15 minute read
Our time is now
Everything you need to know about getting your own provider number
By Warrick Edwards
The planned implementation of provider number access for dental hygienists, dental therapists and oral health therapists is progressing as scheduled to be activated on 1 July 2022. The Commonwealth will accept direct billing claims from these oral health practitioners for dental benefits covered by the Child Dental Benefits Scheme.
While the private health insurance sector has indicated that they are likely to recognise these provider numbers, the decision and implementation timeframe largely depend on individual funds. Several health funds have been liaising with our associations to plan for the implementation, and we will provide information to members as updates become available.
Please note that the Commonwealth Department of Veterans Affairs has no immediate plan to accept our provider numbers for the DHA Dental Benefits Programs, as they are in the process of undertaking a major review of their program. The ADOHTA and DHAA have been liaising with the Department of Veteran Affairs on our profession’s potential contributions and benefits to the veteran community and advocating for a critical role within the DVA dental benefits program.
To facilitate a seamless implementation and provide guidance to the profession, the DHAA invited the Australian Dental and Oral Health Therapists Association (ADOHTA) to establish an expert advisory group jointly.
The purposes of the Provider Number Expert Advisory Group (EAG) are to:
• Provide expert advice to the ADOHTA and DHAA Boards on all relevant matters pertaining to the practice of oral health as a Dental Hygienist, Dental Therapist or Oral Health Therapist that involve the provision of provider numbers and dental benefits claiming and payment within the public and private sectors.
• Identify regulatory, professional and practice issues that may arise from the acquisition of provider numbers and access to various dental benefits funding schemes as billers/providers. Make recommendations to the DHAA board on possible solutions and management strategies.
The EAG has been designed to provide expertise in hygiene, therapy, general and specialist dentistry, remote practice, public sector dentistry, private health insurance and oral health academia. Current members of the EAG are: Warrick Edwards (Advisory Group Chair); William Carlson-Jones; Hellen Checker; Cheryl Dey; Tess Giarola; Jennifer Shaw; A/Prof Carol Tran; Dr Martin Webb; and Dr Mark Wotherspoon.
ADOHTA and DHAA are grateful for the support of the Australian Dental Association (ADA) and the Private Healthcare Australia (PHA) for providing their expert advisors to join the EAG.
The tasks undertaken by the EAG include:
1. Prepare relevant guidelines for the purpose of accessing various dental benefits to ensure professional and ethical practice in accordance with the Dental Board of Australia code of conduct and practice standards.
2. Direct appropriate education activities to foster compliance with the guidelines.
3. Provide expert advice to support the ADOHTA and DHAA boards in monitoring compliance to the guidelines.
4. Review item codes of various dental benefits and advise the ADOHTA and DHAA boards on the relevancy of the codes with the respective scope of practice.
The first educational webinar was delivered by members of the EAG on Tuesday 17 May, and attracted nearly 1,000 registrants. A/Professor Tran provided a progress update on the implementation while PHA representative Ms Jennifer Shaw discussed the key aspects of being a dental provider for the private health insurance funds. Dr Martin Webb from the ADA provided an outline on compliance and risks associated with being a provider number holder. It was an important informative session as it cleared many myths and misunderstandings of what a dental provider means, which have been circulating across some social media and professional networks.
A second (member-only) webinar has been scheduled for mid June to provide further updates and more in-depth advice. To access this webinar (and its recording) and other ongoing updates and advice on provider numbers and many other professional matters, please go through the DHAA member portal.
For further details on DHAA membership, to renew or to become a member, please visit the DHAA website – dhaa.info
GETTING READY FOR THE CHANGE!
Bulletin Editor Brie Jones asks members what having a provider number will mean for them
The time has almost come! According to the plan with the Department of Health (DoH), from 20 June 2022 we can officially apply for our own provider number through Services Australia and as of the 1 July, we should be up and running and able to process claims.
Congratulations to all those who have worked tirelessly behind the scenes to achieve this amazing feat.
