HomeMy WebLinkAboutAgenda - 10-17-2000-8et
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: October 17, 2000
Action Agenda
Item No. $~
SUBJECT: Dental Clinical Fee Increases
DEPARTMENT: Health PUBLIC HEARING: (YIN) No
ATTACHMENT(S): INFORMATION CONTACT:
Draft Fee Schedule Rosemary Summers, ext 2411
TELEPHONE NUMBERS:
Hillsborough 732-8181
Chapel Hill 9fi8-4501
Durham 688-7331
Mebane 336-227-2031
PURPOSE: To consider approving dental clinical fee increases for some procedures.
BACKGROUND: The North Carolina Division of Medical Assistance, the division that
administers the Medicaid program, is requiring all health department dental clinical programs to
"unbundle" their services and bill Medicaid for each individual service provided. The unbundling
was originally to take effect October 1, however due to delays in providing reimbursement rates
to health departments, the implementation has been delayed until November 1, 2000.
Currently, health departments receive a lump sum payment for each Medicaid visit, regardless
of the work performed.
The draft fee schedule reflects the unbundled rate of Medicaid reimbursement and adjusts the
full pay fee accordingly. The full pay fee must be equivalent to Medicaid reimbursement and to
the extent possible reflects the full cost of providing the service. The full pay fees have been
compared with area practices and are consistent with charges by private practitioners and the
UNC Dental School. The health department operates on a sliding fee scale, charging clients on
a 0/20/40/80/100 percent pay scale. 100% pay is based on 200% of the federal poverty level
($32,900 for a family of four). Atypical six month cleaning visit (with no fillings or extractions)
for a patient under the age of 14 prior to this change would have been $70.00 and with the new
fee schedule will be $75. Approximately 3% of total patient visits are at the 100% pay level.
The department also bills private insurance and North Carolina Health Choice for services.
In order to capture the full amount of Medicaid reimbursement under this new policy, the
Department must begin implementing the new fees on November 1, 2000.
FINANCIAL IMPACT: Total Medicaid revenue collected in fiscal year 1999-2000 was $102,200
based on $100 per visit. At the current unbundled Medicaid rate that would have yielded
$99,568 or $2,632 less at the unbundled rate of reimbursement. The current year's projection
for Medicaid revenue was $108,200. The current anticipated loss under the unbundled scheme
2
is a total of $9,032. These projections are somewhat dependent on the exact services needed
by patients and may vary. The department may be able to increase the number of full pay
patients to subsidize the shortfall in Medicaid reimbursement. Medicaid reimbursement for
services represents slightly more than. half of revenues received.
RECOMMENDATION: The Manager recommends that the Board approve the fee increases
for the ,procedures indicated effective November 1, 2000.
ADA 0 DENTAL SERVICES 10054 Medicaid Proposed Number of Revenue ADA A DENTAL SERVICES 10DY. Medicaid Proposed Lab Number of~Rev~
Pea Fee New Fee Services Pro)ection Pea New Fee Fee Services Proj
D0150 Comprehensive Oral Exam '~ 40 38 1811 6,878102920 Recementing 501 1g 1
D0120 Periodic Oral Exam 30 i ~ 28 257 ~, 7,196100470 Study Models 451 31.00 '
D0140 Limited Oral Exam 35 i 38 3B~ 62', 2,3561 D7510 I b D Minor SurgeN I 501
D9310 ,Consultation 30 1
_ '~D9951 Occulsal Equilibrati
n 751
p0330 ~~, Panoramic Film 60 _
o
' 41 - ~ _ 14 ~ 574; D0999 Fractured Tooth Txt 80+ ~ ~ '
b0270 'BWX 1 Film 15 10 4~ 401p3110 PulpCap~irect 401 18 1 I,
p0272 8WX2Films 26 17 2001 3,400 1 03 7 20 PulpCapandiritct 40
p0274 8WX 4 Films 35 33 ~, ~ 331 1089 i b7288 ~~ Biopsy Oral Tissue 751 54.58
D0275 ~ BWX Each Additional Film 12 ~, 1 1 OTHER 'I ~ ~ '1 '1
170220 ! 1st Intrdo2l PA Film 15 14 ~ ~ ~ ;~ 781 10841 ~ ~ '
po230 Additional PA Film 12 10 A 52! 4301 D1610 Band & LaopJOuadrant 176 115 20 41
p0240 :Inlrao210cculusalFilm I 15 16 1~ 81' 1296101510 lpisialShoelOuadrant j 2001 115 '
D0210 ~ Full Mouth Series w BWX I 70 54 - I I D1515 ',Lingual Arch 1 276 173 ~ 30 2'.
