The Child Dental Benefits Scheme has recently been improved to allow greater funding for the dental treatment of children.
In 1994 the Professional Services Review (PSR) part of the Health Insurance Act was created to manage non-fraudulent but ‘inappropriate’ billing under the Act.
This was originally almost entirely for medical practitioners, but as dental treatment has become a larger part since the expansion into chronic disease patients and children, dental practitioners have become part the focus of this scheme.
Any dentist treating patients under this scheme should be aware that the billing is monitored and statistical outliers are identified and initially reviewed under the Practitioner Review Programme, as part of Medicare. If that review results in unresolved concerns, then the matter is referred to the PSR.
The process thereafter is well developed, but the system is quite complex and there are some important junctures where decisions and submissions are critical.
In the last five years as the PSR has become more active in relation to the CDBS, dentists and occasionally their advisors have misunderstood the realities and practicalities of the process.
There are strict compliance requirements. In advising on these matters, concerns frequently arise about records, necessity for treatment, inadequate examinations, and supervision of non dentist practitioners – both before and after the changes to scope of practice in July 2020.
Dentists who are subject to the PSR should get assistance from their indemnifiers. If the indemnifier has a monetary cap on assistance – as some do, then the dentist should seek appropriate specialised legal advice.
Dentists seeking review of a decision of the Director of the PSR, the Chief Executive Medicare, a Committee, or the Determining Authority should seek relevant specialised advice on prospects within the relevant time frames (often but not always 28 days).
An overview is at https://www.bwbarrister.com.au/cdbs/
Brad Wright is a registered dentist and barrister specialising in dental practice issues – including the workplace, practice sales, contracts, restraint of trade, partnership disputes and practice regulations. Call message or email for an initial obligation-free no charge confidential discussion.
Liability limited by a Scheme approved under Professional Standards Legislation.