The Australian Institute of Medical Administration and Compliance
What happens to billing of a private patient in a public hospital who undergoes solid organ (other than kidney) transplantation? There is no MBS item billable for this so it can’t be billed to the patient’s private insurance, so can the hospital just change them back to public or does the patient have to be involved in that decision?
read more >How site specific are provider numbers? e.g. do you need a different provider number for a satellite clinic directly across the road from the main hospital which you already have a provider number for.
read more >The questioner had received this advice which was wrong. “Thank you for your enquiry regarding the revised item descriptor for item 45518, that will come into effect from 1 July 2023.The rationale of the Plastic and Reconstructive Surgery Clinical Committee to amend items 45515 and 45518 was that they were potentially subject to inappropriate use for the revision of cosmetic breast implants. Specifying recording of photographic evidence and the explicit wording around the exclusion of insertion of breast implants concurrent with scar revision adds clarity to the descriptors and assist in preventing cosmetic misuse. To answer your question, if the proposed scar revision does not involve the insertion of breast implants, and all of the other requirements of the items are met, items 45515 and 45518 can be claimed, regardless of whether the original surgery was for cosmetic purposes.”
read more >Can a medical practice registered as a Unit Trust charge a user fee to patients along with the doctors’ fees, if the doctor does not bulk bill that visit. e.g. For an initial visit with an Obstetrician, the Obstetrician charges $200, and the patient can claim about $78 from Medicare as rebate. Can the practice under its own name, charge $70 as user fee, i.e. Issue 2 invoices: 1 doctor’s invoice for $200 with the correct Medicare Item number, and another invoice of $70 under the practice’s name?
read more >We have been informed that a GP re-referral for “ongoing care” where no duration is specified should be interpreted as an INDEFINITE REFERRAL. We do not think this is sufficient for something to be construed as being an indefinite referral, but instead would be 12 months if no duration is stated.
read more >Is a verbal consent noted in the patient’s file enough? If a bulk billed patient has to provide consent by signature for items put through to Medicare this creates additional admin work, in particular for telehealth.
read more >We have a scenario where Medicare reject claims submitted by the physician for an item 38417 because it states fluoroscopy can only be claimed by one provider once for that occasion of service. The physician performs the bronchial biopsy and a radiologist performs the fluoroscopic imaging to guide the physician when taking the biopsy. In this case the doctor physician claimed a 38417. The radiologist claimed a category 5 diagnostic item group 13 MBS item and the radiologist claim was submitted prior to the physician lodging their claim. As stated by the physician, “38417 is the most correct item number for the procedure. The item description does say “with or without associated fluoroscopic imaging”. I performed the procedure described as MBS 38417 for an ultrasound biopsy and the radiologist performed and billed the fluoroscopy. “It does not seem right that the physician cannot claim the 38417 when by description the procedure fits exactly with this item.” When two providers need to partake in the provision of a service due to the particular areas of specialty (i.e. medical procedure v diagnostic imaging), what is the best approach when dealing with Medicare and the claim?
read more >I occasionally have patients who come into hospital for a pulmonary vein isolation (item numbers 38290, 38212, 38206, 55118) but at the time of the procedure we find an intracardiac thrombus which means the case has to be abandoned. Is there a way to bill for abandoned pulmonary vein isolations? The same occasionally happens where a patient comes into hospital for a pacemaker implant (item numbers 38356, 38353, 61109) and I find that the veins are blocked or abnormal and not suitable for passing pacemaker wires into the heart. In these cases I have to abandon the procedure and rebook them for another time after further assessment and discussion with the patient. Is there a way to bill for abandoned pacemaker procedures as well?
read more >We have a Practice Nurse who does vaccinations and wound dressings etc. Does the doctor have to physically see the patient or can the nurse discuss the patient with the doctor, act on his/her behalf and then invoice the patient under the doctors name?
read more >If a principal spinal surgeon is performing an anterior spinal fusion and a vascular surgeon is required to provide anterior exposure, are both surgeons eligible to invoice for their separate MBS items at full rates or do step down rules apply?
read more >If we have regular locums in an ultrasound practice, reporting scans, should these be billed under the partner’s provider numbers or the locum’s provider numbers?
read more >It was my understanding that we can’t bill items 145, 147, 128 over the phone in nursing homes. Is this still correct or do we have numbers equivalent that we can bill for consultations over the phone? I am getting inconsistent advice around this.
read more >I’m working as a surgical assistant. I sometimes charge the patient a gap. My registration with each fund is ‘known gap’. As an example – Bupa pays $386 for assisting a 49518. I want to charge the patient $100 gap. Do I need to charge the fund $486? and then charge the patient $100 or do I charge the fund $386 (under their known gap scheme flag) and separately bill the patient $100. I’m confused about split billing – what is allowed and what isn’t allowed and where we can charge the fund only their known gap scheme amount and where we have to charge the fund the entire amount or whether this is actually what’s always needed?
read more >If you work in multiple outpatient locations, and first see the patient in Location A for an initial consult and bill a 110, can you provide a follow up consult from Location B (which has a different provider number) and bill a 116 under the same Medicare referral? Or do you need a separate referral to bill from a different location/provider number?
read more >I am an Australian Citizen and psychologist. At times clinics have asked me to write court reports on Australian residents for Legal Aid while I am out of the country. So I interview the client online and prepare the report. Can I legally do this?
read more >I am a GP. I have come across an issue with item number 11607. Our pathology company is billing 11607. They fit the patient with an ambulatory bp monitor and send a report to me from a cardiologist stating if the patient has hypertension and a brief recommendation. They do not provide a comprehensive treatment plan, provide any follow up, nor do they actually see the patient. Can the pathology company actually bill this item, or could the GP, as they use pathology to obtain the data and actually sit with the patient and makes recommendations re: medications, lifestyle, follow up and provides a written plan to the patient? Or is it neither can bill this item?
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