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B.9 COMPLETED TREATMENT

PURPOSE


To establish a mechanism to ensure continuity of care for all dental patient who receive a comprehensive examination.
PROCEDURE

At the time a patient receives a comprehensive examination/[or initial assessment by a dental hygienist (if following IHS standards or permitted by the State practice Act)] a treatment plan is written by the dental provider. This treatment plan will list the procedures that will be done for that patient. These procedures will be based upon established priorities, the dental provider’s skills and available time and resources.



[For dental clinics using RPMS or the IHS EDR] When the initial treatment plan is completed, a code of 9990 will be entered into the RPMS system. After scheduled treatment is completed, it is the patient’s responsibility to contact the dental clinic if further dental services are required.

OR

When all services in Level I-III have been completed, a code of 9990 will be entered in the dental record. (IHS recommendation) After scheduled treatment is completed, it is the patient’s responsibility to contact the dental clinic if further dental services are required.

A dentist or hygienist may recall a patient as frequently as he/she feels it is necessary to maintain oral health.



B.10 REFERRAL PROCEDURES


PURPOSE

To establish a procedure for referrals for oral health services for eligible recipients.


PROCEDURE

Intra-Facility Referrals

Emergency Patients Referred to Dental

[Insert facility procedures]

Sample:

Regular Working Hours:

Emergency patients are referred to the dental clinic during regular work hours from any medical care department or school-nursing department using a PCC or facility referral. This referral can come from Out Patient Clinics, Community Health Nursing, WIC, or MCH.

After Hours:

Patients who are experiencing severe pain may go to an emergency room or dental treatment facility, but must notify the Facility’s CHS office immediately or at least within 72 hours from time of treatment. Only emergency treatment services should be provided by an emergency room or dental treatment facility.
Routine Patients Referred to Dental

These patients can be self referred or referred in the same manner as above. The patient may present to the dental receptionist with an "in house" referral form or verbally request that an exam appointment be made.
All Patients Referred from Dental

All patient referrals made from the dental clinic to any department in the hospital are made using a PCC form. All demographic coding, dental subjective and objective findings must be completed.

Inter-Facility Referrals (For programs with multiple dental clinics)

Emergency Patients Referred to Dental

These patients can receive care as above. They can also self refer.
Routine Patients Referred to Dental

These patients can receive an appointment for routine care via self-referral, telephone request, written request or as described above.
All Patients Referred from Dental

The dental records of that patient will accompany all patient referrals made from the dental clinic to another facility. HIPAA regulations that govern transfer of information within the facility network will be followed for information transfer.
Referrals to External Providers


[This needs to be established by Facility Management and CHS Office]
All Patients Referred from Dental to External Providers

These patients must have a referral initiated, for work covered under the Facility’s Contract Health Guidelines, that includes the reason for referral, estimated cost, priority and third party eligibility entered on the form. The patient takes the form to Contract Health so that a contract can be written. Endodontics, Oral Surgery and Pedodontic services done by an external provider must have a referral for services to be provided. The [Dental Program Director] must first authorize emergency visits to external providers so that Contract Health Guidelines are met.

To external provider:

The dentist completes an HSA 199 listing the procedure(s) needed. The completed form is then given to the dental receptionist. Referrals will be made to contract providers.

The [appropriate dental staff] calls the external provider and schedules an appointment.

The [appropriate dental staff] completes the HSA 199 and forwards the original to the Contract Health Services (CHS) clerk, placing one copy in the patient's record. The CHS clerk will complete the HRSA 57 form and mail it and one copy of the referral form (HSA 199) to the external provider.


Use of Contract Health Funds


The Facility CHS Office will be responsible for the allocation of Dental CHS funds.

When obligating these funds the following policies will be used:



Revise as needed to comply with CHS policies.

The patient must be registered for care at the facility to be eligible for contract funds.

Contract money may be used to pay for laboratory services.

Contract money will be used based on the Facility’s priorities for contract dental services.

Contract money will not be used to provide orthodontic treatment.

Contract funds will not be used to provide surgical TMJ "treatments" or care.



B.11 DENTAL LABORATORIES
PURPOSE

To establish procedures for using external dental laboratories and to establish guidelines for laboratory fees to be paid.


PROCEDURE
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