On 13 March 2020, when the government introduced new Medicare telehealth services to deal with the Covid crisis, there was both excitement and chaos in the medical market. Everything changed so quickly, and whilst the rapid response of the government was welcome, confusion prevailed.

So, we started a blog on 16 March 2020 answering billing questions, hoping it might be of benefit, and it took off. The questions kept coming, are still coming, and subscriber numbers are through the roof.

It seems the niche area Dr Margaret Faux had carved out for herself over many years had some value for clinicians and the model seemed to work. For the first time in Australian history, clinicians felt safe asking medical billing questions because they were posted anonymously, and the answers were shared publicly so everyone could benefit and learn.

During Covid we provided the service for free, but by 2023 the volume of complex questions deserving of an answer were piling up, and previous answers required upkeep because of the constantly changing nature of this area of law. We therefore decided to adapt the model to a modest paid subscription to enable the service to continue.

Fee-for-service health systems like Medicare are inherently vulnerable to abuse because correct billing relies heavily on the personal integrity of each clinician. However, it is also true that this area of law can be incredibly vague and interpretive.

How it works

We are retaining the Covid blog model where you submit a question through the online portal, and we will answer it as soon as we can on a first come, first served basis. New answers will be emailed via a weekly blog. If your question requires an answer quickly, you will need to seek independent legal advice.

This site is intended to answer complex questions only. For simple things like “Is there an item number for this…or that…?” Please search the MBS or call Services Australia.

We also assume that you have some knowledge of how Medicare works. We therefore will not answer questions that concern basic Medicare principles. For example, questions like “Why doesn’t Medicare reimburse the schedule fee for specialists?” are answered in the Leo Cussen Centre for Law’s excellent, legally accurate, foundation course on Medicare billing, which you can access here.

You must correctly identify yourself to us as we may need to contact you personally about your question, but the answer to your question will be posted anonymously and shared to all paid subscribers. If you do not correctly identify yourself, your question may remain unanswered.

While this service has been designed principally for health practitioners, we do receive questions from consumers from time to time. Everyone is welcome to subscribe.

Who writes the answers?

Answers are written exclusively by Dr. Margaret Faux.

Dr Margaret Faux is a Solicitor of the Supreme Court of NSW and the High Court of Australia, having practiced law for over two decades. She is an academic scholar of Medicare and health insurance law and has a PhD on the topic of Medicare claiming and compliance. Margaret has published in peer reviewed journals and has administered medical billing since Medicare began. She is also a Registered Nurse, and the founder and CEO of global MedTech company Synapse Medical, which operates one of the largest medical billing services in Australia via an app-based solution with Australia’s only medical billing rules engine outside of Medicare. Synapse also administers medical billing in countries which use the U.S medical billing system based on ICD, CPT, and various other codes.

Margaret is considered one of Australia’s leading experts on the operation of Medicare. She is regularly engaged to provide expert evidence and support to her legal colleagues including in commission hearings, criminal and PSR matters, and has advised General Legal Counsel working in some of Australia’s largest hospital groups. Margaret also presents at legal events on the operation of Medicare and managing fraud and risk through audit processes.

Can I rely on the answers?

The answers on this site are not legal advice. You should always obtain independent legal advice before acting in reliance on these answers. The answers are Dr. Margaret Faux’s opinion in response to the limited information provided by people who have asked a question.

Where the answer is definitive it will be written in clear unambiguous terms with a straight ‘Yes’ or ‘No’ answer. An example is the bulk billing signature law which applies to everyone and is correct.

However, medical billing law is often ambiguous and much of it has not been tested in our Courts, so some answers will have limitations and qualifications which will be indicated such as by use of words and phrases like: ‘Yes, except for…’, ‘In our view, no…’

We will also indicate who the answer applies to at the bottom of the template. For example, supervision rules that apply to Oncologists may not apply in the same way to Pain Specialists.

Medicare laws change constantly so you should check this site regularly for updates. We will endeavour to update quickly when important changes occur, but we cannot guarantee we will always do that the day it happens. We will include the date when the answer was last updated at the top of each post.

You should also read our Terms of Use and Privacy Policy for more information.