Provider Numbers

Who is responsible for Medicare billings in private practice and is it different as between contractors and employees?

11 November 24

This question came from a psychologist but it applies to everyone who can bill to Medicare. No exceptions.

Can a provider number be linked to a PO Box?

4 October 24

This psychologist was considering setting up their practice as a sole-trader and wanted to know whether they could apply for a new provider number using a PO Box rather than their residential address, due to privacy concerns. The practitioner was planning to only provide services via telehealth.

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 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...

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 at practice B (provider number 2). Can Dr Z self-refer for the follow up visit?”

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?

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.