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Child Dental Benefits Schedule

The Child Dental Benefits Schedule will commence on 1 January 2014 and will provide access to capped benefits of $1000 over 2 years for eligible children aged 2-17 years to receive basic dental services. It will replace the existing Medicare Teen Dental Plan.

PREPARED BY THE AUSTRALIAN DENTAL ASSOCIATION

The Facts:

IS THE PRACTITIONER AN ELIGIBLE PROVIDER?

To be eligible to provide treatment under the CDBS, a practitioner (general or specialist) must hold current registration with the Dental Board of

Australia and have a Medicare Provider Number. Allied dental practitioners may provide services under the provider number of a dentist.

IS THE PATIENT ELIGIBLE?

A child’s eligibility for the CDBS is assessed by the Department of Human Services. A child is eligible if they are aged between 2-17 years at

any point in the calendar year and receive a relevant Australian government payment at any point in the calendar year. To check a patient’s

eligibility ring Medicare on 132150 or check online at www.medicareaustralia.gov.au/hpos. Eligibility must be checked before treatment under

the CDBS. You will need to register to use the online checking process.

ARE THERE SUFFICIENT FUNDS?

The entire benefit cap of $1,000 can be used in the first year if necessary. If there is a balance remaining in the benefit cap in the second year, this

can only be accessed if the patient is eligible in the second year. A patient’s cap balance can be checked at any time through Medicare, by calling

132150, or alternatively www.medicareaustralia.gov.au/hpos. Remember to ask the patient if they have seen any other dental practitioner in the

last couple of weeks. There could be an outstanding bill not yet processed. If no funds remain this will need to be explained to the patient.

PATIENT CONSENT BEFORE EXAMINATION OR TREATMENT

If you wish to participate in the Child Dental Benefits Schedule it is a requirement of the program that you inform the patient or the patient’s

parent/guardian of the proposed treatment and the cost of that treatment as well as the dental practice’s proposed payment procedures.

It is a requirement of the CDBS that financial consent is obtained from the patient* or parent/guardian prior to proceeding with examination,

and again before beginning treatment. This should include any out-of-pocket expenses the patient will incur beyond that covered under the

CDBS. Initially consent can be obtained verbally but must be recorded in writing before the patient leaves the practice on the day of service.

Prior to performing any services, you must have a discussion with the patient or the patient’s parent/guardian about:

• the proposed treatment;

• the likely treatment costs;

• the billing arrangements of the practice (ie. bulk billed); and

• the approximate out-of-pocket costs for non-bulk billed services.

After you have informed the patient or the patient’s parent/guardian of the likely treatment and costs, you must obtain consent from the

patient or patient’s parent/guardian to both the treatment and costs before commencing any treatment.

WHAT METHOD IS THE PATIENT BEING BILLED?

Regardless of the way the account will be settled, verbal and written consent to treatment and the costs of that treatment must be obtained.

The frequency with which consent has to be recorded varies depending on the billing method. In order for an account to be payable it must

contain:

PRIVATE BILLING

• the patient’s name

• the date of service

• the CDBS item numbers

• the dentist’s name and provider number

• the amount charged in respect of service

• total amount paid and any amount outstanding in relation to the service

Record comprehensive clinical notes making reference to consent, and retain for 4 years.

BULK BILLING

Bulk billed patients only need to complete a consent form at the first visit. The consent form will apply to all services provided under the

treatment plan during that calendar year. A new consent form is required each calendar year if the patient remains eligible. Claims to Medicare

must be submitted either electronically or manually using the ‘Child Dental Benefits Schedule claim form’. The ‘Bulk Billing consent form’ and

the claim form are both available at www.medicareaustralia.gov.au/provider/pubs/medicare-forms/dentists.jsp.

PRIVATE BILLING

For privately billed patients you will need to record consent at every visit. The ‘Non-Bulk Billing consent form’ and the claim form are both

available at www.medicareaustralia.gov.au/provider/pubs/medicare-forms/dentists.jsp.

PREPARED BY THE AUSTRALIAN DENTAL ASSOCIATION

BULK BILLING

• the patient’s name

• the date of service

• the CDBS item numbers

• the dentist’s name and provider number

• the amount of the dental benefit being assigned to the

dental provider

*Age of consent varies in each state and territory – check the arrangements for your jurisdiction