Speak To a Risk Management Consultant
Working with a risk management consultant, Health Management Solutions, Inc. compliance services begin with a thorough and detailed inspection of the practice’s compliance level with federal, state and local regulations; our compliance inspection is strict and thorough not only in our detailed reports or audits, but in our narrative presentations as well where we provide an objective explanation to a compliance corrective action plan.
We try to provide healthcare professionals with the latest academic and business information. Our clients highly respect and appreciate “peer-review”, and recognize HMS’s dedication to helping them with their healthcare facility’s risk management efforts. We have a team of professionals, specialists from each discipline we serve—dentists, physicians and business management; their combined years of teaching and professional experience contributes to our expertise and credibility. Furthermore, these professionals understand firsthand the healthcare provider’s business and ethical concerns. We look forward to being of service to your organization.
QUARTERLY DENTAL DOCUMENTATION AND RECORD-KEEPING AUDITS PROGRAM.
GOALS: Encourage dentists to implement quarterly dental documentation and record-keeping practice audits, to reduce risks and improve their dental risk management practices. Health Management Solutions, Inc’s goal is to raise the dental practitioner’s level of compliance with community standards of dental care, and to provide a thorough and comprehensive dental practice documentation analysis and dental documentation improvement program.
PROGRAM DESCRIPTION: This was developed with the purpose on offering periodic dental documentation and record-keeping practice audits in order to reduce the practice’s liability risks and to improve compliance with “recommended” community standards of dental practice, and or “required” professional community standards of dental practice.
We closely look for Florida’s Dental Board Compliance as well as other regulatory agencies’ requirements. It is a detailed audit concentrating in dental documentation, record-keeping and billing practices. We will look in detail for the implementation of all of the topics discussed in Health Management Solutions Inc.’s risk management seminar—which is an expansion of the Florida Laws and Rules course—and the topics discussed in the dental documentation management and record keeping requirements seminar.
Health Management Solutions, Inc. quarterly documentation audits are comprehensive, and they encompass “detailed individualized record audits” per patients’ records audited and a “Narrative Audit Report” with findings and recommendations, and a written “Corrective Action Plan”. Additionally, we will provide a written outline of our findings in each area. Finally, we will provide assistance in obtaining recommended forms to assist the dental practice in the implementation process of the recommended dental documentation practices.
1* Price for this service depends on the size of the practice; depth of investigation; length of time requested and level of commitment and cooperation from the dental practice.
HUMAN RESOURCE MANAGEMENT PRACTICES
Health Management Solutions, Inc. will provide personnel management assistance for healthcare facilities which lack management expertise or need additional assistance with their human resource’s efforts. HMS takes a proactive approach in managing the healthcare facility’s staff. Some of the services offered are:
- Create and update a Personnel Policy Manual tailored to the organization’s needs. The Personnel Policy Manual will help the practice comply with the American with Disabilities Act (ADA), a federal law that covers all companies with 25 or more employees; Equal Employment Opportunities, Employment Medical Examination and the Family and Medical Leave Act (FMLA)
- Assist in determining and changing personnel assignment as needed; assist in interviewing, selecting hiring, and terminating clerical and managerial staff. Test applicants for required skills; conduct interview analysis and run references back-ground check; train employees; conduct performance and salary reviews and conduct regular staff meetings
- Create accurate Job Descriptions describing the technical requirements and industry standards for the healthcare facility’s employees. The health services industry Job’s descriptions must include the technical requirements and industry standards; well-written job description will spell out the employers expectations and make sure that each employee clearly understands their duties. This lays the groundwork to discuss employee problems objectively
- Health Management Solutions, Inc. will assist in creating, or up-dating, personnel files to ensure compliance with immigration, OSHA, HRS, State and Federal requirements in order to reduce employee related Risk Management.
Our goal is to educate healthcare professionals on the legal requirements of having properly implemented human resources practices, and in teaching them how important this practice – is often overlooked or is improperly carried by management–can be the source of huge liability risks.
