We have entered a new age of working arrangements, with the global pandemic opening the door for legitimate home working options for many people. While this option is denied to many in the dental sector, there is still much to consider for dental professionals

With the rolling implementation of lockdowns and restrictions, many dental professionals have been looking for alternative ways to utilise their skills and maintain an income in these uncertain times.

What are the other ways that we can continue to work and assist our patients remotely? Is teledentistry an option and how about those instances where dental practitioners have been approached by companies with opportunities to use their skills in a non-clinical setting? For example, to undertake desktop clinical reviews, assessing cases for direct-to-consumer aligner companies based overseas, or even to start an arrangement of ‘renting’ a provider number to other dental health professionals.

Teledentistry

One option utilised by many has been the use of teledentistry. In itself teledentistry is not contentious and has become more mainstream in recent times, as it has enabled practitioners to assist patients where access is an issue. Reflective of the usefulness of this, in 2020 the Australian Dental Association introduced a new but temporary code into the Glossary. While this code is no longer in use, we await clarification if codes of this nature will be included in the future, in recognition of teledentistry’s place in treating patients in the current climate.

Assessing cases remotely for a third party

This could be for a direct-to-consumer aligner company. A practitioner first needs to consider what liability they are willing to accept. What information is required for a comprehensive assessment, diagnosis and appropriate treatment plan? While the company may be based overseas and therefore exempt, the treating practitioner will be subject to the requirements of the Dental Board of Australia. Does the practitioner have the requisite skills to undertake this type of treatment modality, and what liability are they willing to accept on behalf of the company as their representative, in instances where the orthodontic treatment does not proceed as anticipated, due to any number of reasons?

Important considerations and definitely an important conversation to have with any third party requesting your clinical expertise for their treatment planning.

Letting others use our provider number

Akin to ‘renting’ of a provider number, where a fee is paid to the owner of the provider number for the use of this by other practitioners.

The use of a provider number by a colleague is commonplace with not all dental practitioners having the ability to obtain a provider number; this arrangement can be formalised in a number of alternative ways. Commonly, we see this arrangement as part of an agreement contract with colleagues within the clinic teams, where providers without a provider number (such as OHTs/DTs/DHs) use a dentist’s provider number for their billing, to enable patients to have access to rebates under Medicare or their health fund. We also see instances where the holder of the provider number does not treat patients within the same facility and there may be an arrangement negotiated relating to either a set fee, or alternatively a percentage of treatment billed under that provider number.

As an ‘owner’ or holder of a provider number, you hold responsibilities and obligations in relation to claiming under that number. Critically, the holder of the provider number is charged with the responsibility of ensuring that any item numbers claimed through their provider number are legitimate and in accordance with all relevant codes and guidance – including that appropriate clinical records support the claim. Some schemes have an added layer of compliance; any Medicare Australia funded scheme, such as CDBS, references a requirement for supervision by the dentist owning the provider number of any practitioners working under their provider number. Alarmingly, this does not correlate with the current guidance of the Dental Board relating to scope of practice and independent practitioners.

These obligations do not mean that arrangements where our provider number is used by others are necessarily inappropriate; as always, it is important that practitioners are aware of the guidelines they are required to adhere to, to enable them to implement these arrangements appropriately.  

Learning points

• When investigating these possible opportunities to maintain an income without direct patient contact, it is imperative that practitioners consider the implications and potential risks.
• It is critical that practitioners review the obligations associated with holding a provider number.
• If it sounds too good to be true – it probably is. Seek advice from Dental Protection before signing up!