There are two reasons for submitting incomplete claims, such as when a patient fails to return for treatment.
You have planned the treatment, but not carried it out. You have set out your "to do " list but the patient has failed to return for the rest of the treatment. You now want to claim for the treatments you have completed.
You may have started higher UDA Band work, such as a denture or a bridge, but the patient fails to return for fitting and so you now need to abandon the treatment. This means you are entitled to the UDAs for the work you have carried out, but the patient charge remains at the band for the treatment they received.
The only method of telling BSA that a plan is incomplete is by sending 2 bands for complete work and incomplete work. This means that, in Dentally, you need to have some incomplete work on the plan of the appropriate banding.
If you are claiming the higher band, then the genuine incomplete work on the plan will fill this in for you, simply leave all of the proposed work on the plan and leave the incomplete work unticked.
If you are not claiming the higher band, but you still want to send it as incomplete, you need to only have complete work on the plan of the band that you are claiming and an incomplete treatment of the band you are claiming.
This may mean that you need to add additional items to the plan of the band you wish to claim that need to be left as incomplete. You should have in your Dentally settings a treatment for this very purpose called Incomplete Treatment and the band which it will raise.
If not, you may need to add these treatments following the guidelines below.
If you need to, set up 2 new treatments that you can leave incomplete when sending the incomplete claim. We recommend that a new Treatment is created, called something like "Incomplete Treatment (Band 1 Claimed)", Category "Other" and NHS Band 1 or NHS Band 2 as appropriate.
Step 2 - How to use this new code
Suppose you have a set of Band 2 treatment planned, but your patient fails to return, so you have only completed Band 1 work. You therefore need to send as "Incomplete Treatment (Band 1)". There should be an 'Incomplete Treatment (band 1 claimed)' item left on this plan as unticked.
Patient Fails to Return for Planned Treatment
- Remove the Band 2 treatment from the Treatment Plan.
- (If the Band 2 treatments are all in unattended service appts, then the snip tool works well for this) - you can put them onto another plan and close this so the treatments are retained in notes.
- Use the scissors (Snip Tool) to cut the incomplete treatment out of that Treatment Plan.
- Move the treatment into a new Treatment Plan. Add any notes as appropriate. This keeps a record on the patient's history that they were offered the treatment, but that it was not carried out.
- You may prefer to chart a General Note if this suits you better.
- On the original Treatment Plan, add an 'Incomplete Treatment (Band 1 claimed)' treatment to the plan. Leave this UNTICKED.
- This then means that the claim will show Band 1 completed work and Band 1 incomplete work, and will inform the BSA that the plan is incomplete without claiming for the Band 2 UDAs.
- Submit the original Treatment Plan with the Failed To Attend date as the last visit date. This date does NOT need to be within the last 2 months (even though Dentally will still give you a warning about this).
The same scenario works for Band 2 claims going off as incomplete where the dentist does not want to claim Band 3. In this case use a Treatment called something like 'Incomplete Treatment (Band 2 claimed)' should be left on the plan as unticked and the band 3 treatment should be removed.
You would use this, for example, if you have not completed any moulding, lab work or denture and the patient fails to attend for any reason and the treatment is now abandoned.
Example 1: Band 2 planned, but abandoned at the Band 1 stage
Example 2: Band 3 planned and started. Abandoned at band 1 stage, but band 3 UDAs requested
Charging the Patient
The patient can be charged as normal, with only the treatment ticked as complete that the patient has received, the band charge appropriate for the completed work will be produced.
Just remember that any incomplete treatment on a plan and submitted on the claim will register the band of UDAs you wish to claim. If you have not started or incurred any costs for the higher band of treatment, then it should be removed from the plan and an incomplete treatment left on the plan of the band you do wish to claim.