Web enabled in nature, and available in real time, DentalMax offers Clinical Records, it offers Facilities Management, it offers Payment Management, and it also offers a robust Back Office operation enabling Billing, Accounting and Financial Reporting.
Available through a simple internet connection on just about any internet ready device, no special equipment is ever required, it directly integrates with your present X-Ray system, there’s no further need for system back-ups, there’s no longer a need for merchant accounts or credit card terminals, there’s no more loss of data due to power outages or other irregularities, there’s no more patient data stored on local computers, there are no more HIPPA nor OSHA violations.
DentalMax is without a doubt, the ultimate path to a successful, compliant, automated practice.
Here are some of the Clinical Records highlights:
- Staff and Patient Scheduling.
- Staff and Patient Profiling.
- Staff Time and Attendance.
- Dental Inventory Control – Costing and Re-Ordering.
- Patient Assessments and Plans.
- Automated Diagnosis, Treatment and Procedure Codification.
- X-Ray Integration.
- Treatment Plan Prioritization.
- On Going Patient Treatment and Office Visits.
- Voice to Text Progress and SOAP Notes.
- Three Dimensional Charting for Dental, Prosthetic and Oral Screening.
- Voice to Text Periodontal Charting.
- Prescriptions and Drug Interactions.
- Patient Treatment Estimated Insurance Coverage and Out of Packet Costs.
- Referrals, Follow Ups and Post Operatives.
- Automated Authorizations, Consents, Discharges and Termination Forms.
- Work Order Records for Hygienic, Laboratory, Imaging and Prosthetic prescriptions.
- Insurance Verification and Billing.
- Patient Clinical and Financial Views.
- Digitalization of existing Paper Records.
Here are some of the Facilities Management highlights:
- Building and Facilities Inventory Control – Costing and Re-Ordering.
- Vendor/Contractor Management.
- Work Order Management – Electrical, Plumbing, Waste, Equipment etc…
Here are some of the Payment Management highlights:
- Acceptance of World Wide Credit Cards and Domestic ACH.
- No Conventional Merchant Accounts.
- No Credit Card Terminals.
- Robust Mechanism for Reporting and Reconciliation of Patient Payments.
- Payment Data Retention – 7 Years.
- No Cost to Practice (NO FEES).
Here are some of the Accounting and Financial Reporting highlights:
- Accounts Payable – Conventional Paper Checks or Electronic.
- Accounts Receivable – Insurance Billing and Patient Out of Packet.
- Vendor Management.
- Patient Billing Ledger – Charges, Insurance Billing and Out of Packet.
- Patient Monthly/Yearly Statements – Paper or Electronic.
- General Ledger – Adjustments, Journal Entries, Balances.
- Cash Receipt Journal.
- Treatment – Financial Arrangement Delinquencies.
- Complete Patient Ledger.
- Balance Sheet.
- Profit and Loss Statement.
- General Ledger Trial Balances.
- Budget and Forecasting.
Personnel Policies and Procedures Manual
We understand that it is often difficult for small to medium size organizations, particularly healthcare providers, to comprehend the importance of implementing personnel policies and procedures for their small to medium size practices. Healthcare professionals’ general consensus is that “these Human Resource’ practices do not apply to our type of business, this is for larger organizations.”
This attitude is perpetuated by the fact that “Business Principles” are not something most dental or medical school make part of their educational curriculum; yet when healthcare providers go into private practice, they face a mountain of business related challenges and they are totally unprepared to manage them appropriately, let alone implement required practices to be in compliance. Thus, a myriad of frustrating experiences and liability issues arise.
HMS mission is to help dental professionals, Develop clearly defined, “Written Personnel Policies and Procedures” that are documented, implemented, updated, and followed by Staff, Managers and Administrators, with the goal to bring structure and significantly reduce the practice’s liability risks. Personnel Policies and Procedures add financial value to the practice and are a remarkable tool in the daily decision-making processes, and the many challenges associated in managing effectively, any size, healthcare facility.
