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20 January 21

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?

20 January 21

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?

10 January 21

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...

8 January 21

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.

31 August 20

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.

26 August 20

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.

4 August 20

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.

1 August 20

Annual enrolment or membership fees have become a controversial feature of bulk billing GP practices in recent years. One example was the now defunct National Health Co-op in the ACT, which publicly charged a $100 per year membership fee and a $30 sign up fee in return for bulk billed services. It was even awarded State based grants to support this business model. However, there is debate around the legalities of these arrangements with the Federal Government expressing the view that such arrangements breach the bulk billing law.

1 August 20

A gastroenterology practice asked whether a service provider providing two services to a patient on the same day, one for which there is an MBS item number, and the other for which there is not, can bulk bill the MBS service and simultaneously collect private payment for the non-MBS service. The question related to an outpatient context and both services were clinically relevant for the treatment of the patient, meaning neither would be considered cosmetic. NB: The scenario presented in this question is distinct from the common scenario of bulk billing a consultation and charging a private fee for a cosmetic botox injection, which is permitted, because Medicare specifically excludes rebates for cosmetic procedures, which are not clinically relevant. In this scenario, both services are clinically relevant. It is an important distinction and often a point of confusion.

1 August 20

A group of haematologists in private practice, who operate across various locations under a single brand with a central point of contact, asked if they could agree to all charge the same fees. Behind the brand, they each operate their own private practices with separate legal entities, separate ABNs and so on. They also asked if anything changed if they all agreed to bulk bill everyone.

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