General

Can we charge sleep study equipment hire fees to patients when we bulk bill their sleep studies?

5 October 24

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?

Can a psychologist bill to Medicare for a walk and talk session?

4 October 24

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’.

Can allied health professionals using a Team Care Arrangement charge a separate gap when bulk billing?

4 October 24

This physiotherapist was under a misunderstanding that there existed a separate bulk billing law just for allied health professionals.

Can a specialist bill a 91836 as their first billing in a private practice setting?

4 October 24

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

Why are outpatient item numbers that attract 85% of the Medicare Schedule Fee not listed by the private health insurers?

3 October 24

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.

When bulk billing, is the patient’s agreement to assign their Medicare benefit required for all items or just the consultation items?

2 October 24

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.

Can we charge facility fees to cover the cost of consumables when bulk billing?

30 September 24

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.

If a patient presents at a public hospital outpatient clinic with a named referral from their GP and needs admission but wants to go to a private hospital, is a new referral required?

27 September 24

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?

Is there a legal restriction to claiming a new initial day of ICU when the patient was discharged from ICU and readmitted within 3 days?

25 September 24

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.

Can a fellow of the Australasian College for Emergency Medicine (FACEM) bill MBS codes outside of a private emergency department?

24 September 24

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?

Can a podiatrist’s receptionist sign the acceptance of a GP referral?

24 September 24

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?

Do items 60506 and 60509 refer to surgical procedure time or fluoroscopy time?

23 September 24

No context was provided.

Do you have to withhold billing item 723 until a formal acceptance to participate is received from at least 2 care team members?

19 September 24

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.

Can a cardiologist self-refer to follow up a patient post discharge from hospital?

24 February 21

The question posed was: “Cardiologist, Dr Z, performs a procedure (permanent pacemaker implant) at hospital A (provider number 1), but would like to see the patient for ongoing care/follow up at practice B (provider number 2). Can Dr Z self-refer for the follow up visit?”

If a public inpatient is discharged and then referred back to the hospital outpatient clinic by the GP (so, no previous Medicare billing), can I bill item 132 if I spend more than an hour with the patient?

28 January 21

A hospital billing manager asked: If we have a public inpatient that is discharged from the brain injury unit to the outpatient clinic for follow up (at this point no previous Medicare billing would have taken place as they were a public patient) and the GP writes a specific referral for the patient to see a specialist post inpatient discharge (different specialist from their inpatient stay). The patient is seen in the outpatient clinic for > 1 hr. Can we bill a 132, given that no previous billing has occurred? The factors here are that the patient is referred to a new service by a GP; no previous 132 has been raised.

Can I take over a named referral in a public hospital outpatient setting if I am of the same specialty?

22 January 21

Doctor A was a rehabilitation physician working in a public hospital day rehabilitation unit. Prior to patients commencing the day rehab program (where they are admitted inpatients on each day they attend), they have an initial outpatient visit to determine their eligibility for the program. The referrals from the GPs always name one of the rehabilitation specialists. Doctor A wanted to know whether Doctor B could see the patient for the initial outpatient assessment even though the referral was to Doctor A.

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Topics

Specialities

General

Can we charge sleep study equipment hire fees to patients when we bulk bill their sleep studies?

Can a psychologist bill to Medicare for a walk and talk session?

Can allied health professionals using a Team Care Arrangement charge a separate gap when bulk billing?

Can a specialist bill a 91836 as their first billing in a private practice setting?

Why are outpatient item numbers that attract 85% of the Medicare Schedule Fee not listed by the private health insurers?

When bulk billing, is the patient’s agreement to assign their Medicare benefit required for all items or just the consultation items?

Can we charge facility fees to cover the cost of consumables when bulk billing?

If a patient presents at a public hospital outpatient clinic with a named referral from their GP and needs admission but wants to go to a private hospital, is a new referral required?

Is there a legal restriction to claiming a new initial day of ICU when the patient was discharged from ICU and readmitted within 3 days?

Can a fellow of the Australasian College for Emergency Medicine (FACEM) bill MBS codes outside of a private emergency department?

Can a podiatrist’s receptionist sign the acceptance of a GP referral?

Do items 60506 and 60509 refer to surgical procedure time or fluoroscopy time?

Do you have to withhold billing item 723 until a formal acceptance to participate is received from at least 2 care team members?

Can a cardiologist self-refer to follow up a patient post discharge from hospital?

If a public inpatient is discharged and then referred back to the hospital outpatient clinic by the GP (so, no previous Medicare billing), can I bill item 132 if I spend more than an hour with the patient?

Can I take over a named referral in a public hospital outpatient setting if I am of the same specialty?

Topics

Specialities

General

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