Dentists are usually issued with provider numbers without any great fuss if they have hold registration as a dental practitioner.
They are responsible for seeing that all of the services billed under their provider number are appropriate and correct and meet the requirements of the Health Insurance Act and – of late- the Recognised Provider Rules (or similar) of the various Health Funds.
This is a really a matter of personal conduct and responsibility. Where it comes less clear is when services are billed using a dentist’s provider number by dental hygienists and therapists for example who are independently registered, but who are unable to obtain a provider number.
In these circumstances dentists should be aware of precisely what services are being billed using their provider number.
They should only authorise the billing using their provider number where:
- They have a contract with the entity that actually provides the services and bills Medicare or the Health Fund;
- They have a contract with each non dentist dental practitioner who will bill under their provider number;
- They have met and communicate with those non dentist dental practitioners;
- They review those services that are billed regularly to ensure they are clinically appropriate;
- They are satisfied that the persons using their provider number do so in accordance with the rules and regulations.
- They are otherwise satisfied that there is no over-servicing.
To allow the use of a provider number otherwise leaves the dentist open to significant responsibility for those fees where the services could be found not to be necessary, appropriate, clinically relevant or to have been performed appropriately..
Although it is arguable that the non dentist dental practitioners have responsibility, Medicare and the Health Funds have – to date at least – sought redress from the person who was issued with the provider number.
It may not seem fair, but these are the current issues whilst non dentist dental practitioners are not offered provider numbers, although they have independent practice within scope.
Liability limited by a Scheme approved under Professional Standards Legislation.