Public Hospital billing

If Doctor A writes a named referral to Doctor B from Doctor A’s private rooms to a public hospital outpatient clinic and through the triage process Doctor A is assigned the patient to treat in the public hospital outpatient clinic can MBS be claimed?

3 March 25

If Doctor A writes a named referral to Doctor B from Doctor A’s private rooms to a public hospital outpatient clinic and through the triage process Doctor A is assigned the patient to treat in…

Can professional attendances rendered by a registrar be billed by a supervising specialist who does not physically attend the patient?

24 February 25

Can Category 1 Professional Attendance items (e.g., 104, 105, 110, 116) serviced by a registrar, be billed ‘on behalf of’ a specialist or consultant physician if the supervising provider i…

Can hospital administrators type change a patient from a valid private election back to being public without the patient’s consent?

3 February 25

What happens to billing of a private patient in a public hospital who undergoes solid organ (other than kidney) transplantation? There is no MBS item billable for this so it can’t be billed to…

If a referral is addressed to “Dr ABC or Dr XYZ” can both doctors use it when exercising a ROPP?

17 November 24

This question relates to medical specialists exercising rights of private practice in public hospital outpatient departments. The questioner wanted to know if both Dr ABC and XYZ can use the r…

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.

…

Why are outpatient item numbers that attract 85% of the Medicare Schedule Fee not listed by the private health insurers?

3 October 24

The question was posed in the context of public hospital outpatient services where clinicians can bulk bill when exercising a Right of Private Practice providing all other criteria are met. Th…

Can a nurse practitioner bill Medicare for public outpatients when the nurse practitioner is simultaneously being paid by a hospital that does not have a section 19(2) exemption?

30 September 24

I’m a Nurse Practitioner working in a small rural centre. I am a public employee 4 days a week and work privately on one day in the co-located primary health clinic/urgent care centre, which 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 sessional Visiting Medical Officers have the same Rights of Private Practice as Salaried Medical Officers?

30 September 24

Is there the same concept of Rights to Private Practice for Sessional VMOs? We have not been able to locate any specific information on this combination. Essentially are we allowed to bill MBS…

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

27 September 24

No additional context was provided.

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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 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 …

If a public inpatient is discharged and then referred back to the hospital outpatient clinic by the GP (so, no previous Medicare billing), can I bill item 132 if I spend more than an hour with the patient?

28 January 21

A hospital billing manager asked: If we have a public inpatient that is discharged from the brain injury unit to the outpatient clinic for follow up (at this point no previous Medicare billing…

What constitutes a referral from the Emergency Department to an inpatient medical unit?

20 January 21

This is a common question. Who should the referrer be in these circumstances?
…

Can I bill a private patient in a private hospital who was transferred from a public hospital, and who should the referral be from?

20 January 21

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.

…

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…

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Topics

Specialities

Public Hospital billing

If Doctor A writes a named referral to Doctor B from Doctor A’s private rooms to a public hospital outpatient clinic and through the triage process Doctor A is assigned the patient to treat in the public hospital outpatient clinic can MBS be claimed?

Can professional attendances rendered by a registrar be billed by a supervising specialist who does not physically attend the patient?

Can hospital administrators type change a patient from a valid private election back to being public without the patient’s consent?

If a referral is addressed to “Dr ABC or Dr XYZ” can both doctors use it when exercising a ROPP?

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

Why are outpatient item numbers that attract 85% of the Medicare Schedule Fee not listed by the private health insurers?

Can a nurse practitioner bill Medicare for public outpatients when the nurse practitioner is simultaneously being paid by a hospital that does not have a section 19(2) exemption?

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 sessional Visiting Medical Officers have the same Rights of Private Practice as Salaried Medical Officers?

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

If a public inpatient is discharged and then referred back to the hospital outpatient clinic by the GP (so, no previous Medicare billing), can I bill item 132 if I spend more than an hour with the patient?

What constitutes a referral from the Emergency Department to an inpatient medical unit?

Can I bill a private patient in a private hospital who was transferred from a public hospital, and who should the referral be from?

How do in-hospital referrals work?

Topics

Specialities

Public Hospital billing

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