expiration
In our last episode, we talked about how the Texas State Board allowed their COVID-19 rules to expire. We think it’s a good thing! But a lot of dentists are not happy about it. So in this episode of Talking with the Toothcop, Andrea and I dive a little deeper into the topic. We’ll share why we think it’s a good thing and what dentists can do moving forward.
Outline of This Episode [2:51] The feedback on the COVID-19 rule expiration [5:22] You can continue what you were doing [8:10] Dentists are encouraged to follow CDC guidelines [11:00] Let us know if you have any episode requests! The feedback on the COVID-19 rule expiration I’m not entirely surprised dentists aren’t happy with the expiration of the rule. Many dentists want to know what they have to do—they like structure. I thought it was a beautiful thing that the state board was allowing dentists to take the reins again.
But a large cross-section of dentists like the comfort of being told what to do. I don’t entirely understand. I get that you want to focus your energy elsewhere. But I like to be recognized for my ability to think, reason, and make my own decisions. Not everyone feels the same way as I do.
Oddly enough, there were a lot of gray areas when regulations were first announced last year. Dentists wanted clarity. Now they’ve taken clarity away again and it can be overwhelming. So what can you do?
Continue what you were doing We want to be clear. Just because the Texas state board allowed their COVID-19 rules to expire does not mean you have to stop following them. If you—and your patients—were comfortable with the level of safety it afforded you, then by all means stick with it. Work within your comfort level.
However, I believe you need to get comfortable stepping outside of your comfort zone. It’s how you grow. You learn to trust your instincts and your ability to trust your own decisions. As a dentist, you’ve earned respect and you’re recognized as someone qualified to make tough decisions beyond the average person (when it comes to oral health). But everything that pertains to your patient’s health is your responsibility. Don’t be afraid to do your own research and make your own decisions.
Dentists are encouraged to follow CDC guidelines The state board encouraged dentists to follow CDC guidelines but did not instruct them to. It sounds like this governing body understands it’s stressful, so if you want guidance, you can continue to follow the CDC recommendations. But they are giving you room to make your own interpretations. By the tone of the ruling, there is flexibility and forgiveness if you get something wrong.
Any recommendations for requests for our next topic? Let me know at toothcop(at)dentalcompliance.com!
Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! The expiration of the COVID-19 Rule Texas Dental Board Rule 108.7 Subsection 16 CDC Guidance for Dental Settings Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube
The Expiration of the COVID-19 Rule: How Does it Impact Dentists?
The Texas dental board let the COVID-19 rule expire (rule 108.7 subsection 16). How does that impact dentists moving forward? What rules do some providers still need to follow? What procedures are still recommended by the CDC? We cover it all in this episode of Talking with the Toothcop!
Outline of This Episode [3:20] The impact of the expiration of the COVID-19 rule [4:41] The OSHA Emergency Temporary Standard [9:25] 1910.504: The Mini Respiratory Protection Program [16:35] Subscribe to the podcast and sign up for our newsletter! The impact of the expiration of the COVID-19 rule How does this impact you? Maybe very little. There is no longer a Texas State Board rule that says you have to follow these specific rules. You don’t have to wear N95 masks. You don’t have to do twice daily temperature checks. You don’t have to screen patients and check their temperature. But many of you have gotten used to the process and feel like it’s best to continue. You absolutely can! You get to decide how to care for and keep your patients and staff safe—whatever that looks like for your practice.
The OSHA Emergency Temporary Standard There is an OSHA standard—the “Emergency Temporary Standard”—that was released a few weeks ago and was effective immediately upon release. That means it is an enforceable federal law. Who is impacted by this law? Those who work with people who are suspected of having or confirmed to have/had had COVID-19. This can include employees at:
Hospitals Nursing homes Assisted living facilities Emergency responders Home healthcare workers Employees in ambulatory care facilities It does not apply to non-hospital care centers where non-employees are screened before entry and those with COVID-19 are not allowed to enter. So if you screen everyone that walks in the door, this rule doesn't apply to you.
If it does apply, you must have a written safety plan, patient screening management, transmission-based precautions, PPE, physical distancing, and more. What qualifies as screening? Listen to find out!
