The Australian Institute of Medical Administration and Compliance
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?
read more >If I have been providing services to a client under Medicare through a Mental Healthcare Plan (MHCP) and they have been admitted to hospital as an inpatient. Is the client able to continue with their therapeutic intervention sessions via video link from the hospital and claim this under their MHCP?
read more >If my patients book a video telehealth with me online and pay prior to my consultation (given that they have a GP referral in advance) can they get a medicare rebate? Or does the payment need to occur on the same day as the consult for me to charge a 91824 (video consult) or a 91825 (for follow up). My plan is to give my patients an invoice once they pay and they would claim from Medicare. For example, if a patient books and pays for a video consult on Sunday (for a Monday session) but does the actual consult on Monday, can they claim for the consult that occurred on Monday even if the payment was on Sunday? Or do I need to tell them to pay me during or after my actual video consultation. This is very important for me since I would rather take the payment in advance before they actually do the video consultation rather than request payment during my consultation.
read more >This question relates to medical specialists exercising rights of private practice in public hospital outpatient departments. The questioner wanted to know if both Dr ABC and XYZ can use the referral in this context, given they are both named on it. In addition, the questioner had received advice that a “named referral” under the National Health Reform Agreement can only have one name on it, not two. The advice was that the referral had to have “a” name on it, and this was therefore an invalid referral.
read more >A PICC line insertion is performed by a nurse/nurse practitioner and radiographer, including imaging (Fluoroscopy + Digital Subtraction Angiography of thorax). Post examination, a radiologist reviews the images and confirms the positioning and readiness of the PICC line. Noting that the initial catheterisation procedure (13815) cannot be claimed as a nurse performed the procedure, could the radiologist claim for the relevant DSA imaging charge (e.g. 60012)?
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