Decision Rights and Clinical Boundaries for a Dental VA

Unclear authority creates two bad patterns. The VA asks for approval on every routine choice, or makes a decision the practice never intended to delegate.

Write decision rights before onboarding using three lists.

Can decide alone

These are routine choices inside agreed rules. Depending on the role, they may include:

• Offering any open appointment that follows the scheduling policy
• Rescheduling at a patient’s request
• Sending approved reminders and recall messages
• Rechecking eligibility or contacting a payer
• Resubmitting a clean claim with the required attachment
• Answering questions about hours, location, parking, and accepted plans

Can recommend, practice decides

These choices need context or authority the VA does not hold:

• A payment arrangement outside standard terms
• Adding a patient to a full day
• Overbooking or changing block rules
• Appealing an unusual denial
• Writing off a balance
• Changing how a difficult payer is handled

The VA should gather facts and make a recommendation. The named practice contact makes the decision.

Always stays with the practice

A VA must not:

• Give clinical advice or interpret symptoms
• Comment on whether treatment is necessary
• Discuss radiographs or clinical findings
• Make promises about clinical outcomes
• Change fees, offer discounts, or waive balances without approval
• Publish a patient-specific review response without approval
• Disclose information to a family member, employer, or another office without documented authorization
• Perform work that requires physical presence or a professional license

Patient-facing VAs need a practiced clinical-boundary response. When a patient asks, “Do you think I need a root canal?” the VA should explain that they cannot answer clinical questions and connect the patient with the appropriate person in the practice.

Turn the lists into an escalation system

For every item that needs approval, name the approver, backup, channel, and expected response time. A rule that says “ask the office” still leaves the VA guessing.

Review decision rights after 90 days. Repeated routine escalations may mean the policy is unclear or the VA is ready for more autonomy. Expanding authority should be deliberate, documented, and supported by reliable performance.