Dental Services Flashcards
Who must pay for dental services?
-Both-483.55(2)/19.1401(b)
Facility is required to ASSIST in obtaining routine and emergency dental care.
Medicare: Facility is not required to pay, Resident may be charged.
Medicaid: Will pay for Emergency Dental Services
How often must the facility ask each resident if they desire a dental exam, at there expense?
-Texas Only-19.1401Once a year
If facility is a licensed-only facility what must they provide?
-Texas Only-19.1401-a-5a list of local dentists for those who want one.
When a resident is admitted when what are the two things that need to be done in regards to dental services?
-Texas Only-19.1401-1-Obtain the name of the residents preferred Dentist2-Must put that name in the residents clinical record.
When must the facility obtain the name of the residents preferred dentist?
-Texas Only-19.1401On time of admission
Although facility is not required to PAY for dental Service what MUST facility DO?
-Combo-
1-All facilities Must Provide [In House] or [Outside Services] both routine and emergency care. -Only Fed:483.55-a-
2-Assistance in: making appointments & Transportation TO and FROM dentist office.-Both- Texas is Medicaid Facilities-
3-Prompt referrals of residents with lost or damaged dentures to a dentist.
How old must resident be in order to qualify for Medicaid dental services?
-Texas Only-19.1402
21 years of age
When will emergency services be covered in Medicaid.
-Texas Only-19.1402
only if the attending physician orders a dental consultation
What government agency processes Medicaid claims?
-Texas Only-19.1402
TDHS - Texas Department of Human Services or DADS
How long does the facility have to submit a dental claim under Medicaid?
-Texas Only-19.1402
Complete and accurate claims for services must be received within 12 months from the date of service.
When a facility accepts payment from DADS (Medicaid) on payment of dental services and that amount is not equal to the amount of service given can the facility charge the resident the difference?
-Texas Only- 19.1402
NO, the Facility MUST accept payment by DHS or DADS as payment in full for services. Neither the dentist nor the facility may charge an additional fee to the recipient, his family, or his trust fund
What does routine dentist services mean?
F411
Once a year inspection.
