CDBS - New Consent Forms | South Australia

The new consent forms are available at: Child Dental Benefits Schedule – Bulk Billing and Non-Bulking Billing Patient Consent Forms | Australian Government Department of Health, Disability and Ageing

Billing and claiming under Medicare – making sure you get it right:

In private dental clinics, practitioners can elect to see CDBS patients either under a bulk-billing arrangement OR can charge out-of-pocket fees/patient co-payments.

This is explained in the CDBS – Guide to the Child Dental Benefits Schedule | Australian Government Department of Health, Disability and Ageing:

Deciding what to charge the patient

Like providers under Medicare, private dental providers are free to set their own fees for services. You may choose to either:

bulk bill the patient, or
charge the patient (dental providers set their own fee and charges the patient directly).

If you directly charge the patient an amount above the CDBS benefit for a service, additional charges have to be met by the patient.

Where patients are charged any kind of co-payment or fee for CDBS services, this represents a non-bulk-billing payment arrangement.

Non-bulk billed patients – processing payments:

It is important to understand that, if the patient is required to make any kind of co-payment, then you are NOT bulk-billing and, therefore, your practice administrative staff MUST NOT use the “bulk-billing” button on the HICAPs machine to process Medicare benefit payments.

In this regard, it must be clearly understood by dental practice administrative staff that the process for claiming CDBS benefits will likely be different to their usual payment processing sequence. For most private fee-paying patients, staff will process the patient’s private health fund rebate payment first, then seek the balance from the patient as an out-of-pocket/co-payment in order to zero the balance owing. This sequence cannot be followed for non-bulk billed CDBS patients.

The payment process for CDBS non-bulk billed patients will generally be as follows:

At the end of the visit, the patient pays the account in full.

The Medicare rebate can be claimed by the patient either online, using the Medicare App or at a Medicare office using their receipt with CDBS “88” item codes.

Alternatively, the benefit may be claimed electronically on the patient’s behalf by practice administrative staff utilising an electronic claims system such as HICAPS and pressing the “fully paid” button (the Medicare CDBS benefit will be transferred directly to the patient’s bank account).

Under a non-bulk billing arrangement, practitioners should also note:

Consent form must be executed for each and every appointment and retained on file as part of the patients record: Child Dental Benefits Schedule – Non-Bulk Billing Patient Consent Form
Treatment must be fully completed for each item number before an invoice can be raised.

Medicare explain the above claims process in the CDBS Guide:

Patient claim

At the end of a visit, you can request the patient to pay, in full, for the services provided.

You will need to provide the patient with an itemised account/receipt containing all of the necessary details (see the ‘What information must be included in billing/claiming for services?’ section of this guide) so that they can claim the benefit from Medicare.

Your patient can then claim the benefit from Services Australia.

Please note: there are other ways to process a non-bulk billed claim (such as part-paid or unpaid accounts). For a step-by step explanation of HICAPs processes for non-bulk billed Medicare claims, see: HICAPS_Medicare_Easyclaim_User_Guide_July_19.pdf

Bulk billing:

A bulk-billed claim means that you are agreeing to accept the benefit assigned by Medicare to you as FULL PAYMENT for that service. This means that no additional fees may be levied):

In the case of bulk billing, you accept the relevant CDBS benefit as full payment for the service

By law, you cannot charge the patient a co-payment of any kind for a bulk billed service.

Under a bulk-billing arrangement, a bulk billing consent form must be completed by the patient/parent/carer on the first date of treatment for each calendar year – the form expires on December 31st of that year. The completed consent forms should be retained as part of the patient’s record.

Any treatment provided in a different calendar year will require the patient/parent/caregiver to complete and sign a new bulk billing consent form: child_dental_benefit_schedule_-_bulk_billing_patient_consent_form_0.pdf

When and how are PHI benefits applicable?

It is permitted to submit claims both to Medicare and to a PHI for services provided on the same day, as long as each item only appears on one invoice or account – either a Medicare account (’88’ item codes) or an account suitable for a private health insurance claim (accounts with ADA item codes):

Can private health insurance be used for CDBS services?

Patients with private health insurance covering dental services cannot claim a benefit from both the private health insurer and the CDBS for the same dental service.

Patients cannot use private health insurance to ‘top up’ the CDBS benefit they have received for a service.

However, private health insurance can be used for any services not provided under the program, but these items must be billed separately.

Please contact ADA SA to discuss any queries or concerns you may have.

**Highlighted text is sourced directly from the Guide to the Child Dental Benefits Schedule (CDBS) version 13

CDBS - New Consent Forms

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