How to make referal to hospital items not chargeable at practice level with correct uda claimage

[ismailqazi]

Hi all

i having some issues with claims system. If i want to refer external it should be claiming only the uda and charging the patient only for what i do. 

When i click treatment refered or treatment on referal on plan, i get the correct udas, but the patients get charged the referal treatment band 2 instead of band 1. 

The other dentists here just dont mark anything to do on the plan that is being refered, but find that looks very unorganised and unless the notes are read in depth would look like there are caries left untreated or asymptomatic teeth present with large abcesses underneath never dealt with -when infact they had been refered to do.

is there anyway to mark the treatment that is to be refered to do on the plan without causing the band 2 charge and the correct uda claimage?

[stephen_skelton · Accepted solution]

Hi Ismail,

The fact that you sometimes refer internally does complicate things a bit because you are all using the same R4 database therefore any treatment that you chart and then complete will update the patient's baseline chart for everyone else.

I can make a suggestion regarding a way around this but I am not a clinician so I don't know if it will be suitable.

As discussed above, you add the extraction in your treatment plan, mark it as treatment on referral and then complete it so that you can submit a claim for the correct number of UDAs and the patient charge is correct.  Then when the patient sees the referring dentist for the actual extraction they can right-click where the tooth was and use the 'Insert a Permanent Tooth' option so that there is a tooth present for them to include in their treatment plan and then they can complete the treatment and submit a claim for the UDAs that they are entitled to.  When they use the 'Insert a Permanent Tooth' option it will make an entry into the clinical notes so they can add their own notes as well to explain why they have done this just so that when anyone looks at it is the future there is an explanation of what has been done.

As mentioned above I am not a clinician so you might want to discuss this with your Clinical Director to see if it is a suitable workaround in these situations.

Regards

Stephen

[stephen_skelton]

Hi,

There was a change to the way that referrals for Advanced Mandatory Services were handled by the NHS in April 2014 and your R4 software was changed to meet these requirements.

If you are referring a patient for Advanced Mandatory Services you can only claim the number of UDAs associated with the treatment actually delivered within the practice, however, you should be collecting the full patient charge for the course of treatment.

I have attached a copy of the guidance notes from the NHS.

I hope that this helps.

[Jennifer]

There is currently a problem with R4 and the referral process.  R4 raises a B2 charge and indeed, as previously mentioned, the correct UDA of 1 but the EDI's bounce back as adjusted with a patient charge corrected to B1 fee which is incorrect.  I have had made many calls to R4 re this error and it is being looked into.  However this has been going on for months with no solution so far.  I have also spoken to NHS help desk regarding this and they have confirmed it is an error with the R4 software as they are not able to see these claims marked as on referral!

When I spoke to R4 it seems I have been the only one to query this which I find amazing?  As it is, I feel, quite an important issue. 

[ismailqazi]

Thanks. Thats useful to know. Its made more complicated by the fact We refer internally for sedation xla/fills on a seperate contract often.

so on the system it gets a bit complicated as they need to tooth present to make it as xla carried out /fill done but i need to mark it as bein refered to be done so it doesnt look like left caries etc at a glance. But the charge i send through is without the treatment ie band 1 but they charge the treatment band ie band 2

as far as i am aware i cant find a way to accomodate both of these at thr same time on the system to show a tooths being refered to be xla without removing the tooth on the computer for them to click xla on?