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News Bulletin : ADA News Bulletin February 2011
16 FEBRUARY 2011 latest news DVA ANNUAL MONETARY LIMIT FOR SCHEDULE C ITEMS APPLICATIONS NOW OPEN FOR INDIGENOUS DENTAL STUDENT STUDY GRANTS The Department of Veterans' Affairs (DVA) has advised that an annual monetary limit (AML) applies to most DVA entitled persons for all items listed as Schedule C items in the Fee Schedule of Dental Services for Dentists and Dental Specialists (fee schedule). These services relate to restorative services such as crown and bridge work and are generally not subject to prior approval for Gold Card holders. Prior financial authorisation is required for all White Card holders, all ex-prisoners of war, and Gold Card holders receiving dental treatment in relation to war-caused disabilities or malignant neoplasia, as they may be exempt from the AML. The following examples will assist providers with a clearer understanding of how the AML works. In both examples the eligible DVA patient has not accessed their AML for the 2011 calendar year. Example 1 You provide two full crowns (Item D615) at $1,215.85 each. A. 2 x $1,215.85 = $2,431.70 B. AML total for 2011 $2,353.00 C. Gap payment balance is A minus B = $78.70 D. DVA will pay $2,353.00 towards the treatment and you can ask the DVA eligible patient to pay the gap fee of $78.70. Example 2 You provide two full crowns (Item D618) at $1,139.25 each. A. 2 x $1,139.25 = $2,278.50 B. AML total for 2011 $2,353.00 C. Cost of treatment -- available AML (B minus A) = $74.50 D. DVA will pay the full cost of the treatment and the patient will be left with an AML balance of $74.50. Example 3 You later provide another crown with a cast post-core (Items D615 and D625) to the patient in Example 2. A. Cost $1,215.85 (Item D615) + $307.55 (Item D625) = $1,523.40 B. AML balance remaining for 2011= $74.50 C. Gap payment (A minus B)= $1,448.90 D. DVA will only pay $74.50 towards the treatment. The patient will be required to pay the provider $1,448.90 for the treatment. For all Schedule C treatment, where there is a gap payment it is important the patient is made aware of this payment prior to commencing treatment. This gap payment cannot be reimbursed to the veteran by DVA. You should check with DVA whether any or all of the AML has been expended for an individual entitled person in a calendar year prior to providing services. The AML is not cumulative, so any part of the AML not expended in a calendar year cannot be used in subsequent years. EXEMPTIONS The AML for services listed in Schedule C does not apply to entitled persons who are ex-prisoners of war or who are receiving dental treatment for an accepted disability or for malignant neoplasia that has a direct or indirect dental component. You should contact DVA to confirm an entitled person's exemption prior to commencing treatment. DVA will pay for the full cost of Schedule C treatment for exempt entitled persons, subject to the following conditions: a) you must obtain prior financial authorisation from DVA before commencing treatment; b) the maximum fee payable is the approved DVA fee for the particular service, and where the fee is 'fee by negotiation', the fee paid is that which is negotiated with DVA; and c) you must not make any separate charge against the entitled person. Further information is available by contacting the Medical and Allied Health section on (Metro) 1300 550 457 or (Non Metro) 1800 550 457 and select Option 3. The ADA advises that applications are now open for the 2011 ADA Study Grants for Indigenous Dental Students. Five Grants of $5,000 each are awarded each year. Each applicant must be an Aboriginal or Torres Strait Islander. Applications must be on the appropriate form available from ADA Inc. and/or the Deans of the Dental Schools. The closing date for applications is 31 March 2011. Applications are considered by a panel consisting of the ADA Inc. Federal President (or his/her nominee), the Federal Vice President, and the Chief Executive Officer. Successful candidates will be notified by the end of April 2011. Visit www.ada.org.au
ADA News Bulletin December 2010
ADA News Bulletin March 2011