“Personnel Policies and Procedures” need to be malleable to the needs of the company and be enforced across the organization, and they must be “industry specific” to be able to address and incorporate employer and employee’s legal and/or professional requirements and/or responsibilities. Health Management Solutions, Inc., with the collaboration of the practice’s administrator and/or healthcare provider, will develop for your particular dental practice “industry specific” Personnel Policies and Procedures. HMS, understands that every private practice or healthcare facility has specific internal practices, concerns, requirements and issues that are sensitive and must be incorporated into the Personnel Policies and Procedures Manual, in order to address them effectively and professionally without unnecessary personal confrontations with any of the staff.
Healthcare professionals need to understand that there is a direct relationship between policies and procedures; for each clearly defined policy, there needs to be a written statement communicating to the staff how to apply the specific policy, how it is enforced, whom it affects, and who is in charge. Policies provide several types of information that new and established employees need to know. New employees need to understand such factors as dress requirements, breaks and lunch practices, working hours, electronic equipment use, treatment of company property, confidential information, what constitute sexual harassment and violence in the work place. All employees must understand policies in regards to vacation, sick time, leaving early, holiday pay, medical leaves, and benefits. Supervisors and managers have policies that explain discipline processes, coaching, and counseling employees.
“Personnel Policies and Procedures” serve as an intricate risk management vehicle to ensure employees, managers and administrators’ compliance, not only with company’s rules, but legal and professional requirements. Therefore, they create a structure and a system of accountability, to clearly define the organization’s expectations, goals, responsibilities and corporate philosophy. If properly enforced, “Personnel Policies and Procedures” create a viable corporate system, capable of having far reaching unimaginable positive benefits for any size organization; not only capable of reducing corporate liability risk from employees, Federal, State, Local and Professional organizations, but Personnel Policies and Procedures create a responsible management infrastructure, with clearly defined corporate goals and objectives creating a viable source of potential capital acquisition and increase the practice resale value. Capital lending organizations and most dental and/or healthcare insurance providers, during their accreditation process, look at their potential risk of either lending the money to a practice capable of generating sufficient revenues to meet their financial obligations; or in the case of a dental or healthcare insurance provider, they want to know whether the practice has implemented risk management systems in order to reduce all types of liabilities. This is significantly important to them because dental and medical insurance carriers, when they engage into a contractual relationship with a dental or medical healthcare provider, they become “vicariously” responsible for any potential liabilities from any of their healthcare providers. Therefore, the importance of implementing Personnel Policies and Procedures, goes beyond having a manual collecting dust in a book shelve. They bring structure to a dental practice, significantly reduce liability risks and add financial value to the practice.
