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exam fee must be complemented by a periodontal charting. Fissure sealants can only be claimed on molars within two years of eruption. The list goes on.


Getting it right So how can you avoid falling foul of the extractive (no pun intended) policies of the agencies which manage payments? In the first instance, it is important to be completely familiar with the


rules that apply in your particular jurisdiction. Don’t simply maintain the same claiming patterns, assuming your grasp of this subject is probably sound and that, if you were misclaiming, wouldn’t you have heard about it by now? Instead, contractors should forensically read and periodically re-read the relevant regulations in regard to claiming fees. At least your insomnia will be cured. The phraseology in these regulations does not lend itself to easy or


consistent interpretation, but a quick phone call to the 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.


and the cumulative fee recovery can be eye-watering. Not surprisingly, some areas are more prone to misclaiming than


others. For example, under the UDA system in England and Wales there are often concerns regarding the commencement of treatment shortly after the previous course was closed. There are of course innumerable reasons why an apparently sound dentition needs to be revisited at an early stage (why do cusps always seem to fall off just after the patient has been finally discharged?) However, where there are repeat claims in rapid succession, the suspicion tends to be that one course of treatment is being ‘split’ in order to optimise revenue. In Scotland, the old favourites include item 10b scalings. Yes, the


relevant narrative in the Statement of Dental Remuneration can be interpreted in a number of ways. However, its purpose is to ensure the patient receives periodontal treatment (rather than just oral hygiene instruction) on at least two separate occasions (otherwise it would be a two-visit 10a). Of course, the accompanying records and BPE scores should be commensurate with this treatment regimen. There are many other potential pitfalls. Prescription fees cannot be claimed in conjunction with other treatments (except recalled attendances, domiciliary visits and continuing care payments). An item 1b


Troubleshooting 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 (until PSD come calling), you cannot correct it. Therefore, it is also important to periodically enrol on courses which are designed to troubleshoot, highlighting common areas of misunderstanding so that delegates can learn from other colleagues’ misfortunes. 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, if you are lucky, an instruction to self-audit your records. Contractors have no option but to comply. Record card investigations have a quality assurance role – poor notes


may give rise to concerns about the contractor’s performance. However, a review of records may also result in a fee recovery or even a probity enquiry. Comprehensive, accurate and contemporaneous notes are a critical component of safe care delivery. However, dentists should always have in mind the possibility that their records may be scrutinised: not only from the perspective of clinical standards but also as a means of testing 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.


Doug Hamilton is a dental adviser at MDDUS and editor of SoundBite


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