The piecemeal nature of NHS dental payments can make them confusing, make sure you’re claiming correctly, Doug Hamilton says.
The treatments offered by our wonderful NHS are many and varied. In most instances care is also free at the point of delivery. One notable exception is NHS dentistry where patients are usually presented with an invoice at some stage in their treatment.
The business and the practice of dentistry are not easy bedfellows. Most dentists are motivated to enter the profession by altruism rather than commercialism. However, where a service has been successfully provided, a fee must be paid or funding for future care delivery will dry up.
Of course, not all treatments proceed as planned. Where something has gone wrong then an opening offer of reimbursement or a free remake is often appropriate. Many disputes are resolved in this manner. Where there has been an adverse outcome, compensation over and above the cost of the original treatment may be demanded.
Even when the treatment appears to have gone as planned, the patient may look for money, perhaps for nefarious reasons or simply because their expectations have not been met. Some members will stand their ground but others will offer remuneration in an attempt to minimise the risk of escalation.
However, the piecemeal nature of NHS dental payments, together with the contributions that are made from the public purse, can create different, though equally worrisome, difficulties.
Within the NHS there are a significant number of rules restricting the fees that can be claimed. These provisos are buried in somewhat opaquely drafted NHS regulations, but failing to comply can have consequences.
A number of agencies, primarily PSD, are tasked with protecting the public purse. In relation to dental payments, this may involve the sampling of records, identification of ‘outliers’ and statistical analysis. If they find the rules have been broken, the relevant fees may be recovered.
The sums involved in each misclaim may be pretty trivial, but practitioners tend to unknowingly repeat the same error year after year. Once the problem has been detected, the results tend to be extrapolated and the cumulative fee recovery can be eye-watering.
So how can you avoid falling foul of the extractive (no pun intended) policies of the agencies that manage NHS dental payments?
Terms of service
In the first instance, it is important to be completely familiar with the rules that apply in your particular jurisdiction. Scottish contractors should therefore forensically read their terms of service and the SDR.
The phraseology does not lend itself to easy or consistent interpretation, but a quick phone call to the PSD customer services department will usually provide the desired clarity. Members concerned about disclosing their list number can call MDDUS for advice. This is a commonly encountered issue and we may already know the answer. If not, we can make an anonymised enquiry on your behalf.
Yet, these risk management measures may not suffice. To my surprise and dismay, I find myself reaching for the words of Donald Rumsfeld who once pointed out that there are ‘unknown unknowns – the ones we don’t know we don’t know’.
It seems reasonable to accept that, if you are completely oblivious to a problem, you cannot correct it. Therefore, it is also important to enrol on courses that are designed to troubleshoot.
Finally, it is vital that compliance with the claiming directives is clearly reflected in the clinical records. As stated above, enquiries into a contractor’s claims can commence with a records card request or an instruction to self-audit your records.
Comprehensive notes are a critical component of safe care delivery. However, whilst PSD may scrutinise records in order to assess clinical standards, the primary intention is usually to test the validity and veracity of claims for NHS fees. So make sure your records are compatible with the claim or you may have to hand back your hard-earned money.