Postcards from the Edge (of the PSR)*

Mobile Dental Clinics or person who claim a large number of CDBS services – through statistics collected by Medicare – are often the subject of interest by the PRP. This is a Medicare programme that is not independent like the PSR.

It is the first contact that someone might have with a Medicare “discussion” about ‘concerns”.

The statistics rarely lie, but they can be explained.

The practitioner with the provider number will be asked to have perhaps a telephone interview after being send a statistical report. If that report shows that the subject practitioner has very high number of procedures on a daily basis or has a high rate of procedures compared with other in the data set- other providers, this is an opportunity to explain.

The PRP process may result in a request being made by the Chief Executive Medicare ‘or their delegate’ to the Director to review the relevant services over a period of up to 2 years retrospectively from the date of the request. If the Chief Executive Medicare becomes aware of a likely pattern of inappropriate practice, a request to the Director must be made.

The Director of the PSR may well do any number of things.

Practitioners who get a call about the PRP should understand that the interview will be about the frequency of billing. If it becomes clear that therapists are working under provider numbers, then questions will be asked about responsibility and knowledge of what the therapists and hygienist actually do and bill.

Consent, records medical history are often raised as sub issues, but at this point the only material the PRP has is the statistical result. Records will come later.

  • Take it seriously.
  • Have the current CDBS guide ready.
  • Review your PRODA account.
  • Know what its being done under your provider number.
  • Ensure you have some knowledge of clinical protocols, and processes where the services are provided.
  • Seek expert advice.

*Practitioner Review Programme