Locum Arrangements

When an obstetrician takes over the care of another obstetrician’s patients while they are on leave and intends to undertake the births is that shared care?

5 October 24

Obstetrician A is going overseas. Obstetrician A’s patients due for delivery while she is away will be looked after by Obstetrician B for antenatal visits billing 16500. Obstetrician B usually works in the same practice as Obstetrician A and sometimes sees Obstetrician A’s antenatal patients billing item 16500. Can Obstetrician B bill for a pregnancy management fee for those patients who are due while she is away using item 16591? Does this scenario qualify as shared caring?

How do in-hospital referrals work?

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?

Can I bill to Medicare when a patient is in Australia but I am overseas?

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.

Do you get one item 132 and two item 133’s every 12 months?

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.

Is a written handover sheet a valid inpatient referral between specialists covering each other on weekends, or does it have to be a formal letter?

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.

If a patient is having chemotherapy at a hospital and the doctor goes on holiday, can we still bill for treatment under that doctor’s provider number because they created and approved the treatment regime?

1 August 20

Question: Wanting to confirm that if a patient is on a chemotherapy regime at a hospital and the doctor goes on holiday, can we still bill the treatment under the doctor’s provider number, as they created and approved the treatment pathway? For example: A patient has chemotherapy scheduled on Thursday, their doctor goes on holiday on the Wednesday, so the covering doctor sees the patient and bills for a consultation. The patient’s usual doctor (who is on holiday) is still allowed to bill for the treatment code though, as they created the pathway. Is that correct?

When I am covering another physician’s inpatients and it’s the first time I see the patient, can I bill an initial consultation?

27 July 20

When one physician covers anothers’ inpatients who have already been admitted, but are new to the doctor covering for the weekend, Dr A wanted to know if it is acceptable to bill a 110? Dr A’s instincts were that all encounters should be billed as 116 since they are generally part of the same episode of care, (even if provided by a different physician) but she had received conflicting advice.

Can I bill using my provider number when a locum is covering for me?

10 July 20

Doctor A was an oncologist who understood that when on leave with a locum covering, Doctor A could continue billing as usual, even though Doctor B was acting as a locum and was providing all services to Dr A’s patients. Doctor A would reimburse Dr B for the locum services under an agreement they had reached.

How to navigate your Medicare statement and more informative free resources