TABLE OF CONTENTS
40 INTRODUCTORY STATEMENT
41 HIRING PROTOCOL
41 A. EMPLOYEE INTERVIEW ANALYSIS
42 MISSION STATEMENT
43 YOUR ROLE AT CORAL GABLES DENTAL HEALTH CENTER
44 CREDENTIALING PROCESS
45 DENTIST’S CREDENTIAL CHECKLIST
46 RECERTIFICATION OF STATE LICENSE
47 POLICIES AND PROCEDURES ACKNOWLEDGEMENT FORM
70 REPORTING INJURIES
71 STEPS TO BE TAKEN IN CASE OF AN EXPOSURE INCIDENT
80 STANDARD PRECAUTIONS
81 OSHA’s REGULATIONS
82 CHAPTER 64E-16 F.A.C.
83 HIPAA REGULATIONS
84 WORKFORCE CONF. AGREEMENT
85 TUBERCULOSIS SCREENING OF HEALTH CARE WORKER
101 NATURE OF EMPLOYMENT
102 EMPLOYEE RELATIONS AND PROBLEM SOLVING
103 EQUAL EMPLOYMENT OPPORTUNITY
104 DISCIPLINARY PROCEDURE
105 HIRING OF RELATIVES
106 EMPLOYEE MEDICAL EXAMINATIONS
107 IMMIGRATION LAW COMPLIANCE
108 CONFLICTS OF INTEREST
110 OUTSIDE EMPLOYMENT
113 NON-DISCLOSURE STATEMENT
201 EMPLOYMENT CATEGORIES
202 ACCESS TO PERSONNEL FILES
203 EMPLOYMENT REFERENCE CHECKS
203 A. REQUEST FOR EMPLOYMENT REFERENCE
203 B. REQUEST FOR REFERENCE
204 PERSONNEL DATA CHANGES
204 A. EMERGENCY NOTIFICATION
205 INTRODUCTORY PERIOD AND EMPLOYEE ORIENTATION
206 JOB DISCRIPTION
207 EMPLOYEE ACKNOWLEDGEMENT FOR OF INTRODUCTORY PERIOD
208 EMPLOYMENT APPLICATIONS
209 PERFORMANCE EVALUATION
301 EMPLOYEE BENEFITS
303 DOCTORS APPOINTMENTS
304 VACATION BENEFITS
305 CHILD CARE BENEFITS
307 WORKERS’ COMPENSATION INSURANCE
308 SICK LEAVE BENEFITS
309 TIME OFF TO VOTE
310 BEREAVEMENT LEAVE
311 SALARY ADMINISTRATION
312 JURY DUTY
313 WITNESS DUTY
314 LEAVE OF ABSENCE
315 EDUCATIONAL ASSISTANCE AND STAFF TRAINING
315 A. EMPLOYEE TRAINING RECORD
405 EMPLOYMENT TERMINATION
407 SEVERANCE PAY
409 ADMINISTRATIVE PAY CORRECTIONS
410 PAY DEDUCTIONS
500 AFTER HOUR’S EMERGENCIES PROTOCOLS
501 SAFETY AND SECURITY
501. EMPLOYEES AWARENESS SAFETY ITEMS FORM
502 WORK SCHEDULES
503 E-MAIL AND INTERNET POLICY
504 USE OF TELEPHONES
506 MEAL PERIODS
507 OVERTIME, PAY ADVANCES AND LOANS
508 USE OF EQUIPMENT
509 STAFF MEETING
510 EMERGENCY CLOSINGS
512 BUSINESS TRAVEL EXPENSES
513 PARKING SPACE ASIGNMENT
514 VISITORS IN THE WORKPLACE
515 LEAVING AND REMAINING ON PREMISES
516 PATIENT AND PUBLIC RELATIONS
517 INTERPERSONAL RELATIONSHIP WITH CO-WORKERS
518 GOOD HOUSEKEEPING
520 MEDICAL EMERGENCY PROTOCOL
521 ADVERSE OCCURRENCE PROTOCOL
522 ORAL HYGINE RECALL PROTOCOL
523 PATIENT REFERAL PROTOCOL
524 SCHEDULING PROTOCOLS
525 MEDICAL ALERTS PROTOCOL
526 BILLING PROTOCOL
527 COLLECTION POLICY
528 PURCHASING POLICY
529 FINANCIAL AGREEMENT AND TREATMENT POLICY
601 MEDICAL LEAVE
602 FAMILY LEAVE
603 PERSONAL LEAVE
604 EDUCATIONAL LEAVE
605 MILITARY LEAVE
607 PREGNANCY-RELATED ABSENCES
701 EMPLOYEE CONDUCT AND WORK RULES
702 DRUGS AND ALCOHOL USE
703 SEXUAL AND OTHER UNLAWFUL HARAMENT
704 ATTENDANCES AND PUNCTUALITY
705 PERSONAL APPEARENCE
706 RETURN OF PROPERTY
710 SECURITY INSPECTIONS
714 DRUG TESTING
715 FALSIFICATION OF RECORDS
800 LIFE-THREATENING ILLNEES IN THE WORKPLACE
PRACTICE MANAGEMENT ASSESSMENT
Health Management Solutions, Inc. will be looking to significantly improve the healthcare facilities’ management needs. We offer objective professional advice from an impartial position. Our experience demonstrates that healthcare professionals and office managers spend countless hours trying to evaluate their practice’s performance lacking the proper tools to make proper management decisions. They are simply too busy with the daily practice’s demands, and many management tasks are simply overlooked. This leads to costly oversights due to improper decision making processes which can be the source of potential liability risks!
