SNS Client Dashboard Data Survey Questions

Transcription

1 SNS Client Dashboard Data Survey Questions *This document lists the questions asked in the online SNS data survey; all responses should be submitted via the client portal Step 1 If your dental program has multiple locations, all of the survey questionnaires within the Step One section of the data survey should be answered as program-wide responses. If there is variability from location to location, you can explain the differences in the Additional Notes field located at the bottom of every page. Program Profile 1. Clinic type 2. If you are an FQHC, are you paid fee-for-service or by an encounter rate for Medicaid? 3. If you are paid on an encounter rate, what is your current rate? 4. If you are an FQHC, how much of your 330 grant funding is allocated to dental? 5. Has your service area, population, or facility been designated as a Dental Health Professional Shortage Area? a. If yes, what is your score? 6. What Electronic Dental Record (EDR)/Practice Management System does the dental department utilize? a. If you selected other, please type the name of the product here. Also if you know the version you are using from the above list, please type that here. 7. If your dental clinic is associated with a larger organization, what Electronic Medical Record (EMR) is utilized by the medical clinic of your organization? 8. If your organization has an EMR, to what extent is it integrated with your EDR? 9. Does the dental clinic staff have access to the patient s medical record, and vice versa? 10. Does medical provide any dental services (if applicable)? a. If so, please explain: 11. Is there a formal referral process between medical and dental (if applicable)? a. If so, please explain: 12. Are there regularly scheduled meetings for the dental department? a. How often? b. Who leads the meeting? c. What is discussed?

2 13. Are there regularly scheduled joint meetings of the medical and dental providers (if applicable)? a. How often? b. Who leads the meeting? c. What is discussed? 14. Is there a formal dental provider orientation process? 15. Is there a dental provider manual? 16. Do your hygienists practice expanded duties? a. If yes, what do the expanded duties include? 17. Do your dental assistants practice expanded duties? a. If yes, what do the expanded duties include? 18. Do you offer an incentive program for providers? a. If so, please explain: 19. Do you offer an incentive program for other members of the dental team? a. If so, please explain: 20. Are you experiencing high staff turnover in your dental program? a. If yes, please select the position(s) that you have the most difficultly retaining: (check all that apply): i. Dentists ii. Hygienists iii. Dental Assistants iv. Front Desk Representatives v. Dental Billing Specialists vi. Clinic Managers 21. Please rate your program s ability to recruit dental staff. a. Please select the position(s) that you have the most difficultly recruiting (if applicable): (check all that apply): i. Dentists ii. Hygienists iii. Dental Assistants iv. Front Desk Representatives v. Dental Billing Specialists vi. Clinic Managers 22. How many years has it been since the Dental Director graduated from dental school? 23. How many years has the Dental Director worked in a community-based setting? 24. How many years has the Dental Director served as Dental Director? 25. Is the Dental Director a member of the health center leadership team (if applicable)? 26. How much administrative time is allocated to the dental director s schedule?

3 Dental Insurance: 1. Who is responsible for verifying insurance eligibility/enrollment? a. When is this done? 2. What happens if a patient claims to have insurance, but their enrollment/eligibility cannot be verified? 3. Do you document a patient s breakdown of benefits? a. If yes, when is this done? 4. Select from the following insurance benefit information that your staff routinely discuss with patients: a. Covered vs. non-covered services b. Their deductible (if applicable) c. Remaining annual dental insurance d. The full fee value of the service, expected insurance payment and patient copayment e. We do not discuss insurance with patients 5. When do you collect the patient s insurance copayment? 6. How often do patients make their insurance copayment at the date of service? 7. What happens if the patient is ineligible for a (non-emergent) proposed service? 8. Are dentists and hygienists educated about Medicaid services and the reimbursement for adults versus children? 9. How are providers updated about changes in insurance coverage and reimbursement? 10. Does clinic staff understand which services require prior authorization? 11. Who is responsible for submitting a prior authorization request? 12. When a procedure requires a prior authorization, what is the process? 13. How often are procedures requiring prior authorization provided without prior authorization? 14. If a preauthorization for a service is denied, what is the process? Patient Payments 1. Are dental clinic fees representative of current market rates? 2. Do you offer a sliding fee discount schedule (SFDS) for uninsured dental patients? 3. How do you document patient s eligibility for the SFDS? 4. Who is responsible for verifying and documenting eligibility for the sliding fee discount schedule? 5. How often is SFDS eligibility determination updated? 6. Are patients with private or public dental insurance educated about the SFDS?

4 7. What happens if a patient reports that they are eligible for the SFDS but they do not bring proper documentation? 8. Are patients asked to sign a document to agree to their financial responsibility? 9. Are patients educated about the full value of the services they receive, the amount of their discount, and their portion of the balance? 10. What is your nominal fee for patients who are at or under 100% of the Federal Poverty Level (if applicable)? Billing & Collections: 1. Who is responsible for dental billing? 2. Prior to the creation of the dental claim, who verifies the accuracy of the encounter? 3. How much time passes between the receipt of remittance (payment) and the posting of payments to patient accounts? 4. What percentage of dental claims are paid after the first submission? 5. Why are claims denied? Please rate the frequency of the following potential reasons for denied claims at your dental program: a. Untimely filing b. No process for resubmission c. No staff for resubmission d. Service not covered e. Duplication of service f. Coding Error g. Prior authorizations not obtained h. Patient not eligible/enrolled in insurance 6. When a claim is denied, who scrubs and resubmits the claims? 7. When are denials resubmitted? 8. What percentage of denied dental claims are paid subsequent to resubmission? 9. What percentage of rejected claims are written off? 10. Why are claims written off? Please rate the frequency of the following potential reasons for rejected claims at your dental program: a. Service not covered b. Duplication of service c. Patient ineligibility d. Claim submitted too late e. Prior authorizations not obtained f. No process for resubmission g. No staff for resubmission h. Unfamiliar with resubmission process

