The following is the American Dental Association’s position on the HHS Provider Relief Fund for Dentists. We have received many inquiries about the “balance billing” issue and participation with this grant. You will see below that the ADA worked with HHS to resolve this issue. It ONLY becomes an issue if you are treating patients that have been diagnosed with the virus.
FROM ADA PRESIDENT:
As you may recall, the Department of Health and Human Services (HHS) announced on Friday, July 10 that all dentists with a verifiable dental provider Taxpayer Identification Number (TIN) are allowed to apply for funding through the Enhanced Provider Relief Fund (PRF) Payment Portal.
The deadline to apply has been extended to Monday, August 3.
Many of you have already applied and the number one concern we’ve heard has been about accepting the Terms and Conditions on balance billing, also known as surprise billing. The ADA worked with HHS to set the record straight and they’ve now clarified that:
- Dental providers who are not caring for patients with presumptive or actual cases of COVID-19 are not subject to balance billing prohibitions. ‘Presumptive’ is defined as a case where a patient’s medical record documentation supports a diagnosis of COVID-19.
- HHS thinks few, if any, dentists are performing dental work on active COVID patients. So, there should be very few dental patients covered by this bar.
- Qualifying payment for the PRF has to do with past treatment earlier this year when HHS broadly viewed every patient as a possible case of COVID-19. Balance billing prohibitions apply only to treating current active COVID-19 patients with a medical records that supports a diagnosis of COVID-19.
- For those concerned about reporting requirements, HHS did release a notice stating that detailed instructions regarding future reports will be released by August 17 and will apply to payments exceeding $10,000 in the aggregate from the PRF.
- The reporting system will become available to recipients for reporting on October 1, 2020. The reports will allow providers to demonstrate compliance with the terms and conditions, including use of funds for allowable purposes.
- Recipients of PRF payments do not need to submit a separate quarterly report to HHS or the Pandemic Response Accountability Committee.
- There are plans by HHS to provide recipients with Question and Answer (Q&A) Sessions via webinar in advance of the submission deadline.
Webinars and Other Help Available
- HHS is hosting a webinar for dentists and Medicaid/CHIP providers to learn more about the application process. The webinar will be held on Monday, July 27, 2020 at 3pm ET.
- ADA is also hosting a webinar. This webinar will educate dentists on the PRF as well as Small Business Administration (SBA) loans and updates on Congressional activity. This webinar will be held on Tuesday, July 28, 2020 at 8pm ET.
- HHS instructions are available to act as a guide in applying to the PRF.
- Read the recent ADA News article where Dr. Phillip Fijal, chair, Council on Government Affairs, has a conversation on his application process and gives helpful tips. The article also reviews eligibility requirements to apply.
Terms and FAQs
- Dentists should review the Terms and Conditions and consult the Provider Relief Fund FAQs.
- For help with the application process, HHS has also set up a Provider Support Line, 866.569.3522, to assist with questions.
The ADA is proud to support dentists as they return to serving their communities. Together, we are driving dentistry forward on its path to recovery. Be sure to visit ADA.org/COVID19Advocacy for regular updates.