The Australian Institute of Medical Administration and Compliance
This question came from a psychologist but it applies to everyone who can bill to Medicare. No exceptions.
read more >This question came from a consumer. I am an inpatient in a private mental health unit in a private hospital. I am under an inpatient psychiatrist. While I am an inpatient, I have a telehealth review consultation booked with an outpatient psychiatrist who is known to me. I also have a review consultation with an outpatient specialist in person, and a review consultation in an outpatient clinic at a public hospital. I am allowed to leave the private hospital to attend the in-person consults and will then return. But I have heard that these services can’t be bulk billed. I am a pensioner so cannot afford private fees.
read more >In the last 12 months or so, I’ve had repeated problems with referrals marked “indefinite” by the GP. These will be accepted by Medicare for some time, then randomly start getting rejected. Repeated phone calls to Medicare cannot provide an explanation. As a result, I am tempted to reject indefinite referrals – but GPs just see that as a self-serving request assuming I’m just doing it to increase my billings. An issue mostly for patients as they get very disgruntled when Medicare refuses their rebate, and since the event has occurred, they can’t get a new referral from their GP, since it would have to be backdated. An example was given: An inpatient ECLIPSE claim contained both a 116 and a 13918 on the same date of service, with a valid indefinite referral. Claims for this patient had previously been accepted without issue under the same referral. The 116 claim was rejected by Medicare, but the 13918 was paid. This makes me question whether 13918 and 13706 are item numbers that require a referral at all… Nothing in the item wording says they are a referred item number. Can you advise?
read more >This questioner said that every time they called Medicare about this, they received different advice and were concerned they may be billing incorrectly. The setting was outpatient sleep studies which are bulk billed by the respiratory and sleep physicians using item 12250. The company (described as an external provider) supplies the patients with the sleep study devices and charges them a hire fee for the equipment. Is this allowed?
read more >I was hoping to please clarify which billing code is appropriate for a generally registered psychologist session using a valid mental health treatment plan lasting more than 50 minutes that is conducted at a regular location that is outside (walking session). Is 80115 the out of office code appropriate to be used for each session? My understanding was that this may constitute an unusual pattern of billing, however the code 80110 mentions specifically ‘in consulting rooms’.
read more >This physiotherapist was under a misunderstanding that there existed a separate bulk billing law just for allied health professionals.
read more >The specialist had received a referral from another respiratory physician to perform a bronchoscopy on a patient. The specialist called the patient to discuss the procedure, make them aware of the risks and what could be done as part of the procedure i.e. a biopsy. The patient was given the opportunity to ask any questions they had about the procedure and the costs were explained. The phone consultation was documented in the patient’s record. No previous billings for the patient with the referral have been made yet
read more >The question was posed in the context of public hospital outpatient services where clinicians can bulk bill when exercising a Right of Private Practice providing all other criteria are met. The questioner wanted to know how they easily determine which item numbers should be claimed at 75% and which 85% because the Private Health Insurance (Benefit Requirement) Rules do not seem to include some MBS item numbers that are relevant to outpatient services and normally claimed at 85% of the schedule fee, such as telehealth and face-to-face consults, and the associated bulk bill incentives.
read more >The questioner added that everything they had read talks about telehealth items only. Their understanding was that the assignment of benefit is only required for consultation items but not for other items. They gave the example of whether consent was required to bulk bill a 11714 ECG.
read more >A GP practice wanted to know how to “manage” facility fees for bulk billing patients. The question said that the practice needed to charge this fee to cover the cost of consumables, but the doctors also wanted to bulk bill and be able to claim the full bulk bill incentives. The practice is in a regional area where the bulk bill incentives are highest.
read more >If I see patients referred to me in the public clinic, and they are unwell and require admission to hospital at presentation to the clinic as patients with chronic disease sometimes are, do I need a separate referral from the referring GP or other senior doctor to admit them to the private hospital?
read more >If a patient is discharged from ICU and readmitted within 3 days and we claim a new initial day of ICU management (13870), the claims reject. We find that if we resubmit the claim as item 13873 (subsequent day of ICU management), it is paid. However, this is not strictly a correct claim because the service provided best matches the initial day item 13870. Is there a legal barrier? The practitioner was also experiencing the same problems in relation to a number of other first and subsequent day services such as dialysis, haemofiltration and extracorporeal life support.
read more >This FACEM was planning to open a walk-in emergency clinic similar to a GP urgent care centre. Importantly, this would not be an approved private emergency department (ED). The following scenarios were posed as part of the question. Scenario 1: A 68-year-old female presents to the treatment centre (FACEM lead) post fall and sustains a right wrist fracture & a laceration to her forehead. The patient is assessed by the FACEM which includes history, examination and organising investigations – some blood tests, ECG and X ray. As a part of treatment, the patient requires interpretation of an ECG, reduction of the fracture and application of plaster under a local block, and suturing of forehead laceration under local. Which code applies for the consult, is it 104 or 107? Which code applies for the fracture reduction and plaster application? Which code applies for the local block? Scenario 2: A patient presents with abdominal pain on a Sunday. The patient requires assessment by a FACEM, which includes, history, examination and organising investigations followed by treatment. Is seeing this patient on a Sunday considered an afterhours presentation? If yes, which code applies for the consult?
read more >When a podiatrist has received a referral from a GP to be involved in a coordinated care plan, can their receptionist sign the acceptance of the referral?
read more >No context was provided.
read more >At our practice we do not hold the billing, and we charge item 723 on the same day as the GPMP (721). I have heard of other practices who withhold the 723 billing until signed faxes are exchanged with team care members so that it is all documented before charging.
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