Here are a few key messages from the webinar for those who missed it. n Applying for a provider number is an opt-in choice. It is not compulsory. n But if you do opt-in, you must use it! n We will only be able to claim CDBS at this stage. There are ongoing discussions with DVA. n Three major health insurance companies indicated that they are on board and working through their policies and procedures to include us in their systems. Ongoing conversations are being held with other health insurance companies. n You may use Health Point or Hi-Caps to claim electronically (electronic claiming is the preferred method). n It is important to follow up and read through the individual terms and conditions of each health insurance company, Medicare, Hi-Caps or
The DHAA recently hosted a very informative webinar on applying for a provider number.
Health point and your indemnity insurance; because once you make a claim you have agreed to those terms and conditions. n Patient records must coincide with the item numbers claimed. If you claimed for a prophy/polish or a fluoride treatment, you must include reasons why you have claimed for that item number and how this has benefited your patient. n The DHAA are still working with the DoH in regards to being able to refer for OPGs.
And finally, as re-iterated by Dr Martin Webb; “With power comes great responsibility” – Mr Miyagi.
We must remember to stick within our scope of practice and although we may now be eligible to claim for an item number, it does not change our scope of practice and allow us to perform that procedure!
What members say...
During the 2020 ‘Bad Mouth’ campaign, a number of members were featured in our advocacy publications. Reflecting on the success of the campaign, they have shared what it would mean for them to have access to their own provider number and what their plans are.
Beth Irvin
“As an OHT with adult scope I’m very much looking forward to the provision of a provider number. I would like to congratulate and thank the Associations in bringing about this change.
In the last two years, I have turned my career around from Aboriginal healthcare into my Independent private practice. I practice solo in my oral health therapy ‘studio’ in Bairnsdale, regional Victoria. It started out as a part-time ‘side hustle’ in 2020 and has steadily grown since. I have no associate dentists and thus no claiming ability. So now that provider numbers are on the horizon we can finally feel a sense of equality that will only benefit our patients.
In my last article entry, I was employed in Aboriginal health in Gunai-Kurnai country. After nine years in my OHT role there, the organisation secured two local dentists who plan to stay long term. It was the right time in my life for a change and to find a balance between raising my young family and establishing my independent practice.
So far, without a provider number, I have needed to refer patients elsewhere for claiming under their private health insurance and CDBS. This has ultimately been a detriment to my business and also disappointing for my patients, who have built a trusting relationship with me and know me as a local. But for financial reasons, some need to seek treatment where they are able to claim. And for this reason, I have kept my fees comparatively low compared to most private clinics.
Around 20% of the patients I see currently are children. Come July, there will be a higher demand in my practice for children’s dental. I have kept patients/parents informed of the impending changes via social media since the provider number announcement last year, and I now have a list of clients and families eagerly awaiting my service provision from July.
I am very much looking forward to seeing what these revolutionary changes will bring to our profession.”
Lyn Carman
“Since writing, in 2019 we have continued to work hard toward a sustainable, equitable and innovative model of care for oral health in rural and remote areas. This is still very much a work in progress and is reliant on oral health professionals coming to rural areas to provide care.
Oral health services in rural Australia are traditionally delivered by privately owned dental practices. These practices treat private patients and deliver treatment to public patients on behalf of SA Health. Private practice in rural areas face ongoing challenges, including workforce recruitment/ retention, viability, and succession planning. Many of these businesses are failing.
In the South Australia Oral Health Plan, people living in regional and remote areas are already clearly identified as a priority population. If no action is taken, there will be even poorer health outcomes for rural communities in the future.
Despite increased awareness in recent years, there has been no dedicated effort to solve this problem.
Access to provider numbers for oral health professionals will enable clinicians to independently provide care for eligible children under CDBS, and as access to health funds and DVA broadens, a much greater level of service availability for this priority population, who deserve equitable care, will occur.
Recruitment and retention of the workforce is vital to rural areas to provide a high level of timely, local care. Provider numbers will enable an easier pathway for us to recruit clinicians to work within this model of care and provide much needed, improved oral health outcomes in rural and remote areas. We look forward to many more dental hygienists and oral health therapists taking up the opportunity to support rural and remote areas while gaining a greater wealth of clinical expertise in a supported and collegiate environment - working as truly part of a team where each professional can utilise their full range of scope. Now, that’s a dedicated effort to solve this problem!”
