risk – Beyond the Bite

By Julie Brightwell, JD, RN, Director, Healthcare System Patient Safety, The Doctors Company

Recently, hurricanes, floods and fires nationwide have highlighted the importance of planning for disasters. Hurricane and flood damage in Texas and Florida left practices without power for days or even weeks. Wildfires in California forced several dentists to quickly relocate their practices ― some permanently ― and to move scheduled procedures to different facilities. Is your practice prepared for this type of situation?

A disaster can overwhelm a dental practice, with damage that can include shattered windows, flood debris, power outages, disrupted telephone systems, computer and system outages, unsafe drinking water, destroyed dental records, medication exposure to temperature and humidity extremes, contaminated instruments and building structure failure.

Disaster preparedness requires a continuous cycle of planning, organizing, training, equipping, rehearsing and evaluating. Dentists are critical participants in disaster preparedness, ensuring that patient care and critical services are not interrupted.

Plan Ahead Now
Before the next disaster strikes, make sure your practice has a plan in place. A checklist, ordered by priority and customized to specific types of disasters, can provide the framework for a comprehensive plan. The checklist should include these elements:

A full-circle call tree that outlines who contacts whom.
Instructions for setting up instant messaging technology that enables staff to communicate without a wireless network or cellular data connection.
A Certificate of Insurance for your dental malpractice coverage, or instructions for contacting your agent or insurer directly to obtain proof of coverage. This document will be necessary if you are forced to temporarily relocate your practice or procedures.
Steps to follow upon returning from evacuation.

When Disaster Strikes
Planning today makes accomplishing the following tasks more feasible during a disaster:

Communication

Contact staff immediately to determine realistic time frames to return to work.
Notify external vendors and business associates of your practice interruption and targeted resumption of operation.
Implement staff briefings at the beginning and end of each day.
Create temporary phone, fax and answering services.
Establish patient telephone triage.
Implement temporary controls to ensure HIPAA compliance.

Computers and systems

Contact computer service vendors to ensure integrity and recovery.
Verify insurance coverage for repair or replacement costs and losses.
Evaluate applicable warranties and consider an information technology restoration service contract.
Inventory and document hardware and software.
Document the type and extent of both lost electronic and paper data.
Ensure data backup and periodically test compliance.
Re-establish filing systems and internal programs.

Dental records

Determine the extent of damage to, or loss of, patient records and filing systems.
Attempt to restore all damaged charts and document inventory findings.
Notify the state dental board for specific guidance pertaining to lost or damaged records.
Document all efforts to restore and protect existing records.
Reconstruct lost charts at the next patient encounter.
Contact your insurance carrier for restorative services and/or claim procedures.
Re-establish a filing system and temporary storage if necessary.
Obtain legal guidance for patient notification during recovery efforts.
Contemporaneously date and initial all late entries and duplicate information in context of recovery efforts.

In addition, create an inventory of all equipment and medications that may have been exposed to water or extremes in temperature. Repair, replace or discard damaged items appropriately.

Once your plan is in place, regularly re-evaluate its steps and update all contact information. Practice and rehearse the plan’s protocols. An effective disaster preparedness plan will help keep your practice focused on delivering care during an emergency.

The guidelines suggested here are not rules, do not constitute legal advice and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

By Julian Dozier, CPA, ABV, CFF, CFE, Thomas Howell Ferguson P.A. CPAs

You work hard in your practice, enjoy spending time with your patients, and do your best to manage your office staff and bookkeeping. While you’d rather be spending time on the medical side of your practice, you understand the importance of being involved in the business side of your practice. No one wants to think their employees would steal from their company, but every organization faces the risk. So, do you have a sound system of internal controls in place to mitigate the risk?

Here are five simple steps you can take to reduce your risk of employee embezzlement:

1. Conduct background checks. Your employees may have access to your financial information, bank accounts, prescription pads and expensive medical supplies. Be sure to conduct background checks before hiring any employee, and make it your policy to update those checks at least every two years for financial personnel.

2. Segregation of duties. Financial tasks should be assigned so that no single employee is responsible for authorizing transactions, maintaining custody of assets and resources, recording transactions and reconciling accounts. While it’s best for all four of those functions to be segregated, be sure no single employee is responsible for more than two of them. As an example, if an employee can authorize payments to vendors, they should not be authorized to add vendors to the accounting system, print and sign checks, or reconcile the bank account.

3. Oversight is important. The perception of detection can be as important as any other internal control your practice puts in place. If employees know their work is being checked, and that the bank accounts are being reconciled and verified, they are less likely to embezzle.

4. Know your bank account. For assets like cash that — when there are poor internal controls — can be embezzled quickly and easily concealed, you need to do more. Receive each monthly bank statement directly (unopened) and review it for unusual or unexpected activity. Ask questions. Know where your practice spends its money and who is authorizing those transactions. Quickly spotting unauthorized bank activity is critical to minimizing your risk of embezzlement.

5. Get outside help. Find a local certified public accountant (CPA) to conduct periodic checkups at your practice. Your CPA can help you design internal controls, implement best practices and conduct random checks to see that your employees are following approved policies and procedures.

Julian Dozier is a CPA with the accounting firm Thomas Howell Ferguson P.A. He specializes in forensic audits and litigation support related to for-profit and governmental enterprises. His certifications and designations include Certified Fraud Examiner (CFE) and Certified in Financial Forensics (CFF). For more information, please visit www.thf-cpa.com/what-we-do.

Tag: risk

Disaster Preparedness for Your Dental Practice

5 Ways to Reduce Embezzlement Risk