Idea Transcript
Electronic Claiming
To refer or not refer that OPG... dental x-rays and Medicare By Dr Angela Marty, BSc BDS Have you ever wondered how that bulk-bill radiology clinic down the road, supplying OPG services, works?
F Dr Angela Marty
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or the most part, general dentists are given Medicare provider numbers expressly for the purpose of making referrals to Medicare-approved medical radiologists. In turn, radiologists are then able to report on OPGs, intra-oral films, lateral cephalograms, and a limited range of facial views that their radiographer takes on their behalf. Dental specialists, like orthodontists and periodontists, have an “upgraded” provider number that allows them to ask for CT scans, and Oral & Maxillofacial Surgeons are even more upgraded in that they can ask for very specialised radiology services like MRI and ultrasound. The whole complicated process ultimately makes the dental x-ray subsidised (or even free when bulk-billed) through Medicare. This is obviously attractive to the patient, very attractive to the radiologist, but not at all attractive to the dentist who after all started the whole diagnostic ball rolling in the first place. Medicare provider numbers are useful for requesting radiology services; but why aren’t xrays taken in our own dental practice similarly subsidised by Medicare? Why is it that a specialist radiologist can charge a fee for reporting and taking an OPG, and yet their reporting is often no better than “See film for details”; or worse, the film is blurred and taken on a machine older than Methuselah? Isn’t it better that as dentists we can take our own OPG’s, in the comfort and convenience of our own practice, report them ourselves, and derive the same Medicare benefits that medical radiologists are able to make? Certainly the process is more convenient and accessible to the patient, the diagnostic process more clinically relevant and accurate, and ultimately overall it is more profitable for the dentist.
The biggest misconception that dentists have is that referring your patient for an OPG to “Lakeside Bulk-Bill X-ray” means you must be referring to a radiologist. Bizarrely though, most of these practices are not owned by radiologists, but usually by lay-run businesses, chiropractors, or by radiographers who contract reading services out to thirdparty radiologists. The radiologist reporting on your OPG may just be 2000 km on the other side of Australia sitting at his bedroom computer, where he is simply cutting and pasting “See film for details” into a thousand reports. On this 25 second process he takes a 35% cut on the fee with 65% going to the radiographer or business operator, and really nothing at all coming back to the dentist except for a dodgy report and usually even dodgier film. Meanwhile, the dentist had to pay for his degree, has to set up his own practice, and had to apply for his provider number; all so that someone else could take a below par, and sub-clinically useful x-ray, with next to nothing in terms of clinical value from a diagnostic reporting perspective. What’s the point? Well, many dentists have seen the surrealism of this issue. Some have started to work out that in fact it is better to spend $100,000 on your own OPG machine, to take your own films, in your own dental practice, obtain superior diagnostic radiology reports (from yourself), and better yet, actually derive an income from your clinical skills.
Electronic Claiming
Of course, if you are providing a superior radiography/radiology service than the bulk-bill x-ray practice down the road, maybe obtaining a Medicare rebate for your patient seems superfluous and unnecessary. It’s all on your point of view, but how does a dental practice compete with Lakeside Bulk-Bill X-ray when your patient believes they can get the same service for free if they get referred? If you’re like the majority of dental practices who have taken the plunge into buying your own OPG machine, then it makes sense to understand how bulk-bill radiology practices work. Contrary to popular belief it is possible to obtain Medicare rebates for your in-house dental x-rays, be they bitewings or OPGs. The question is, are you willing to accept the same non-dental radiologist providing the same useless report of “See film for details”, and paying a 35% commission for the privilege? Whilst there will never be access to the Medicare schedule for general dentists to report on dental films (as there is currently for medical specialist radiologists), there are emerging specialists such as maxillofacial radiologists (usually medically registered maxillofacial surgeons), who are able to provide Medicare funded reports for dentists operating OPGs, I-CATs, 3-D Cone beam devices, cephalograms, and intra-oral x-ray machines. The rebates are considerable, and amount to $40.30 for an OPG, and a whop-
ping $28.00 for a single intra-oral film. The out-of-pocket expense (the difference between your fee and the rebate amount) further attracts 80% rebate through Medicare Safety-Net; and better yet your dental x-ray fee does not impact on the patients dental insurance, leaving that resource available for actual clinical fees. The specialist maxillofacial reports are usually more detailed, dentally relevant, and with reporting fees which are equal to or often less than their medical-radiologist counterparts. There are of course application processes, rules to comply with, and different front-desk set-ups which may make initiation of these processes difficult. Despite the initial uncertainties and organisational energy inherent in any new office system, many orthodontists and general dentists are coming to participate in such arrangements. Potentially, without accepting the same practices yourselves, you and your patients are being left out on something that can probably be making dental diagnosis more affordable and clinically precise. Medicare in dentistry has been with us for a long time. Now there is an opportunity to make Medicare work for your practice, to the benefit of your patients and your purse, rather than to the hands of an anonymous medical-radiologist who couldn’t tell a tooth from a TMJ. u
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