Child Dental Benefits Schedule Overview of a dental visit under the CDBS

Information for dental providers
Child Dental Benefits Schedule
The information contained in this publication is
intended to provide a general overview of the Child
Dental Benefits Schedule only. The payment of
dental benefits is regulated by the Dental Benefits
Act 2008 which can be accessed at comlaw.gov.au.
As a professional provider of dental services you
need to determine how this information applies to
your particular circumstances.
Overview of a dental visit under
the CDBS
This guide provides summarised information on the
requirements for servicing and claiming under the Child
Dental Benefits Schedule (CDBS). The CDBS is a new
program that replaces the Medicare Teen Dental Plan
from 1 January 2014.
Step 2:
Confirm the patient’s eligibility for the CDBS and
check their cap balance if required.
The CDBS will allow benefits to be paid for services
provided to eligible children and teenagers by
eligible dental providers under a newly established
schedule of dental services. The new schedule (items
88011–88943) will include services for out-of-hospital
basic dental treatment such as consultations,
diagnostics, fillings and extractions. Benefits are not
available for orthodontic or cosmetic dental work.
A detailed list of eligible services and the benefits
provided for each service will be available from
humanservices.gov.au/healthprofessionals then
Other health care providers > Dentists
Step 1:
Ensure you are eligible to provide services under
the CDBS.
Step 3:
Explain to the patient or parent/guardian the
proposed treatment to be provided on the day and
associated costs and billing arrangements.
Obtain consent to provide the service(s) and
charge costs.
Note: Consent can be obtained verbally before the
service, but it must be documented appropriately
before the end of the visit (see step 5).
Step 4:
Provide the service(s).
Step 5:
If privately billing, ensure consent is documented on
the day with appropriate signature(s) on a patient
consent form. This must be completed on the day of
the visit.
If bulk billing, ensure services are covered by a bulk
billing consent form signed at the time of the first
visit in that calendar year.
Step 6:
Claim the bulk bill benefit or issue an account for
private billing.
Step 7:
Retain records of services performed and consent
forms for four years.
humanservices.gov.au
Child Dental Benefits Schedule
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Provider eligibility
Informed consent
In order to provide services under the CDBS, a dental
provider must hold general or specialist registration
with the Dental Board of Australia.
Prior to performing any services, a dental provider
must obtain consent from a patient or their
parent/guardian to:
• the proposed treatment, and
• the associated costs for the proposed treatment.
All services must be billed by either a private or
public dentist or dental specialist who has a Medicare
provider number. There are separate administrative
arrangements for dentists working in public dental
clinics. Public dentists should contact their state or
territory government for further information.
Services or part of the service may also be provided
by an oral health therapist, dental hygienist, dental
therapist or dental prosthetist, on behalf of a dentist
or dental specialist. The service must be performed in
accordance with the accepted dental practice, including
appropriate supervision requirements. Items can only
be claimed using the dentist or dental specialist’s
provider number.
Patient eligibility
The CDBS is for 2-17 year olds who satisfy a means
test. The Department of Human Services (Human
Services) will write to children who are eligible each
year. Patients may give dental providers a copy of the
letter as evidence of their eligibility.
You can check a patient’s eligibility through Health
Professional Online Services (HPOS) using a Medicare
Public Key Infrastructure (PKI) Individual Certificate or
by contacting Human Services on 132 150*.
Entitlements
Under the CDBS, eligible patients will have access
to a dental benefit entitlement that is capped over a
two calendar year period. The two calendar year cap
period begins in the year in which the patient receives
their first service. The benefit cap beginning in 2014 is
$1000 per person.
A patient’s eligibility will be assessed annually. If
required, a patient may use all of his or her benefit
entitlement in the first calendar year. If the full amount
is not used in the first year, a patient may use any
remaining balance in the second year if he or she is
still eligible. Any balance remaining at the end of a two
year period cannot be used to fund services that are
provided outside that two year period.
You can confirm a patient’s benefit entitlement balance
through HPOS or by contacting Human Services.
Dental items under the CDBS will not be eligible for
Medicare Safety Net or Extended Medicare Safety Net
benefits and any out-of-pocket amount will not count
towards the thresholds.
This consent can be obtained verbally, but must then be
recorded on a patient consent form and include a signature
from the patient or their parent/guardian for confirmation.
For private billing arrangements, a Non-Bulk Billing
patient consent form must be completed on each day that
you provide a service.
For bulk billing arrangements, a Bulk Billing patient
consent form only needs to be completed on the first
day of service in the calendar year. Once the patient
has signed the form, consent does not need to be
documented again for future bulk billed services that
year. Consent must be documented again on the first day
the patient receives services in a subsequent year.
The Bulk Billing patient consent form and NonBulk Billing patient consent form are available from
humanservices.gov.au/healthprofessionals then
Other health care providers > Dentists
Claiming
Dental providers can either bulk bill or privately bill
for services. Electronic claiming channels, including
Medicare Online and Easyclaim, provide the fastest
and most convenient option for dentists to lodge claims
directly with Medicare from the surgery. Dentists can
also submit claims manually, but these will take longer to
process. Further information can be found on the Human
Services website.
If the dentist issues the patient with an account, the
patient can claim their Medicare benefit electronically at
the surgery if available, or can claim the benefit through
Human Services.
A service must be fully completed before billing the
patient or submitting a claim to Human Services. A
service is complete once all aspects of the relevant Dental
Benefits Schedule item descriptor have been provided.
There are requirements on the information that needs to
be on the account or receipt in order for dental benefits to
be payable. A valid account or receipt includes:
• the patient’s name
• the date of service
• the item number in the Dental Benefits Schedule that
corresponds to the service
• the dental provider’s name and provider number, and
• the amount charged in respect of the service, total
amount paid and any amount outstanding in relation
to the service.
Child Dental Benefits Schedule
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For bulk-billed services, a Medicare approved
bulk-billing form must be used consistent with section
15 of the Dental Benefits Act 2008. The form requires:
• the patient’s name
• the date of the service
• the item number in the Dental Benefits Schedule that
corresponds to the service
• the dental provider’s name and provider number, and
• the amount of the dental benefit being assigned to
the dental provider.
Record keeping
Dental providers must maintain adequate records for
four years from the date of service including:
• patient consent forms, and
• clinical notes (including noting the particular tooth or
teeth a CDBS service relates to, where relevant).
Any other relevant documents such as itemised
accounts or receipts verifying the services claimed
were provided should also be retained.
For more information
Online humanservices.gov.au/healthprofessionals
then Other health care providers > Dentists
for CDBS information
humanservices.gov.au/hpeducation to view
the CDBS eLearning program (available in late
December 2013)
humanservices.gov.au/hpos then Frequently
Asked Questions to view the HPOS factsheet
Call
132 150*
11422.1312
* Call charges apply.
humanservices.gov.au
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