MBS ANSWERS

Public Hospital billing

Can staff specialists at NSW public hospitals register for gap cover schemes? If yes, are their claims paid at the gap cover rate or the MBS rate?

29 June 25

Would you kindly be able to confirm whether a Staff Specialist of a NSW Public hospital is eligible to register for participation in the Medical Gap Cover Scheme? I was under the impression th…

I am a VMO haematologist at a public hospital. I have been told we cannot bill inpatients (neither public nor private) for blood product transfusions. Is this correct?

9 June 25

I am a fee for service VMO haematologist at a public hospital. My head of department has indicated that we are not permitted to bill for inpatient blood product transfusions (eg: item 13703) f…

If a patient cannot ‘elect’ to be a private outpatient due to not having a named referral, how does that impact downstream services such as pathology, radiology, chemo etc?

12 May 25

Patients under ROPP in a Clinic must ‘elect’ for the duration of their referral according to our LHN guidelines. If they cannot ‘elect’ because of an absence of a named referral, we understand…

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…

Can nurse practitioners bulk bill public hospital outpatients if they do it under their own ABN?

10 March 25

I am a nurse practitioner (NP) and am locked in a debate with my public hospital employer/management about MBS billing of NP services provided to public hospital outpatients. Is this allowed?
…

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…

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MBS ANSWERS

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Public Hospital billing

Can staff specialists at NSW public hospitals register for gap cover schemes? If yes, are their claims paid at the gap cover rate or the MBS rate?

I am a VMO haematologist at a public hospital. I have been told we cannot bill inpatients (neither public nor private) for blood product transfusions. Is this correct?

If a patient cannot ‘elect’ to be a private outpatient due to not having a named referral, how does that impact downstream services such as pathology, radiology, chemo etc?

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?

Can nurse practitioners bulk bill public hospital outpatients if they do it under their own ABN?

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?

MBS ANSWERS

Quick links

Topics

Specialities

Public Hospital billing

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