The Australian Institute of Medical Administration and Compliance
I am a breast physician working at a specialised breast clinic but am unable to claim the A4 attendance items that physicians claim – 110, 116, 132 and 133 and the telehealth equivalents. I have tried to claim these items for legitimate services I have provided but the claim always get rejected. Why?
read more >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 – marked Not Duplicate Service and with relevant service text. The example would be a patient who comes into hospital anemic, receives a unit of blood in the morning, then has an upper GI bleed and requires further transfusions in the afternoon. Or someone who is pancytopenic and receives a blood transfusion in the morning, then requires platelets in the afternoon for an emergency procedure. As far as I can tell from the MBS description, the definition should not limit this item to once per day, which is usually clearly indicated in other cases. Medicare used to pay up to 3 or 4 items of 13706 per day but recently they have been rejecting anything beyond 2 items.
read more >Can a request for diagnostic imaging in a public hospital be Medicare billed if: 1) appropriate GP referral to a named obstetrician has occurred 2) the patient has elected to be a no fee private patient for attendance in the antenatal clinic 3) request for ultrasound imaging is filled out by a registrar “on behalf of” a specialist with ROPP named on the request while attending the antenatal clinic 4) patient consents to be bulk billed for the scan Also, the NSW guideline states a request for imaging does not require a signature to be valid. Is that correct?
read more >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 that while they may be able to register, they are not eligible to be paid at the gap cover rate—only at the MBS rate. Could you please confirm the correct interpretation?
read more >I work in the private sector supporting a service run by GPs managing vein conditions. If they do the doppler ultrasounds (items 55244 and 55246) can I bill them under my provider number? I’ve heard this is permitted as long as I supervise them. The person who does the scan is another medical practitioner not a sonographer or radiographer.
read more >When I bill an attendance item with a procedure like say, a skin excision, why is the consult paid but the procedure is rejected? It happens a lot, with similar item combinations. I do both things so why aren’t they both paid?
read more >If an item specifies the place (eg: “at consulting rooms”) can we bill it if we provide the service not at consulting rooms? What is the definition of a consulting room? If we provide the service adjacent to our usual consulting room is that OK? What about at an outside location?
read more >Patients requiring radiation oncology therapy may require daily treatment over several weeks. Are they required to consent to assign their benefit for every radiation oncology appointment?
read more >I am a fee for service VMO haematologist at a public hospital in Sydney. My head of department has indicated that we are not permitted to bill for inpatient blood product transfusions (eg: item 13703) for inpatients admitted to the hospital under our care (public or private). Apparently this directive has come from the hospital finance department. Is this correct? As haematologists, many of our inpatients require blood product transfusions during their stay. I understand that we can only claim for a single transfusion item on a given day (as we would for a single chemo item 13950), but please could you clarify why we are not permitted to bill for transfusions at all when they are part of a treatment required for inpatient care?
read more >I’m an RN and a DVA community nurse. Should I bill all services under my provider number each month, even for my sub-contractors?
read more >If a patient identifies a service on their Medicare records and is emphatic that they did not receive that service, do they have any legal right to make me remove it from their records?
read more >In relation to charging separate fees to patients before their surgery, I’ve heard that inpatient and outpatient claiming is completely separate (except under the aftercare rules) so we can charge whatever we want – like booking/admin/facility fees etc. I’m not sure that is correct. Can you please shed some light on this?
read more >If a patient in hospital has a dialysis session (13100) and then becomes unwell, requiring ICU admission with continuous renal replacement therapy (13885 or 13888) on the same day, can item 13100 be co-claimed on the same day as 13885 or 13888 by the same provider? Can it be claimed by different providers – i.e. 13100 by the nephrologist and 13885 by the intensivist?
read more >As an ophthalmologist, if I have planned a surgical procedure for my patient, but on the day of the procedure, while speaking with the patient pre-operatively, it become apparent that they will also need something additional done to that eye, does this qualify to bill item 111 because it was an unexpected procedure?
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