Lynda van Adrighem
“Exciting times ahead with gaining access to provider numbers for qualified dental hygienists, oral health therapists, and dental therapists will be a game-changer for the profession and open up future opportunities as we pursue access to other areas.
Since I last presented an article in The Bulletin regarding provider numbers and the impact it has had on my work practices, not a great deal has changed for me as a dental hygienist in private practice or as an independent dental hygienist working in aged care!
Working in aged care, I continue to have access to a provider number that I share with a dentist who provides the necessary legal and ethical requirements to refer residents who require advice or dental treatment that is out of my scope of practice.
With this particular arrangement, in aged care, I have found the provider number is only a small part of my invoicing of dental hygiene treatment, the provider number is only beneficial if the residents maintain their private health insurance. Unfortunately, when entering a residential aged care facility, many of the residents stop their health insurance or reduce their health service units for various reasons – many of which are financial.
What of the future? I believe that not having my own provider number will impact my job prospects in aged care. All Allied Health and Specialists in aged care are expected to have a provider number that recognises patients’ eligibility to gain rebates for their professional services and a form of contact.
Having my own provider number would establish equivalency with the other professions in aged care, and make it easier for the residents or next of kin to claim a rebate commensurate with other specialist and allied health professionals in aged care”.
UPWARDLY MOBILE
We talk to two forward-thinking DHAA members who are taking oral hygiene to the people
Until now, many members have had to bill through other dentists’ provider numbers even when they practise independently. Jacqueline Biggar is an oral health therapist who has successfully set up a mobile dental business, focusing on the aging population and attending to those in aged care facilities; and Shida Taheri is also an oral health therapist who has set up a successful business operating as Dental on Demand to provide an outreach service.
Both Shida and Jacqueline have a great working relationship with their current employers and have built over 15 years of mutual trust and respect. This relationship has allowed them access to their employer’s provider numbers during these past two years. Jacqueline says; “The trust and collaboration we have has made my experience stress free. My dentist knows me, knows my work and how I work. I feel as though this has made it an easy partnership, and decision for him”.
Provider number access is essential for the success of both Shida’s and Jacqueline’s mobile dental businesses. They are very grateful to have had access to a provider number so they can claim through Medicare for the Child Dental Benefits Scheme (CDBS), through health insurance companies and with the Department of Veteran Affairs (DVA).
Having access to a provider number has helped them grow their business and see more patients due to being able to claim benefits for their patients.
Both believe that without access to a provider number, they would not have been able to reach a large portion of their patient demographics. Jacqueline explains, “Having the right to use a provider number has allowed patients to access my care. Those with a health fund or DVA gold card have the right to cheaper or free healthcare, and they want to maximise those benefits.”
Using someone else’s provider number has not been easy and has been a hinder at times, Shida explains. “Even though I have a great working relationship with the dentist whose provider number I am using, there was much conversation around using it and the structure of what I could and would claim. Even though my business was separate from his, I felt I needed to ask permission before claiming each item number. It is also an uncomfortable conversation with patients whose health funds have not been paid immediately as my name (not his) was on the receipt. Having to explain to patients that using someone else’s provider number whilst being an OHT is a common practice, it made me feel like I was doing something fraudulent”.
Both agree that having access to their own provider number will help to streamline their business, make the administration process less cumbersome and be less confusing for their patients. Although their employers have been incredibly supportive, it will be a relief for both parties involved once they have access to their own provider numbers. Shida and Jacqueline appreciate all the lobbying the DHAA have done for the provider number campaign.
Although we are no longer required to work in a ‘structured relationship’ with a dentist, Jacqueline recommends “keeping or creating a very good professional relationship with a dentist you chose to work with. This will ensure a clear referral system and support when needed”.
While this has been a long time coming, just remember it’s your oral hygiene to the people choice to apply for your provider number. You do not need to apply for one and you can continue to work in the current arrangement if you are happy to do so.
If you’ve got questions, please email contact@dhaa.info.
We’ve got your back
Don’t panic! The DHAA will be hosting more member-only provider number-focused webinars to offer help and advice. Visit dhaa.info to make sure your membership is up to date.
