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How do I correctly administer a known-gap claim without breaking the law that applies to illegal split bills?

8 December 24

I’m working as a surgical assistant. I sometimes charge the patient a gap. My registration with each fund is ‘known gap’. As an example – Bupa pays $386 for assisting a 49518. I want to charge the patient $100 gap. Do I need to charge the fund $486? and then charge the patient $100 or do I charge the fund $386 (under their known gap scheme flag) and separately bill the patient $100. I’m confused about split billing – what is allowed and what isn’t allowed and where we can charge the fund only their known gap scheme amount and where we have to charge the fund the entire amount or whether this is actually what’s always needed?

Can a specialist use the same referral in different locations?

8 December 24

If you work in multiple outpatient locations, and first see the patient in Location A for an initial consult and bill a 110, can you provide a follow up consult from Location B (which has a different provider number) and bill a 116 under the same Medicare referral? Or do you need a separate referral to bill from a different location/provider number?

Can a psychologist who is overseas conduct an online interview with an Australian consumer in Australia for the purposes of preparing a legal report?

2 December 24

I am an Australian Citizen and psychologist. At times clinics have asked me to write court reports on Australian residents for Legal Aid while I am out of the country. So I interview the client online and prepare the report. Can I legally do this?

If a pathology company fits a BP monitoring device but a GP does the treatment plan, who can claim the item 11607?

2 December 24

I am a GP. I have come across an issue with item number 11607. Our pathology company is billing 11607. They fit the patient with an ambulatory bp monitor and send a report to me from a cardiologist stating if the patient has hypertension and a brief recommendation. They do not provide a comprehensive treatment plan, provide any follow up, nor do they actually see the patient. Can the pathology company actually bill this item, or could the GP, as they use pathology to obtain the data and actually sit with the patient and makes recommendations re: medications, lifestyle, follow up and provides a written plan to the patient? Or is it neither can bill this item?

Can a psychologist continue billing to Medicare under a Mental Healthcare Plan if the patient is admitted to hospital and becomes an inpatient?

24 November 24

If I have been providing services to a client under Medicare through a Mental Healthcare Plan (MHCP) and they have been admitted to hospital as an inpatient. Is the client able to continue with their therapeutic intervention sessions via video link from the hospital and claim this under their MHCP?

If patients book a video consult and pay prior to my consultation can they get a Medicare rebate or do they have to pay on the same day as the consult?

24 November 24

If my patients book a video telehealth with me online and pay prior to my consultation (given that they have a GP referral in advance) can they get a medicare rebate? Or does the payment need to occur on the same day as the consult for me to charge a 91824 (video consult) or a 91825 (for follow up). My plan is to give my patients an invoice once they pay and they would claim from Medicare. For example, if a patient books and pays for a video consult on Sunday (for a Monday session) but does the actual consult on Monday, can they claim for the consult that occurred on Monday even if the payment was on Sunday? Or do I need to tell them to pay me during or after my actual video consultation. This is very important for me since I would rather take the payment in advance before they actually do the video consultation rather than request payment during my consultation.

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How do I correctly administer a known-gap claim without breaking the law that applies to illegal split bills?

Can a specialist use the same referral in different locations?

Can a psychologist who is overseas conduct an online interview with an Australian consumer in Australia for the purposes of preparing a legal report?

If a pathology company fits a BP monitoring device but a GP does the treatment plan, who can claim the item 11607?

Can a psychologist continue billing to Medicare under a Mental Healthcare Plan if the patient is admitted to hospital and becomes an inpatient?

If patients book a video consult and pay prior to my consultation can they get a Medicare rebate or do they have to pay on the same day as the consult?

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