Context
Billing to Medicare for non-admitted patients in public hospital emergency departments is strictly prohibited, even if patients have private health insurance and are happy to use it. This is provided for in various provisions of both the Health Insurance Act 1973 and its intersection with the National Health Reform Agreement. However, in this scenario, Dr A was a haematologist who worked at a private hospital with an approved private emergency department (ED). Dr A wanted to know whether non-admitted patients in the ED could be billed to Medicare and whether the patient would be entitled to a Medicare rebate. Further, Dr A wanted to know at what point a patient is considered an inpatient after a decision to admit has been made, so that the patient’s private health insurer (PHI) could be billed. Was it: 1. When the patient is physically out of the ED and on the ward, or 2. When a decision has been made to admit the patient, but the patient is still in the ED, or 3. When the patient’s admission status has been changed in the hospital administration system indicating the patient is an inpatient.
