If a dentist is Medicaid-certified and the patient needs a panoramic X-ray not covered by MA, can the dentist bill the patient for that X-ray if the patient still wants it done?

If the dentist is certain MA does not cover the service needed and informs the patient up front, then it is acceptable to bill the MA recipient for non-covered services. It is recommended patients sign a financial waiver prior to receiving the service(s) to confirm they understand their financial obligations.

If a Medicaid-certified dentist has an established patient with commercial insurance who now presents with MA as secondary insurance, and the office is not accepting new MA patients, can the patient be billed the secondary portion rather than billing MA?

No, the MA-certified provider cannot choose to accept payment from a commercial insurance and then bill the patient (rather than the MA program) the balance. If the services are provided by a MA-certified dentist, the MA program must be billed as secondary insurance, prohibiting the dentist from billing the patient for the balance.

Can I forgive co-payments for patients covered by dental insurance or government programs like Medicaid and Medicare?

No, the forgiveness of co-payments may subject a dentist to sanctions by the Wisconsin Dentistry Examining Board pursuant to section 447.07(3)(k) of the state Statute. Under section 447.07(3)(k), the DEB may reprimand or suspend the license of a dentist who has participated in “repeated irregularities in billing a third party.” Subsections (3)(k)(1)-(5) enumerate the specific… Continue Reading Can I forgive co-payments for patients covered by dental insurance or government programs like Medicaid and Medicare?

If I cannot forgive co-payments, can I ever offer discounts?

Arguably yes. While offering discounts is not explicitly prohibited, discounting can raise a number of unintended and/or unexpected issues. As noted above, the discount cannot be given in a manner that results in the forgiveness of a co-payment. Forgiveness of co-payments is prohibited by Section 447.07(3)(k) of the state Statute. Additionally, both the Medicare and… Continue Reading If I cannot forgive co-payments, can I ever offer discounts?

Can I provide gift certificates to patients that refer new patients to my office?

You can provide current patients with gift certificates to retail establishments, but discounting issues would again arise if patients receive gift certificates for dental services. As long as the gift certificates are for non-dental services, we do not believe they should be treated as a billing irregularity under subsection 447.07(3)(k).  Although whitening is a dental… Continue Reading Can I provide gift certificates to patients that refer new patients to my office?

Can I provide city chamber dollars as a “thank you” for a refferal to my dental office without being in violation of any state statutes?

As we understand chamber of commerce dollars, they are essentially equivalent to checks or gift cards which can be cashed and used as payment by the holder at any local business that is a member of the chamber and in good standing. Chamber members can purchase the Chamber Dollars and then provide them to individuals… Continue Reading Can I provide city chamber dollars as a “thank you” for a refferal to my dental office without being in violation of any state statutes?

Am I permitted to report suspected child abuse if I observe symptoms during my treatment of a patient?

You are not only permitted, but required by Wisconsin Statute §48.981(2) to report suspected instances of child abuse or neglect. HIPAA also permits that disclosure, since 45 C.F.R. §164.512 authorize disclosures “otherwise required by law”. Abuse is broadly defined to include physical, emotional and sexual abuse. Neglect means, “…failure, refusal or inability on the part… Continue Reading Am I permitted to report suspected child abuse if I observe symptoms during my treatment of a patient?

Are there different reporting considerations if I observe symptoms of domestic abuse or violence affecting an adult?

Yes, Wisconsin’s treatment of child abuse is, from a dental perspective, considerably different from its treatment of adult abuse. As noted above, the state has a specific statute that requires reporting of child abuse by dentists and provides protection against civil liability if the reporting dentist issued. The statutory reporting requirement also works as a… Continue Reading Are there different reporting considerations if I observe symptoms of domestic abuse or violence affecting an adult?

Does an email request from a patient provide appropriate authorization for a release of records or must the request include the patient’s signature?

HIPAA and Wisconsin law provide that an authorization to release medical records should include the signature of the individual making the request (which may be the patient, an authorized agent of the patient, or an appropriate court appointee) to reduce liability. The e-signature may be an original, a copy of the original, or a signature… Continue Reading Does an email request from a patient provide appropriate authorization for a release of records or must the request include the patient’s signature?