Third party payers- such as health funds and Medicare – have an increasing interest in the billing for services by non dentist dental practitioners under their provider number. 

As Medicare has not made arrangements for persons other than dentists and prosthetists to have a provider number for dental services, there is an ongoing issue where ‘independent’ dental practitioners – such as oral heath therapists- actually treat the patients but bill using the provider number of a registered dentist.

If these treatments are not well evidenced as to records or need, then the third party payer will seek explanation and sometimes repayment from the provider- who may have received little or no benefit for the treatment and the use of his/her provider number. It is presently the case, that the repayment will be initially and perhaps only sought from the individual with the provider number.

Of course, it is not an issue so much where the dentist actually works directly with the therapist, but even so, it is wise for holders of provider numbers to check who is using their number and how they are using it.

Third party payers have access to rivers of data and can easily check for statistical anomalies.

Here are some things to consider…

How many services are billed with your provider number per day on average?

Do you have any insight into who has access to your provider number ?

In relation to these services is there an agreed protocol about the process ?

Do you have a signed agreement with the users of your provider number – being the oral health therapists or hygienists and the owner of the practice ?

Are you confident these treatments and processes meet the Recognised Provider requirements of the health funds and the Health Insurance Act, Dental Benefit Rules and the CDBS guide in relation to Medicare and the CDBS ?

It is worth asking these questions, before they are asked by a third party payer. 

For a free discussion of the issues, call Brad on 07 3007 1777 or email