MBS ANSWERS

Can a service that is provided outside of a hospital be claimed on Medicare if it is provided to a patient who is “on leave” from a hospital where they are currently an admitted patient?

Context

What are the Medicare billing considerations for a hospital inpatient on gate leave who attends an outpatient service not related to the hospital admission? Patient attended private specialist rooms appointment and announced on arrival that he was an inpatient under different specialty for unrelated issue but on gate leave. Practice Manager flagged that Medicare may not be claimable and would seek advice. Is the patient eligible for a Medicare rebate given their status at the time of consult?

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Health Insurance Act – Cases and Commentary by Bruce Topperwien

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