DAL NH 19-06: Notice to Providers Regarding Dental Billing

  • Letter is also available in Portable Document Format

July 17, 2019

Dear Provider:

A recent review of the Medicaid billing system has found that overpayments for dental services were made to number of nursing home and dental providers. The overpayments resulted from providers claiming reimbursement for dental services provided to residents which had been billed within the nursing home rate. The Dental Guidelines Policy Manual may be of help to providers and help avoid confusion when there are question about the appropriate billing procedures. The dental billing guidelines are available online here. An excerpt from the manual states:

"Dental services are included in certain facility rates. Payment for services to residents of such facilities will not be made on a fee–for–service basis. Dental providers should seek reimbursement for services provided to Medicaid–eligible residents of all New York State Residential Health Care Facilities (RHCF) and some Intermediate Care Facilities for the Developmentally Disabled (/CF–DD) directly from such facilities."

NYSDOH will continue to monitor these billings and will provide guidance as necessary. For questions regarding nursing homes rates and billing may be addressed to: NFRates@health.ny.gov with the subject: Dental Billing.

Sincerely,

Laura Rosenthal
Director
Bureau of Residential Heath Care Reimbursement
Division of Finance and Rate Setting
Office of Health Insurance Programs