The Australian Institute of Medical Administration and Compliance
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 >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?
read more >There are telehealth wellness and “optimisation” clinics sending patients for Medicare funded tests to a 3rd party telehealth company that has agreed to provide Medicare funded testing automatically. The wellness company does this because they know the patients don’t qualify for Medicare funded pathology under their own clinic. Their attitude seems to be – ‘it’s them, not us, we are clean’. The 3rd party would need to have their own clear clinical reasons for ordering and that would be on them if not complaint. But how would it reflect on the original company knowingly engaging in this?
read more >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 their ‘public’ status infect (for want of a better term) downstream requests and reports: e.g. Pathology in a public or private pathology system — YES: public e.g. Imaging in a public or private imaging service – YES: public e.g. PBS Scripts for outpatient treatment – NO: remains eligible for PBS if meet criterial However what about for other Procedures – Steroid injection by a Rheumatologist in outpatient public or private clinic (referred by name from Public clinic) – Flex-sig by a Gastroenterologist in a outpatient public or private clinic (referred by name form Public clinic) – Chemotherapy infusion by same Public oncologist self-referred to Public or Private chemotherapy infusion centre
read more >There are telehealth companies using the sexual and reproductive health exemption to offer MBS funded pathology tests but some of them don’t do a consult beforehand. They basically just sell a pathology request form. Is this legal?
read more >An ICU specialist asked whether he could bill items 104 and 105 when reviewing the patient after they have been discharged from the intensive care unit.
read more >I asked the below questions to AskMBS, and the answer I received leaves me with more questions. Can you explain any further? If an AMDS practitioner claiming standard TH, 91800 item number – how would they know if the patient has had a face to face visit to their regular doctor in the last 12 months?
read more >I’m an obstetrician/gyanaecologist and want to know if I have to personally do all elements of item 16590? And does it all have to happen on one day – at one appointment?
read more >If I call and speak with the patient prior to their surgery I claim that as a pre-anaesthetic consultation (telehealth item 92701). Then, when I see the patient on the day I claim either 17610 or 17615 when I greet the patient and insert a cannula. I wanted to check this is compliant.
read more >When patients are seen by our GP and they have a care plan in place, is it OK for the practice nurse to see the patient immediately after they are finished with the GP and then claim item 10997?
read more >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?
read more >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)?
read more >I’m a geriatrician and am sometimes called to ICU to review ventilated and sedated patients. I can’t talk to the patient obviously but I review their records and do a physical examination and speak with the treating team. These patients are often complex and take a long time. Can I claim item 132?
read more >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)?
read more >I understand that nurse practitioners (NP) cannot bill outpatients seen in public hospital outpatient clinics but what about private hospital outpatient clinics?
read more >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.
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