The Australian Institute of Medical Administration and Compliance
This GP has completed training for voluntary assisted dying (VAD) and has been receiving some referrals from nurses who run the VAD navigator service. The GP has been asked if they would be willing to see these patients when they are admitted in a private hospital if the GP is credentialled.
read more >The context for this question involves co-claiming diagnostic ultrasound and vascular access items. After the last MBS review, vascular access items 13815, 13842 and the newly introduced ECMO item number 13837/13838 and 13834/13835 definitions included a new clause to stipulate that no ultrasound item numbers can be claimed in association with these procedures. Traditionally 55054 was co-claimed when ultrasound was used, however the review taskforce stipulated that this was now standard of care and these procedures should attract no further ultrasound benefit. That is all fine, except the way this was implemented at a processing level, is that the above vascular access item numbers restrict with ALL diagnostic ultrasound item numbers. It is sometimes necessary to provide diagnostic imaging services to ICU patients (either referred or self-deemed). This is most often echocardiography, but it can be general abdominal, soft tissue, etc. These diagnostic imaging item numbers are not related to vascular access, but unfortunately even if it is clearly indicated in the service text that they are unrelated, a large majority of the time they get rejected and require manual processing. Someone suggested we could overcome this by obtaining a separate provider number that would be used for medical imaging services only and then the items would not conflict at processing. For example, the same intensivist would claim all intensive care item numbers including vascular access under their “ICU” provider number and then claim any medical imaging services they provide under a different provider number. I am not sure this...
read more >I am working in a day rehabilitation setting at a private hospital (patients are admitted for the day for allied health interventions mostly after joint replacements and are inpatients when I see them). For patients who have come from an inpatient admission under another rehabilitation specialist, can I charge 110 when I first assess them, or would it be a 116?
read more >My question is regarding clarification of billing case conferences for day rehab patients. These patients are ‘admitted’ as inpatients on the day they attend. However, I perform the case conference with the team on a day they are not coming in for day rehab. For example, a patient may attend day rehab on Monday and Friday, but I do their case conference on a Wednesday when all the team members are present. Billing options: 880: inpatient case conference 825: community outpatient case conference. Up until this point I have been billing an 880 regardless of whether the patient has been admitted that day or not, but should I be billing an 825 instead? I don’t have a preference either way, but I think the 880 sounds more reasonable to me. Hopefully that makes sense but clarification around this would be great.
read more >No additional context was provided.
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 >Can vocationally registered (VR) GPs claim any non-urgent after-hour attendance item numbers for admitted inpatients? For example, the “in-consultation room” items 5020/5040. Or are we restricted to items 4/24/37/etc?
read more >There is nothing in the MBS to preclude multiple transfusions (item 13706) being provided on the same calendar day and the item number covers three different types of regularly provided transfusions (blood, platelets, IVIg). There are ample examples in ICU when a patient legitimately requires multiple appropriate transfusion episodes during a 24 hour period and these are due to changing clinical circumstances, not part of a pre-defined transfusion plan (e.g. blood transfusion at 4am with 2 units of packed cells, subsequent transfusion of platelets and another unit of blood at 2 pm and another transfusion with a unit of blood at 10pm – for ongoing surgical bleeding). In my interpretation these would account for three distinct, time separated transfusion episodes and item 13706 should be claimed three times. However, Medicare seems to reject claims with more than two 13706 items on it. The error message is usually that the service has already been paid or maximum number reached. This is in spite of times and NDS override documented on the submission. Also, how does one reconcile a massive transfusion episode in billing (sometimes dozens of units of blood and platelets are given) – clearly this is a very different level of clinical workload and involvement compared to a single unit transfusion.
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 >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 >This is a common question. Who should the referrer be in these circumstances?
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 >Billing to Medicare for non-admitted patients in public hospital emergency departments is strictly prohibited, even if patients have private health insurance and are happy to use it. This is provided for in various provisions of both the Health Insurance Act 1973 and its intersection with the National Health Reform Agreement. However, in this scenario, Dr A was a haematologist who worked at a private hospital with an approved private emergency department (ED). Dr A wanted to know whether non-admitted patients in the ED could be billed to Medicare and whether the patient would be entitled to a Medicare rebate. Further, Dr A wanted to know at what point a patient is considered an inpatient after a decision to admit has been made, so that the patient’s private health insurer (PHI) could be billed. Was it: 1. When the patient is physically out of the ED and on the ward, or 2. When a decision has been made to admit the patient, but the patient is still in the ED, or 3. When the patient’s admission status has been changed in the hospital administration system indicating the patient is an inpatient.
read more >
1 Year subscription includes unlimited access to all answers and ability to ask questions.
How does MBS Answers work?
Save $9 by subscribing to the BEGINNER PACK
and get an additional $49 worth of learning.
Pay only $50 more by subscribing to the INTERMEDIATE PACK
and receive up to $248 of additional benefits.
Try the EXPERT PACK for an extra $110 with up to $686 of benefits.
Check out our subscription packages No, ThanksSubscribe to gain access to all answers, new answers added weekly.
See the complete answers to four popular questions.If you like what you see, you can join our yearly subscription for full access. Free trial will expire after 7 days.