Privacy, records, and insurance

April 1, 2006
Privacy ➠ After Hurricane Katrina, the advantages of computerized health records came to the forefront.

PrivacyAfter Hurricane Katrina, the advantages of computerized health records came to the forefront. Displaced persons with little knowledge of their own medical histories, and medical/dental offices totally destroyed after the storm, could have benefited from a national system of health record retrieval. With computers so much a part of the modern world, it seems a natural progression for patient records to “go digital.”

HIPAA legislation has pushed the privacy aspects of both digital and paper records, but according to published reports in several medical business journals, public confidence in computerization lags. Why is this? According to a survey sponsored by the California HealthCare Foundation in 2005, two-thirds of the consumers contacted said that computer security problems as reported in the news made them worry about privacy; 52 percent worried that their employers might use their medical information to limit job opportunities, and 13 percent reported that they did not want their physicians to record or report certain types of medical problems to insurers. State-by-state variations concerning electronic signatures vs. handwritten signatures of physicians and dentists complicate computerization problems even further. Many states still require that records carry health-care providers’ handwritten signatures. In the midst of this debate comes the process of establishing a national patient identity and provider identity number for retrieval of information over the Internet. With an identifier number, all information concerning a person’s health could be revealed to anyone knowing the number. Groups against national identifiers point to frequent computer hacking of currently established databases. They argue that databases are not secure.

Physicians and dentists appear to be slow to embrace patient record computerization. Cost, software and hardware issues, and problems with transferring information are barriers. While many dentists use computers for certain aspects of their practices, such as billing, accounts payable, and insurance claim filing, fewer use digitized patient records. As for the current status of HIPAA privacy violations and convictions, according to the American Bar Association, only one person has been convicted of a criminal case under HIPAA privacy provisions since it went into effect in April 2003.

RecordsWhat are important aspects of record keeping for dentists? Dentists must always be aware that a complete and thorough patient record, whether paper or digital, is the only legal documentation they have to support treatment rendered. Malpractice issues, and most commonly, insurance problems can be mediated with thorough records. At a minimum, each patient should have a complete and updated medical/dental history, documentation of “chief complaint” or what brought the patient to the dentist, baseline/existing conditions including decay and perio problems, cancer exam documentation, dentist recommendations (treatment plan for each tooth and entire case), and detailed progress notes. Without detailed records, the dentist has no basis for a blueprint for treatment or support for treatment decisions.

InsuranceMany types of insurance claim issues could be reduced with competent record keeping. For example, one of the most common complaints of patients is that they are receiving standard “cleanings” (D1110) but being billed for periodontal maintenance (D4910). Insurance carrier “utilization review” also commonly targets this complaint. Carriers may audit patient records for their subscribers. If records do not support treatment, dentists can be forced to pay back amounts they have already received. Many dentists nationwide have received letters asking for “payback” for supposed overtreatment. The dentists who have detailed records supporting treatment have nothing to fear from such requests. In the case of D1110 and D4910, patient records need to focus on periodontal probing and recording (at each D4910 appointment), plus documentation of bleeding, recession, furcations, and mobility. According to the ADA, periodontal maintenance follows periodontal therapy, so documentation of the original “therapy” (root planing or surgery) is essential. It is also extremely helpful if patients understand their treatment so that complaints are not made in the first place. To read a patient brochure describing the differences between a “cleaning” root planing and perio maintenance, go to and click on “brochures.”

Carol Tekavec, CDA, RDH, is the author of the Dental Insurance Coding Handbook 2005-2007. She is also the designer of a patient chart endorsed by the Colorado Dental Association, and is a lecturer with the ADA CELL Seminar Series. Contact her at (800) 548-2164 or visit her Web site at, where you may read her patient brochure, “My Insurance Covers This ... Right?”

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