OSHA Standard 1910.504: The Mini Respiratory Protection Program When respirator use is required, the respiratory protection standard applies. This requires medical evaluations, fit testing, a written safety program, user seal checks, and training. What does the “mini” version require? User seal checks and proper training. 90% of dental offices are already here.
CDC COVID-19 guidelines are still recommended The state board still recommends finding the CDC guidelines:
Postpone procedures if they aren't medically necessary Implement Teledentistry and Triage Protocols (doesn’t apply yet) Screen and triage everyone entering for signs and symptoms of COVID-19 Monitor and Manage Dental Healthcare Professionals (if you’re sick, stay home) Create a process to respond to COVID-19 exposures among DHCP and others Implement universal source control measures Encourage physical distancing Consider COVID-19 testing for patients and staff who don’t exhibit symptoms (we recommend you don’t do that) Do things to minimize exposure Implement universal use of PPE Familiarize yourself with this stuff!
Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! The expiration of the COVID-19 Rule Texas Dental Board Rule 108.7 Subsection 16 COVID-19 Healthcare ETS The Mini Respiratory Protection Program CDC Guidance for Dental Settings Save the date for bootcamp: Nov. 19th and 20th Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube
Don’t Neglect Your Sedation and Anesthesia Reviews
Are you doing proper sedation and anesthesia reviews? Are you making sure you don’t have drugs sitting in your office that expired pre-COVID? Are you checking with a patient’s primary care provider before administering anesthesia? Being busy and overwhelmed isn’t an excuse for not doing your due diligence. In this episode of Talking with the Toothcop, Andrea and I touch on the importance of doing a proper review.
Outline of This Episode [4:09] Sedation and anesthesia reviews [8:49] Upcoming anesthesia course Check for expired drugs and equipment I’ve done a lot of sedation and anesthesia reviews in the last few months, and I can tell that some offices have been quite distracted. Those that have been quite busy aren’t staying on top of the things they should, like an annual inspection of the sedation process and equipment reviews. As a result, I’m finding a lot of expired stuff. They’re lucky I found it—not the state board. You need to be routinely checking to make sure you’re not storing expired drugs.
Sedation and anesthesia reviews You also need to be diligent in your patient screening and selection for anesthesia. Don't overlook even the slightest detail. Get the proper medical consultations done versus just getting medical clearance. “Medical clearance” is not an absolution of viability for you. You can’t just exchange paperwork with their primary care physician. Take the time to document the conversation in your clinical notes (with great detail).
Take your pride out of the equation. Even if you’ve done something 1,000 times, there may be one time something goes wrong. If you can’t prove you’ve done your due diligence and properly screened your patient, you won’t have a leg to stand on. Err on the side of caution. If a conversation happened—but it’s not in your records—it didn’t happen.
Upcoming anesthesia course We have an anesthesia CE course coming up on June 5th from 8 am to 12 pm central, but open to anyone across the US. The course is “Principles and Practices of Dental Office Anesthesia,” taught by Dr. Justin Bonner and Dr. Garrett Starling. If you’ve done the same anesthesia course, change it up. Hearing the same thing from a different perspective might impact you in a more meaningful way. Learn more by clicking the link in the resources!
Call to action: When you get to your office, check the expiration dates on your emergency drugs and all of your equipment. Make sure they aren’t expired.
Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Principles and Practices of Dental Office Anesthesia: https://dentalcompliance.com/products/live-anesthesia-principles-and-practices-of-dental-office-anesthesia Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube
I appreciate your podcasts and information so much. You and your guests are informative and I learn so much. Compliance is my passion, and i take every course available, although I am still working chair side as an RDH. Thanks for increasing awareness of all of us dental peeps out there. You all are my spirit animal!
DA Rockstars loves Talking with the ToothCop🤩
I recently met Duane in person at the Voices of Dentistry and was floored with his extensive knowledge in so many things practice related. I have learned so much already probably because I’ve been binge listening for the last two days! This podcast is a must listen for every member of the dental team. Keep up the great work and thank you so much for this podcast.