Margaret Faux, Author at AIMAC

Can diagnostic imaging for a public hospital outpatient be bulk billed if there is a named referral and patient consent, but the registrar completes the imaging request form – and is it true that the request does not have to be signed?

29 June 25

Can a request for diagnostic imaging in a public hospital be Medicare billed if: 1) appropriate GP referral to a named obstetrician has occurred 2) the patient has elected to be a no fee private patient for attendance in the antenatal clinic 3) request for ultrasound imaging is filled out by a registrar “on behalf of” a specialist with ROPP named on the request while attending the antenatal clinic 4) patient consents to be bulk billed for the scan Also, the NSW guideline states a request for imaging does not require a signature to be valid. Is that correct?

Can staff specialists at NSW public hospitals register for gap cover schemes? If yes, are their claims paid at the gap cover rate or the MBS rate?

29 June 25

Would you kindly be able to confirm whether a Staff Specialist of a NSW Public hospital is eligible to register for participation in the Medical Gap Cover Scheme? I was under the impression that while they may be able to register, they are not eligible to be paid at the gap cover rate—only at the MBS rate. Could you please confirm the correct interpretation?

As a surgeon working in the private sector, can I bill doppler ultrasounds if they are performed by another doctor who I supervise?

23 June 25

I work in the private sector supporting a service run by GPs managing vein conditions. If they do the doppler ultrasounds (items 55244 and 55246) can I bill them under my provider number? I’ve heard this is permitted as long as I supervise them. The person who does the scan is another medical practitioner not a sonographer or radiographer.

Why are the procedures I bill being rejected when I bill them together with a consultation? I do both so why aren’t both paid?

23 June 25

When I bill an attendance item with a procedure like say, a skin excision, why is the consult paid but the procedure is rejected? It happens a lot, with similar item combinations. I do both things so why aren’t they both paid?

If an item says “at consulting rooms” can we bill it if we provide the service not at consulting rooms? What is the definition of a consulting room?

16 June 25

If an item specifies the place (eg: “at consulting rooms”) can we bill it if we provide the service not at consulting rooms? What is the definition of a consulting room? If we provide the service adjacent to our usual consulting room is that OK? What about at an outside location?

Do patients have to consent to be bulk billed at each attendance while having daily radiation oncology therapy?

16 June 25

Patients requiring radiation oncology therapy may require daily treatment over several weeks. Are they required to consent to assign their benefit for every radiation oncology appointment?

I am a VMO haematologist at a public hospital. I have been told we cannot bill inpatients (neither public nor private) for blood product transfusions. Is this correct?

9 June 25

I am a fee for service VMO haematologist at a public hospital in Sydney. My head of department has indicated that we are not permitted to bill for inpatient blood product transfusions (eg: item 13703) for inpatients admitted to the hospital under our care (public or private). Apparently this directive has come from the hospital finance department. Is this correct? As haematologists, many of our inpatients require blood product transfusions during their stay. I understand that we can only claim for a single transfusion item on a given day (as we would for a single chemo item 13950), but please could you clarify why we are not permitted to bill for transfusions at all when they are part of a treatment required for inpatient care?

I am a registered nurse doing DVA community nursing. Can I bill everything under my provider number for other nurses who I subcontract to?

9 June 25

I’m an RN and a DVA community nurse. Should I bill all services under my provider number each month, even for my sub-contractors?

Can patients make me remove an item from their Medicare records?

2 June 25

If a patient identifies a service on their Medicare records and is emphatic that they did not receive that service, do they have any legal right to make me remove it from their records?

I have been told that inpatient and outpatient care is never linked, except under the aftercare rules. Is that true?

26 May 25

In relation to charging separate fees to patients before their surgery, I’ve heard that inpatient and outpatient claiming is completely separate (except under the aftercare rules) so we can charge whatever we want – like booking/admin/facility fees etc. I’m not sure that is correct. Can you please shed some light on this?

Can items 13100 and 13885/13888 be billed on the same day for the same patient?

26 May 25

If a patient in hospital has a dialysis session (13100) and then becomes unwell, requiring ICU admission with continuous renal replacement therapy (13885 or 13888) on the same day, can item 13100 be co-claimed on the same day as 13885 or 13888 by the same provider? Can it be claimed by different providers – i.e. 13100 by the nephrologist and 13885 by the intensivist?

