Iowa Admin. Code r. 481-574.12 - [Effective 4/9/2025] Representation of treatment and fees
Licensees and registrants shall not represent the care being rendered to their patients or the fees being charged for providing the care in a false or misleading manner.
(1) The
following billing practices are deemed to constitute deception,
misrepresentation, overbilling, fraud or a combination thereof:
a. Accepting a third-party payment under a
copayment plan as payment in full and not collecting the patient's portion
without disclosing that to the third-party payer.
b. Increasing a fee to a patient merely
because the patient has insurance.
c. Submitting a claim form to a third party
and knowingly reporting incorrect treatment dates.
d. Describing a dental procedure incorrectly
on a third-party claim form in order to receive a greater payment or
intentionally making a noncovered procedure appear to be a covered
procedure.
e. Recommending or
performing unnecessary dental services or procedures.
f. Billing for services not rendered. A
dentist may bill for those services that have started or been rendered, for
actual costs incurred in the treatment of the patient, or for missed
appointments.
g. Billing or drawing
on a patient's line of credit prior to services being started or rendered. A
dentist may bill or draw on a patient's line of credit for those services that
have been rendered or for actual costs incurred in the treatment of the
patient.
(2) A dentist
may allow patients to prepay for services, in whole or in part, on a voluntary
basis.
(3) Payments accepted by a
dentist under a government-funded program, a sponsored access program, or a
participating agreement entered into under a program of a third party are not
considered as evidence of overbilling when determining whether a charge to a
patient or to another third party on behalf of a patient not covered under any
of these programs constitutes overbilling under this rule.
Notes
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