Private Hospital Billing

Can item 599 be billed for admitted patients?

26 October 25

We are seeking clarification regarding MBS item no. 00599 (after-hours item) and its applicability in certain settings. Specifically, we would appreciate your guidance on the following points:…

I was informed by askMBS that two item 13706 services are generally paid in one day. Is that correct?

7 July 25

Is the following correct? For item 13706, I was informed by askMBS that two items are generally paid in one day, as long as they are clearly indicated to be separate transfusion episodes -…

Can you claim MBS items that have an “(H)” at the end of the description and no 85% rebate as outpatient services?

14 April 25

I work in a public hospital and suddenly all of my outpatient procedures that I bulk bill are being rejected. They have been paid without issue for years. What’s going on?

…

Is the name of the patient’s GP required on an in-hospital referral?

24 March 25

On an internal referral written by a Specialist/ Physician does the patients GP details have to be written as per the Health Insurance Regs Section 99. As it is an internal referral the patien…

How do I correctly administer a known-gap claim without breaking the law that applies to illegal split bills?

8 December 24

I’m working as a surgical assistant. I sometimes charge the patient a gap. My registration with each fund is ‘known gap’. As an example – Bupa pays $386 for assisting a 49518. I want to …

Can an inpatient of a private psychiatric hospital attend bulk billed outpatient appointments whether by telehealth or face-to-face?

28 October 24

This question came from a consumer.
I am an inpatient in a private mental health unit in a private hospital. I am under an inpatient psychiatrist. While I am an inpatient, I have a telehealth…

Can GPs bill home visit item numbers for voluntary assisted dying patients admitted to a private hospital?

1 October 24

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 …

Can an intensivist use a separate provider number for medical imaging services and their main provider number for usual ICU services to avoid rejected claims that should be paid?

30 September 24

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 E…

Should I bill an initial consultation or a follow-up the first time I see a patient in day rehab whose admission was under one of my rehab colleagues?

30 September 24

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 …

Should I bill an inpatient case conference or a community case conference when I organise and coordinate a case conference on a day when the patient is not admitted?

30 September 24

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 c…

Do I need a specific referral to admit the patient privately for every episode requiring admission?

27 September 24

No additional context was provided.

…

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 …

Can vocationally registered GPs claim any non-urgent after-hours attendances for admitted private patients?

26 September 24

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 res…

Are there any legal restrictions to claiming more than one blood transfusion on the same day for the same patient?

26 September 24

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 tr…

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 …

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 …

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Topics

Specialities

Private Hospital Billing

Can item 599 be billed for admitted patients?

I was informed by askMBS that two item 13706 services are generally paid in one day. Is that correct?

Can you claim MBS items that have an “(H)” at the end of the description and no 85% rebate as outpatient services?

Is the name of the patient’s GP required on an in-hospital referral?

How do I correctly administer a known-gap claim without breaking the law that applies to illegal split bills?

Can an inpatient of a private psychiatric hospital attend bulk billed outpatient appointments whether by telehealth or face-to-face?

Can GPs bill home visit item numbers for voluntary assisted dying patients admitted to a private hospital?

Can an intensivist use a separate provider number for medical imaging services and their main provider number for usual ICU services to avoid rejected claims that should be paid?

Should I bill an initial consultation or a follow-up the first time I see a patient in day rehab whose admission was under one of my rehab colleagues?

Should I bill an inpatient case conference or a community case conference when I organise and coordinate a case conference on a day when the patient is not admitted?

Do I need a specific referral to admit the patient privately for every episode requiring admission?

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?

Can vocationally registered GPs claim any non-urgent after-hours attendances for admitted private patients?

Are there any legal restrictions to claiming more than one blood transfusion on the same day for the same patient?

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

Topics

Specialities

Private Hospital Billing

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