5 11. How many attempts are made to collect patient payments? 12. Are unpaid accounts turned over to a collection agency? 13. Is there a balance limit after which patients with unpaid accounts are no longer allowed to receive non-emergent services? a. If yes, what is the limit? Scheduling: 1. Is there a standard appointment length for all visits? a. If yes, how long are the appointments? 2. If you provide different appointment lengths for different visit types, please enter the amount of time in minutes. a. New adult patients b. New pediatric patients c. Adult recall patients d. Pediatric recall patients e. Restorative f. Oral Surgery g. Endodontics h. Perio Treatment i. Emergency j. Sealants 3. Do you double-book patients? a. If yes, please explain 4. Do you use designated access scheduling? a. If yes, please explain 5. Who can schedule appointments? 6. If your dental practice utilizes a different scheduling philosophy or template please describe: 7. How far out are appointments booked in the dentists schedules? 8. How far out are appointments booked in the hygienists schedules? 9. Are you satisfied with your current scheduling program? a. If you are dissatisfied with your current scheduling program please explain. 10. Do you feel that your schedule is negatively impacting the following: a. Completion of phase 1 treatments? b. Financial sustainability? c. Patient satisfaction? d. Staff satisfaction?

6 Emergencies: 1. Briefly describe your policy for emergency treatment. 2. Is your emergency policy in writing? 3. Describe the criteria used to define an emergency patient. 4. Do you offer block scheduling for emergency appointments? a. If yes, how many appointments per day and are they at a specific time? 5. What is the standard protocol for services provided during emergency visits? Is this routinely followed? 6. Are your dental staff on call after hours? 7. How are emergencies handled after hours? 8. Are there restrictions on how many emergency patients per day the dental clinic will take? a. If so, what are they? Broken Appointments: 1. What does your clinic consider a broken appointment? 2. Do you have a policy for patients who break their appointments? a. If yes, what is it? 3. Is the broken appointment policy documented in writing? 4. Are all patients asked to sign a written copy of the broken appointment policy? 5. Is the broken appointment policy enforced uniformly with all patients? 6. How do you track broken appointments? 7. What is your current broken appointment rate for dental? 8. Do you confirm patient visits in advance? a. If yes, how, when and who is responsible? Dental Program Evaluation 1. Please describe your quality assurance and/or quality improvement plan. (How do you monitor it? How is it documented? If your dental program is part of a larger organization, is there a standalone dental quality improvement program or is it integrated with the overall quality improvement program of the organization?) 2. Do you currently track the number of Phase 1 completed treatment plans? a. If yes, what is your current treatment plan completion rate? 3. On average, how long does it take for patients to complete their Phase 1 treatment? 4. Does your dental program incorporate caries risk assessments (CRA) into patient visits? a. If yes, what is your process? 5. If applicable, do you track the HRSA sealant metric?

7 a. If yes, what is your current rate? 6. Do you track any other preventive measures? a. If yes, please describe: 7. Does the dental practice have patient satisfaction surveys? a. If yes, how often is this done? b. If yes, what does the clinic do with the results? 8. Does the dental practice have a risk management plan? a. If yes, please briefly describe. 9. Does the dental program have access, financial, and/or outcome goals? a. If yes please answer the following: i. Who takes part in the creation of these goals? ii. Please describe the goals: iii. How often are these goals measured and evaluated? 10. Does the dental clinic receive a transaction report by CDT code? a. If yes, how often? 11. Does the dental clinic receive a profit and loss statement from finance? a. If yes, how often? 12. Does the Dental Director take part in the budget development (or planning) process for the dental department? 13. Does the budget estimate enough revenue will be generated to cover dental program expenses? 14. In the last fiscal year has the dental program reduced staff, operating hours, number of chairs, or is the practice as risk for such cutbacks? a. If yes, please explain. 15. What specific objectives would your dental program like to achieve as a results of working with Safety Net Solutions? Step 2 Location Specific Data In Step Two you will enter location specific data. If your dental program has multiple locations, create your main location first and then create a unique location profile for any additional dental clinic locations. If you have a mobile or portable program, you can enter one unique location to represent all of the care delivered outside the physical walls of the clinics. Profile of Location 1. Number of operatories 2. Hours of operation 3. Is this dental clinic location co-located with medical (if applicable)? 4. Number of dental patient visits per year

8 5. Number of new dental patients per year 6. Percentage of overall health center patients who are also patients of record in dental (if applicable) 7. Number of individual, unduplicated dental patients per year 8. Number of unduplicated patients in the following age categories: a. 0-5 years b years c years d years e. 65+ years 9. Number of unduplicated patients in the following payer categories: a. Self-Pay/Sliding Fee Discount Schedule b. Medicaid c. Commercial Insurance d. Managed Care e. CHIP f. Other (please explain) 10. Staffing levels a. General Dentists b. Dental Hygienists c. Pediatric Dentists d. Oral Surgeons e. Endodontists f. Periodondists g. Orthodontists h. Prosthodontists i. Dental Assistants j. Receptionists

9 k. Registration Staff l. Practice Manager m. Dental Billing n. Total Number: o. Total FTE: