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6 April 25

I am a rehabilitation physician that works in a private hospital that is offering a hospital substitution program for post joint replacement rehabilitation. Under the plan the surgeon will determine if the person is suitable for post joint replacement rehabilitation in the home and then the insurer pays the hospital to provide physio and occupational therapy services in the home. I have been asked to participate and offer medical governance through telehealth and case conferences to manage analgesia, blood thinning medications and to offer guidance re safe discharge from the program. Can I charge a no gap fee to the insurers for telehealth item numbers (91824 or 116) or do I have to visit people in their home (128 or 116) and can I charge for case conferences (is it 880 or 820)?

30 March 25

I am a rehabilitation physician that works at a public hospital that offers rehab in the home and hospital in the home for patients, as part of early discharge or hospital substitution strategies. If a patient chooses to use their private health insurance while in a public hospital for the purposes of a joint replacement and is then discharged home for rehab in the home as part of the hospital the hospital substitution scheme – Can I charge the insurer a gap payment for my home visit to them and what item number should I charge a 116 (in hospital follow up) or a 128 (follow as part of a home visit)?

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 patient is already being treated in the same facility and would have already named their GP and have their GP recorded on their file.

17 March 25

If an on-call obstetrician attends a delivery on behalf of the primary obstetrician (perhaps because they are unavailable at that time), should the on-call obstetrician bill with Medicare and then pass this income on (less an agreed service/locum fee) to the primary obstetrician or should this be the other way round? Existing item numbers only seem to cover services that extend beyond the delivery (i.e. delivery plus at least 5 days of post natal care, etc). I am asking in the context of the on-call obstetrician only being involved in the delivery and not any of the pre-natal or post-natal care. I need to establish billing practices for this exact scenario.

17 March 25

Can you please weigh in on the following question? I sent this to askMBS and got something of an unhelpful answer. — Dear Medicare Support Team,I am writing to seek formal clarification regarding the applicability of Medicare Benefits Schedule (MBS) Items 110 (initial attendance by a consultant physician) and 116 (subsequent attendance by a consultant physician) when multiple attendances occur on the same day for what appears to be a single clinical problem. ContextAccording to MBS Note AN.0.7, payment may be made for multiple attendances on the same day provided the subsequent attendances are not a continuation of the initial or earlier attendances. The guidance includes examples such as an eye examination followed by instillation of mydriatics, with a later refraction considered part of the same attendance. However, the examples in AN.0.7 typically describe scenarios where no new assessment or additional clinical decision-making is required.I am seeking confirmation on whether a different interpretation might apply in cases where a clear, distinct clinical decision needs to be made at a later time—thus constituting, in essence, a separate attendance. Example ScenarioInitial Attendance (MBS Item 110)A paediatrician assesses a child presenting with moderate asthma at 10:00 a.m. The assessment involves taking a history, performing an examination, and deciding on an initial treatment plan (e.g., bronchodilators, supportive measures).Subsequent Attendance (Potential MBS Item 116)Several hours later (e.g., 2:00 p.m.), the child is reviewed again. This visit requires reassessment of...

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