The Australian Institute of Medical Administration and Compliance
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?”
read more >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.
read more >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.
read more >The question asked was: Is there any way to do outpatient billings where the patient pays the gap only on the day, and then the clinic submits a claim for the unpaid Medicare rebate? Currently the patient pays us the gap only as cash on the day, and we need to then bill Medicare for the unpaid rebate. Medicare sends a cheque for the rebate amount to the patient, and they then have to send it to our practice. It takes a lot of time chasing the cheques. Is there was a way to get the cheques addressed to us rather than the patient such as by changing the billing address recorded at Medicare maybe? Also, can we get the 90-day cheque reimbursement from Medicare directed to us so we can follow up on rejected claims?
read more >The question posed was: Can the bulk bill “Assignment of Benefit” be specific to the hospital setting? We understand that patients sign this upon admission, and while it is not specific to any one doctor, it covers all the services rendered to the patient whilst in care.
read more >Dr A was unsure about correct referral pathways for patients transferred to a private hospital after an episode of care in a public hospital, and how such patients should be billed.
read more >A specialist doctor asked how the various specialists below should claim for their services in this very common scenario. Patient attends the Emergency Department (ED). The ED Dr refers the patient to Dr A and Dr B (of different specialties) for inpatient management of a complex presentation. Dr A performs an initial consultation and is then covered for a few days by Dr C. Dr B performs an initial consultation, which identifies another problem requiring the expertise of Dr D. At the end of the admission, there are outstanding specialist issues that require outpatient follow-up with Drs A and D. 1. Should all four specialists bill using the in-hospital override for all consultations? Can A, B and D all claim a 110 or 132 as reflective of the service they provided? 2. If C identifies a new issue that requires assessment and a change in treatment, can C claim an in-hospital 110 (non locum tenans)? 3. If A and D use an in-hospital override for inpatient claims, and then receive a subsequent Medicare-compliant referral for outpatient review of the issue(s) managed during the admission, does the outpatient review occur “after the end of the period of validity of the last referral to have application” (because the last referral expired at hospital discharge). If so, can they claim a 110?
read more >Doctor B had received written advice from askMBS which he believed was not only wrong, but likely illegal. He wanted to know if he could rely on the advice. Detailed Reasoning The Department of Health and Aged Care is not a law firm and cannot give legal advice. This is why all askMBS answers come with a comprehensive disclaimer. Only lawyers with a current practicing certificate are authorised to provide legal advice in this country. Medicare interpretation is legal advice. The below court decisions (even though one is about fishing!) make clear that relying on government advice in any setting will not protect you. Ignorance of the law is no excuse. High Court authority In the 2004 High Court case of Ostrowski v Palmer, Mr Palmer had obtained a commercial fishing licence and was found guilty of fishing for rock lobsters in a place where that was prohibited. However, before he did this, Mr Palmer had first sought advice from the relevant state government department, which led him to believe he was allowed to fish there. Mr Palmer raised this as a defence when the case was in court but was unsuccessful. The court held firm on the principle of ignorance being no excuse of the requirement to comply with law. The court stated: “Ignorance of the legal consequences that flow from the existence of the facts that constitute an offence is ordinarily not a matter of exculpation, although it may be a matter of mitigation, and in some circumstances...
read more >Doctor A asked what happens when the treating doctor goes overseas for a week of conference leave while the patient is midway through a course of treatment such as chemotherapy or radiotherapy. The patient cannot stop or delay the treatment because it is required to be administered via incremental doses at set intervals. The doctor wanted to know if billing could continue from overseas under the supervision arrangements.
read more >Doctor A wanted to know whether billing to Medicare was permitted in circumstances where an Australian, Medicare eligible patient, was overseas working or holidaying, and the doctor was in Australia, and the service took place via telehealth.
read more >Question: If a clinic receives a referral to “Dear specialist” can this be used by anyone in that practice? Or if it comes to a named specialist, can that validly be used by another provider in the same practice? These are privately referred non-inpatient in a public oncology setting that is bulk billed.
read more >Doctor A worked in a public hospital outpatient department where they exercised a right of private practice. They thought that they were not automatically permitted to bill item 132 every 12 months but had received contrary advice. Further, they were unclear about whether item 133 applies twice in the first year only or twice every year. They had been further advised that 133 can be billed twice during a 12 month period and therefore, for a patient of 20 calendar years that would mean they could bill item 133 40 times.
read more >Question: If the same treating rehab physician sees a patient following discharge in their outpatient rooms, can this be billed as a 132 (obviously with a relevant referral), or is it a 133/116 depending on other factors? I’m just not clear if the inpatient and outpatient episodes are to be considered in isolation of each other.
read more >A general practitioner has asked whether they can claim item 41764 given they have appropriate surgical training to perform the procedure, which is a nasendoscopy/sinoscopy.
read more >A practice manager for an oncology practice asked whether the oncologists can claim item 14206 even though it is in the assisted reproductive technology (ART) section of the MBS, because it accurately describes a service the oncologists provide, being “HORMONE OR LIVING TISSUE IMPLANTATION by cannula.”
read more >Doctor A was a respiratory and sleep physician who had been trying to obtain clarity around this question. The question specifically related to weekend cover when doctors are rostered to cover each other’s admitted patients on a rotating basis. Doctor A said that some groups and individuals seem to apply and interpret the requirements differently, which was of concern to them.
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