07120 ,Prophy/Child 25 28.00 15 j 3901 D1520 ', Removeable Unilateral 250 ~ '
07203 ~ Fluoride Treatment 16 19 S 17 j 3231 D1525 Remdveable Bilateral 250 ~. I i
01201 ,Prophy/Fluoride Child c13) 40 41 285 1D,865 ~ D8210 Removable Habit Appl. 275 I
D1110 . Prophy/Adult 46 32 - ` ~ ~ 32 1,0241 D8220 ~ Fixed Hatt Appl. 275 ifr4,, I
D1205 Prophy/Fluodde Ad01t (13-21) 80 43 ~ '~y 29 1 1~47 I, Deliver Appliance NC .
'' ~ '
04345 Pedo Spline Gross 80 ~ ^- ~ : Chapc Appliance NC ~~.
04341 Perto Scale Root Plane Per Quad 80 43 _- 1 ~ RenWVe Appliance NC 7
t_.:-~
D4355 Full Mduth Debddement 80 _
BO ~~»~ 6
~ 380 ~Haaltnchdp wpayment 5 ~ F
02110 Amalgam one Surface Prim 50 58.00 ~
23 1,334 ~ I<
.
.
D2120 Aural Two SurFap Prim 60 81.00 ~ 78 6,31a .
.
D2130
D2131 Aural Three Surfap Prim
Aural Four Surface Prim 70
86 102 "- 3
115 ~ 306
'
D2140 Aural One Surface Penn 80 68.00 76 4,400
D2160 Aural Two Surface Perm 70 61.00 54 4,374
D2180 Aural Three SurlBCe Perm B5 102 - 18 1,632
D2161 Aural Fqur Burlap Pam1 90 115 4 460
D2161 Aural Flve Surface Perm 100
p2330 Resin One Surface Anterior 85 68-00 36 2,080
D2331 Resin two Surface Anterior 75 83. 9 747
D2332 Resin Three Surface Anterior 85 102 5 510 I I
D2335 Resin Four Surface Antedar 100 116 5 575
D2380 Resin One Sufidce Posl/Prlm 75 Se 51 2,950
D2381 Resin Two Surface Pasf/Prlm 10D 83 7 587
D2382 Resin Three Surface Posf/Prlm 126 2 D I
D2385 Resin One Surface Post/Perm 80 66.00 59 3,422
D2386 Resin Two Surface Pdsf/Perm 105 115 14 1,610
02387 Resin Three Surface PosflPerm 130 143.20
02388 Ra3in FOUr Surfep3 Postlf enn 175.20
D1351 Sealant 30 . 32 477 13,264
D3220 Pulpotom 86 83 21 1,743
D2930 SSC Primary Tooth 125 715+ 43 4,945
D2931 SSC Permanent Tooth 186 173
p2932 Prebacriceted Resin Crown 150 - I
D2833 Prefabricated SSC w Resin Wln 150 103.33 i
D2940 Treatmem Restoration 5D 19 2 30 j
D2961 Pin RetentionrtDOth 25 20.20
D9110 Palllatlve Treatment 45 23 12 270 1
D7110 Extraction Pdmary To001 55 57 ~ 71 4,047 ~
D7120 Extraction Prim. TOpOm adtlidOnal 50 56 6 330
D7110 Extracton Pannenant Tooth 65 57 29 1,653
D7120 Extracton Penn. Additlonal Tooth 80 56 5 280
p7210 Extraction Surgical 100+ ~ 68 5 290
Post Op NC '~
D2336 Com resin prawn ant. Prim. 68.5
Topl Rww1w Prof ~Ct101/. -
:: i
.
Based art teat aagl year 9P60r. '
Madlpid PfOdtlGtlOfr. - 1
~Y.6d6" ~
TotalalaWWldRavarrwCoYar:IgE'
In flsal ypr 99-00 was I
based oln f100 par vhk.
5702,20Q
Medicaid R9vMtUa Prpjalykip ~I
for flaral ywr 00-0'19r9s ~ 1
s1Dl,I700
Lost D.tnar M.raeaw Rrmrarar
afy.caan wear tits far sarrks
o3z
Medicaid fe9 for Service 1 OH/00