MBS ANSWERS

Why are outpatient item numbers that attract 85% of the Medicare Schedule Fee not listed by the private health insurers?

Context

The question was posed in the context of public hospital outpatient services where clinicians can bulk bill when exercising a Right of Private Practice providing all other criteria are met. The questioner wanted to know how they easily determine which item numbers should be claimed at 75% and which 85% because the Private Health Insurance (Benefit Requirement) Rules do not seem to include some MBS item numbers that are relevant to outpatient services and normally claimed at 85% of the schedule fee, such as telehealth and face-to-face consults, and the associated bulk bill incentives.

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Health Insurance Act – Cases and Commentary by Bruce Topperwien

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