- Health Management Solutions, Inc., will help healthcare facilities to re-focus on planning, organizing and controlling the business practices of the healthcare facility.
Our objectives are to:
- Provide healthcare professional with the managing tools to effectively organize and monitor the practice’s performance. This will include the evaluation of existing computer software and implementation of newer more cost effectives state-of-the art ELECTRONIC HEALTHCARE RECORDS (EMR) dental management programs and totally HIPAA Compliant Dental or Medical software systems.
- Identify problem areas, after speaking with Administration and Employees, and offer alternative solutions in a written Corrective Action Report;
- Assist and guide the practice’s staff to implement management information system (MIS) in order to monitor performance and develop Marketing Strategies;anagement” strategies to maximize profitability;
- Show the practice’s staff what information is important; how to properly gather and use information effectively to determine referral trends–in order to implement or improve marketing strategies;
- Measure service quality, reduce financial risks; and implement “Cash Management” strategies to maximize profitability;
- Evaluate current telephone techniques and the dental practice’s use of telephone services, such as answering service company being used, electronic answering service system, and make sure it meets the practice needs and requirements with Florida’s Board of Dentistry’s requirements; patient recalling system or appointment reminder services; make evaluation of current practices and provide recommendations for services to improve patient care, treatment plan compliance and appointment retention;
- Ensure that the practice is in compliance with all Federal, State and Local regulatory Agencies;
- Establish utilization review systems to monitor over utilization or under provision of certain modalities, such as preventative care, smoking sensation, or other issues such as improper documentation of suspected domestic violence incidents, or suspected Human Trafficking cases;
- Implementation of patient’s files Quality Assurance (QA) review;
- Establish Management Systems for technical and management staff to follow and create a practice accountability tracking system for the practice.
Our Goal is to establish management systems that:
- improve productivity
- reduce cost
- increase patient treatment acceptance
- improve marketing results
- improve employee retention
- obtain quality employees
- improve patient care
- improve profitability
- stress reduction
HMS offers a World of difference in reducing your Dental Practice’s Risk Management.
I. EVALUATION OF DENTAL PRACTICE’S STATE OF AFFAIRS
HMS will need to review the following:
- Billing Practices: identify missing/overlooked procedure codes;
- Credit practices: identify additional means of offering credit access to patients in order to maximize approval of treatment plans;
- Telephone practices: identify telephone techniques and recall practices;
- Evaluate existing marketing efforts and their results. Identify patient demographics;
- Examine insurance verification practices to identify deficiencies;
- Examine patients treatment planning presentations’ techniques;
- Evaluate patients’ credit financial assistance options;
- Evaluate current financial policy, or if there is none; create a written clearly defined financial policy;
- Review Personnel Files to verify required staff’s credentialing documentation;
- Revise and update existing written Job Descriptions;
- Evaluate staff utilization levels, to determine under or over utilization levels, and to ensure that the practices adhere to the require Florida’s Board of Dentistry’s regulations;
- Create a Professional Practice Presentation Folder with the purpose to enhance the practice’s image, explaining and clearly demonstrating to patients all of the dental professional’s credentials, expertise and type of dental services performed by the practice;
- Introduce and/or revise the dental practice’s Personnel Policy Manual;
- Introduce and/or revise HIPAA Policies and Procedures Manual and ensure that complies with the High Tech Act or Omnibus Rule;
- Create and enforce OSHA’s required Blood-borne Pathogen Standard;
- Create and enforce OSHA’s required Globally Harmonized System of Classification;
- Create and enforce OSHA’s requirements under the General Safety Rule of having a Protocol to document Violence in the Work-force;
- Create and enforce a Human Trafficking Protocol with clearly defined staff training, reporting and documentation procedures;
- Create and enforce a Domestic Violence Protocol with clearly defined staff training, reporting and documentation procedures;
- Create and enforce the Health Department, required Biomedical Waste Operating Plan, as per Chapter 64E-16,FAC, with clearly defined staff training, biomedical waste spills instructions and waste removal procedures;
- Create a Facility Security Plan to comply with the new High Tech Security Standards;
- Create a Dental Documentation Risk Management Protocol.
