Welcome to the third edition of the 'Practical Guide to Compliance' series. This series is intended to act as informal guidance to dental teams working toward CQC compliance. The contents of these articles are based on personal opinion and interpretation of the CQC framework and other relevant legislation. Whilst the author has full confidence in the suitability and appropriateness of the information contained within these articles, the information shall not be regarded as fact and those requiring definitive information should consult the relevant governing body.
Outcome 3- Fees
This outcome is all about how you charge fees for your services. Although not one of the core 16 outcomes it is considered relevant to dentistry and it is important that you comply with it.
What do the regulations say?
People who pay for a service should know how much they have to pay, when and how to pay it, and what they will get for the amount paid.
-CQC Essential Standards
This should be one of the easier outcomes to comply with as most practices have been producing fee guides, written treatment plans and cost estimates for some time. However this guidance encourages you to take this a little further to comply with this outcome.
The first step towards complying with this outcome is to have a published fee guide and payment terms. This applies to both NHS and Private practices, if your patients are expected to pay for all or part of their treatment they need to know how much they will be required to pay before they go ahead with anything- this includes examinations, consultations and diagnostic tests.
Your fee guide should be comprehensive covering all the services and treatments that you offer, where it is not possible to provide a fixed cost for example a filling is usually priced by surface and in this instance you need to provide a fee scale for example £75 - £125.
Your payment terms should clearly state how and when the patient will be expected to pay. You should state what methods of payment are accepted for example cash, cheque and credit debit cards. If you offer finance or payment plans then some mention should be made to these. the payment terms should also make clear the patients obligations for example fees are due on completion of treatment or similar. It needs to be made clear when you expect the patient to pay your fees. Payment terms should also clearly state the consequences of late or non payment of fees agreed. You should also include details of how a patient would cancel their agreement for treatment once they had started the treatment and what proportion of fees may be payable.
When you are prescribing treatment you must provide the patient with details of the full cost in writing, this can be done by supplying patients with a written estimate detailing the cost of each treatment recommended. When providing estimates it is important to be as clear and transparent as possible, there is no requirement at the moment to itemise the individual fee components of treatment but in some cases this would be advisable for example when providing an estimate for Endodontic Treatment, if you are applying a surcharge to cover the cost of single use files this should be stated.
For more complex or high valued treatment it would be advisable to provide a written treatment plan which is a little more detailed than a standard estimate. Within this you could include your recommendations, associated fees and also include a section about any additional fees that may become necessary.
Within any estimates or treatment plans you must be explicitly clear of what is and is not included in the fee quoted for example if you are carry out a root canal treatment and you will be charging a fee on top for the filling this must be made clear, if you also plan to crown the root treated tooth months later the patient should be informed of the cost and an given an idea of when they should expect to pay the additional charges.
It is important to give costs for each stage of treatment and when each payment is due as the patient may wish to discontinue their treatment with you at any time and you need to make sure that they are clear about what costs are incurred up to that point.
Once you have determined the treatment needs of a patient and provided them with details of their treatment plan and costs it is vital they are given time to consider their options. Patients must freely agree to go ahead with treatment and it is important that they sign a copy of any estimates or treatment plans agreed and they should also be given a final copy of this signed document.
You must ensure that there is someone available to discuss the terms of any treatment plan with the patient should they request it. This person should have enough knowledge to answer any questions the patient may have.
Once a patient has entered into treatment and has agreed the fees you are required to:
· Provide a statement of account upon request
· Offer a receipt for all payments received
· Provide written details of any change in cost due to unexpected changes in the treatment plan
In order to implement all of the above into practice it is advisable to incorporate fees into your consent procedures. This will allow you to make sure that agreement to fees is being obtained and recorded effectively and provides you with an audit trail for monitoring compliance. Another way you can monitor compliance to this outcome is through a question in your patient survey to find out whether patients felt fully informed of the fees relating to their treatment.
Whilst this outcome is relatively simple in its requirements I believe it will evolve into something more in years to come. The Office of Fair Trading launched a market study into Dental fees in September 2011 and I see this report highlighting the large pricing inconsistencies between different practices, lack of clarity into what the fee covers and quite possibly the need for a more transparent approach to pricing. OFT plans to complete this report by March 2012 so we'll soon hear about their findings.
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