From 1 July 2022, dental hygienists, dental therapists and oral health therapists have been able to access Medicare provider numbers to directly claim for services under the Child Dental Benefits Schedule (CDBS).
This follows the Dental Board extending the scope of practice from July 2020. In summary, hygienists, therapists, and oral health therapists are no longer required to work in a structured professional relationship with a dentist, meaning they can practice independently within the scope of their education, training and competence.
Mandatory or opt in?
The changes are ‘opt-in’. Practitioners can choose to apply for a provider number (apply here Provider Number Application) and use it to claim for services delivered at a given dental practice. Alternatively, current claiming arrangements can remain in place.
What can you claim?
Refer to the Guide to the Child Dental Benefits Schedule. The Guide provides information on item descriptors, claiming restrictions and benefit amounts.
Monitoring of billing
The provision of all Medicare services is closely monitored by the Department of Health. This is to protect Australia’s health payments system from incorrect claiming, inappropriate practice and fraud. Data of all health practitioners in Australia who bill under the CDBS, including dental practitioners, is analysed to identify potential non-compliance.
Sole practitioner practice entity cover
MIPS membership includes cover for the business entities of independent practitioners and their administrative staff. This cover supports members who own a practice where they are the only practitioner. This cover can assist members to keep insurance costs low when starting a business. Conditions apply. See Administrative staff and sole practitioner covers.
Minimise your risk of investigation
- Did you know that you are legally responsible for services billed to Medicare under your Medicare provider number OR in your name?
- Avoid inappropriate practice by remembering you are responsible whenever your provider number is used. It comes down to you to ensure you are aware and approve of how your practice or youremployer uses your number.
- In order to claim with Medicare, a service must not be an excluded service, it must have been medically necessary, must be supported by evidence in the notes of sufficient medical input.
- Ensure notes are contemporaneous and adequate and they must demonstrate that the conditions of the items number were met.
Should you be contacted by the Department of Health in relation to your Medicare billing under CDBS, ensure you contact MIPS for assistance.
Any queries, contact MIPS
This information is of general nature only and not intended to be legal advice and, as such, should not be relied on as a substitute. You may need to consider seeking legal or other professional advice about your individual circumstances as appropriate. Should you wish to obtain further information about products offered by MIPS, you can call us on 1800 061 113 or review our Member Handbook Combined PDS and FSG. You may need to consider seeking legal or other professional advice about your circumstances as appropriate. Information is current as of the date published.