II.RISK MANAGEMENT PLAN
- We will concentrate on increasing productivity through maximizing human resources’ utilization;
- Improving profitability will be accomplished by implementing sales incentives to the entire staff to generate additional income from sales of treatment plan, cosmetic dentistry procedures and/or dental hygiene product related sales;
- Improving aging account receivables and improving collection practices;
- Ensuring that co-payments are collected when treatments are provided. The coordination of collection practices has to coincide with completion of treatment; or prior to insertions of prosthetic appliances.
- Introduce new revenue producing services and products to improve practice’s profitability;
- Introduce specific and uniform dental documentation practices to improve Risk Management practices reducing liability risk and improving dental communications at all levels;
- Create a clearly defined management structure creating a chain of command and an accountability system;
- Create an organizational chart to visually represent the chain of command and administrative responsibilities of every staff member;
- Create specific job descriptions to define delegable task to technical staff as defined by Florida’s Board of Dentistry; and require strict compliance which will be enforced through the Personnel Policy Manual Policy and Procedures.
- Organize scheduling practices to significantly improve human resources utilization;
- Conduct monthly general staff meetings;
- Conduct administrative weekly meetings to review productivity, collection, marketing and other administrative issues;
- Establish uniform and clearly defined dental documentation practices to be followed by dental professionals, in order to reduce liability risks and improve risk management practices, and to adhere to Community Standards of Practices;
- Implement HIPAA Policies and Procedures and make sure staff understand them as they pertain to their individual responsibilities;
- Enforce OSHA’s Globally Harmonize System of Classification;
- Enforce Chapter 64E-16 FAC’s Biomedical Waste Protocol
- Enforce and Revise the Employee Personnel and Safety Manual
- Conduct HIPAA Staff Training
- Conduct OSHA’s Blood-borne Pathogens Standard Staff Training
- Conduct OSHA’s Globally Harmonize System of Classification Staff Training
- Conduct Chapter 64E-16 FAC Biomedical Waste Staff Training
- Conduct Dental Documentation and Record-keeping Staff Training
- Implement an “Employee of the Month Award”;
- Implement “An Outstanding Sales & Service Award”;
- Offer tangible rewards; such as: a) profit sharing, b) movie or dinner tickets, c) a day at a Spa, sales commissions.
- Daily verbal recognition for a job well done and a “thank you” goes a long way in managing any business;
- Introduce and constantly re-enforce the “Team Effort” philosophy, which can be accomplished by empowering employees; improving accountability thru the enforcement of Job Descriptions and improve morale issues by recognizing their efforts.
- Conduct an initial Risk Management course to explain technical staff and particularly dental professionals the importance of some of the documentation changes, and new management systems.
- Identification of personnel deficiencies on an individual basis in order to immediately address the problem;
- Weekly documentation audits from randomly selected patient’s files will show documentation deficiencies, dental diagnostic errors preventing and reducing the practice’s liability risk. This initiative will establish a constant reminder of accountability to required documentation practices, and community standards of dental practices;
- Deficiencies will be addressed individually and in a professional manner–privately and with a dental professional and/or administrator professional’s presence–addressing issues with sensibility and tact, to explain required community standards of practice, and the sensibility of the practice’s liability exposure due to a multi-specialty dental practice.
- TO BE DISCUSSED BASED ON THE SCOPE OF SERVICES REQUESTED
- CONDITIONS: HEALTH MANAGEMENT SOLUTIONS expects a respectful professional and ethical behavior from the dental staff towards any and all of HMS’s officers, employees and subcontractors. Likewise, we expect complete compliance from clients with all Local, State and Federal Regulatory requirements, after they have been brought to their attention. Failure to do this, will terminate our business relationship and contractual agreements effective immediately.
- A written service agreement is required
OSHA COMPLIANCE SERVICES AND INFORMATION
HIPAA COMPLIANCE RISK MANAGEMENT SERVICES