Department of Health | The Child Dental Benefits Schedule
The Australian Government Department of Health (DoH) are currently performing compliance checks and audits on CDBS claims. If you have recently received a letter from the DoH please see the information and links provided below.
I have received a CDBS compliance notice, what should I do?
- Duplicate the documents you have received. Make sure to keep at least one clean, unmarked copy as well as a working copy
- Scan to a PDF or take photos on your phone of the letter/schedule you have received and email to advisory@adansw.com.au with the subject: FIRST NAME, LAST NAME: CDBS COMPLIANCE LETTER – Request for Assistance or fax to 1300 133 085
- The Advisory Services team will send you more detailed information on what the letter means and your options for responding.
CDBS Compliance 2022
In this short 13 minute video, Peer Advisor Dr Sarah Jones provides information to assist you in managing CDBS compliance.
Frequently asked questions:
What is CDBS?
The Child Dental Benefit Schedule (CDBS) is an Australian Government-funded dental program.
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The CDBS provides eligible Australian children 0–17 years with up to $1,095 of preventive dental services over a two calendar year period.
The scheme targets basic dental services such as consultations, diagnostic services, fillings and extractions.
Reference: Child Dental Benefits Schedule for health professionals – About – Services Australia
What should I do before I start?
Before you decide to participate in the CDBS (or any other government scheme), make sure you understand the rules and administrative requirements that govern patient eligibility and claiming. It’s important you are familiar with all requirements prior to delivering services under the CDBS.
What can provide CDBS services?
Registered dentists and dental specialists.
From 1 July 2022, the registered practitioners listed below can either provide services under their own provider number or continue to provide services on behalf of a dentist or dental specialist:
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Dental hygienists
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Dental therapists
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Oral health therapists
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Dental prosthetists.
The Dental Practitioner whose provider number is utilised for CDBS claiming is responsible for verifying all CDBS claims submitted to Medicare under their provider number.
It is voluntary to participate in the Child Dental Benefits Schedule.
Reference: Child Dental Benefits Schedule for health professionals – Dental practitioner requirements – Services Australia
Are there any restrictions?
The CDBS doesn’t cover orthodontic, cosmetic dental work or dental services provided in hospital. CDBS claims are invalid if a benefit for the same service is paid by a PHI.
There are some additional restrictions for dental services such as limitations on the number/frequency of service provision. These are described in the Guide to the Child Dental Benefits Schedule on the Department of Health’s website.
What clinical records need to be maintained?
Clinical records should always be maintained in accordance with the Dental Board of Australia’s (DBA) Code of Conduct.
In addition, CDBS requires that you obtain and retain signed informed financial consent (IFC) forms for all CDBS services on or before the first appointment for every calendar year for bulk billed services, and for each appointment where the services are not bulk billed.
If your records are audited, your CDBS clinical record must substantiate that:
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The claimed service was provided;
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The claimed service was clinically relevant or necessary;
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The tooth that has been treated is recorded (tooth ID)
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The item code used for claiming matches the service which was provided to the patient; and
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The patient/parent consented to the treatment and costs associated.
Are dental practitioners subject to Medicare compliance checks and audits?
Yes. The Department of Health (DoH) monitors dental practitioners’ servicing patterns and conducts compliance checks and audits regularly.
Compliance checks: The DoH conduct compliance checks of those dental practitioners whose claiming profiles fall outside expected ‘norms’. Practitioners are provided with a schedule of patient names, dates of attendance and list of item numbers claimed and asked to review these against CDBS claims criteria. A number of options for responding are identified. Practitioners who wish to find out more are advised to seek advice and guidance from the ADA NSW Advisory Services team prior to responding.
Audits and regulatory action: In addition to compliance checks, the DoH investigate complaints or tip offs received from members of the public.
Complainants can be referred to a statutory authority (such as the Dental Council of NSW) where the complaint relates to the quality of the treatment or service provided.
Where there is concern regarding potentially inappropriate billing or claiming, the DoH will conduct a service review or audit. The focus here is generally on ensuring that services were properly consented to, clinically relevant and indicated, matched the item number descriptor claimed and that benefits were claimed correctly. Under the Dental Benefits Legislation Amendment Act 2014 (the Act):
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If you don’t voluntarily provide substantiating documents during a CDBS audit, the DoH can issue you (or the entity in possession or control of your records) with a Notice to Produce substantiating documents
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Civil penalties can be applied if the entity in possession or control of your records fails to comply with the Notice to Produce
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If you do not substantiate claims made under your name or provider number for CDBS services, you may have to personally repay the benefit paid for those services
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Administrative penalties may also apply to the Provider Number holder, where it is identified that benefits were paid incorrectly
It is likely that the collection and retention of informed financial consent (IFC) forms will remain a key focus of future audits. If you receive an audit notice, scan to a pdf or take photos on your phone and email to advisory@adansw.com.au or fax to 1300 133 085 for advice and assistance.
Reference: Audits | Australian Government Department of Health
Outcome of a recent compliance audit: https://www.psr.gov.au/case-outcome/psr-directors-update-june-2022
Who is responsible for responding to a Medicare compliance notice or audit?
It is the view of the DoH that the provider number holder is accountable for all claims submitted under his/her provider number.
If non-compliance is identified, it is the provider number holder (dentist/specialist) who will be held responsible and not the practice entity, dental hygienist, dental therapist or oral health therapist who performed the treatment. This is irrespective of who submitted the claim (the practice staff) and whether the owner of the provider number received all, part or none of the benefits claimed
Reference: Audits | Australian Government Department of Health
Where can I get more information?
- Online courses Medicare billing/claiming for health professionals: Health Professionals – AIMAC (aimactraining.com)
- August 2021 Guide to the CDBS: Guide to the Child Dental Benefits Schedule | Australian Government Department of Health