Can an ophthalmologist claim item 111 in circumstances where the planned operation may need to change on the day of surgery?

26 May 25

As an ophthalmologist, if I have planned a surgical procedure for my patient, but on the day of the procedure, while speaking with the patient pre-operatively, it become apparent that they will also need something additional done to that eye, does this qualify to bill item 111 because it was an unexpected procedure?

There are telehealth wellness companies sending patients to 3rd party telehealth companies for Medicare funded pathology tests. Who is responsible?

19 May 25

There are telehealth wellness and “optimisation” clinics sending patients for Medicare funded tests to a 3rd party telehealth company that has agreed to provide Medicare funded testing automatically. The wellness company does this because they know the patients don’t qualify for Medicare funded pathology under their own clinic. Their attitude seems to be – ‘it’s them, not us, we are clean’. The 3rd party would need to have their own clear clinical reasons for ordering and that would be on them if not complaint. But how would it reflect on the original company knowingly engaging in this?

If a patient cannot ‘elect’ to be a private outpatient due to not having a named referral, how does that impact downstream services such as pathology, radiology, chemo etc?

12 May 25

Patients under ROPP in a Clinic must ‘elect’ for the duration of their referral according to our LHN guidelines. If they cannot ‘elect’ because of an absence of a named referral, we understand their ‘public’ status infect (for want of a better term) downstream requests and reports: e.g. Pathology in a public or private pathology system — YES: public e.g. Imaging in a public or private imaging service – YES: public e.g. PBS Scripts for outpatient treatment – NO: remains eligible for PBS if meet criterial However what about for other Procedures – Steroid injection by a Rheumatologist in outpatient public or private clinic (referred by name from Public clinic) – Flex-sig by a Gastroenterologist in a outpatient public or private clinic (referred by name form Public clinic) – Chemotherapy infusion by same Public oncologist self-referred to Public or Private chemotherapy infusion centre

Can a telehealth company sell MBS funded pathology tests if the patient has not had a consultation with a doctor or nurse practitioner?

12 May 25

There are telehealth companies using the sexual and reproductive health exemption to offer MBS funded pathology tests but some of them don’t do a consult beforehand. They basically just sell a pathology request form. Is this legal?

After I discharge a patient from the ICU, can I use item numbers 104 or 105 to review the patient the following day after discharge?

4 May 25

An ICU specialist asked whether he could bill items 104 and 105 when reviewing the patient after they have been discharged from the intensive care unit.

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Can diagnostic imaging for a public hospital outpatient be bulk billed if there is a named referral and patient consent, but the registrar completes the imaging request form – and is it true that the request does not have to be signed?

Can staff specialists at NSW public hospitals register for gap cover schemes? If yes, are their claims paid at the gap cover rate or the MBS rate?

As a surgeon working in the private sector, can I bill doppler ultrasounds if they are performed by another doctor who I supervise?

Why are the procedures I bill being rejected when I bill them together with a consultation? I do both so why aren’t both paid?

If an item says “at consulting rooms” can we bill it if we provide the service not at consulting rooms? What is the definition of a consulting room?

Do patients have to consent to be bulk billed at each attendance while having daily radiation oncology therapy?

I am a VMO haematologist at a public hospital. I have been told we cannot bill inpatients (neither public nor private) for blood product transfusions. Is this correct?

I am a registered nurse doing DVA community nursing. Can I bill everything under my provider number for other nurses who I subcontract to?

Can patients make me remove an item from their Medicare records?

I have been told that inpatient and outpatient care is never linked, except under the aftercare rules. Is that true?

Can items 13100 and 13885/13888 be billed on the same day for the same patient?

Can an ophthalmologist claim item 111 in circumstances where the planned operation may need to change on the day of surgery?

There are telehealth wellness companies sending patients to 3rd party telehealth companies for Medicare funded pathology tests. Who is responsible?

If a patient cannot ‘elect’ to be a private outpatient due to not having a named referral, how does that impact downstream services such as pathology, radiology, chemo etc?

Can a telehealth company sell MBS funded pathology tests if the patient has not had a consultation with a doctor or nurse practitioner?

After I discharge a patient from the ICU, can I use item numbers 104 or 105 to review the patient the following day after discharge?

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