The Australian Institute of Medical Administration and Compliance
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 >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 >If 92210 is the telehealth equivalent of item 599, does this mean the doctor would also have to visit the patient, or open the consulting rooms? I am very confused by this. I asked AskMBS and their answer left me with more questions. Here is the answer I received. “Generally, MBS telehealth (video) and phone items have the same requirements as their face-to-face counterpart items. However, in relation to item 599 and 92210, the advice in explanatory note AN.0.19–i.e. ‘If the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to and specially open the consulting rooms for the attendance’ (and the advice in note AN.0.19 generally)–applies to face-to-face services only. Where the service is provided via telehealth, this requirement does not apply.”
read more >We have a Practice Nurse who does vaccinations and wound dressings etc. Does the doctor have to physically see the patient or can the nurse discuss the patient with the doctor, act on his/her behalf and then invoice the patient under the doctors name?
read more >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?
read more >This question asked whether items 160 to 164 could be billed in the context of voluntary assisted dying (VAD).
read more >This GP has completed training for voluntary assisted dying (VAD) and has been receiving some referrals from nurses who run the VAD navigator service. The GP has been asked if they would be willing to see these patients when they are admitted in a private hospital if the GP is credentialled.
read more >A GP practice wanted to know how to “manage” facility fees for bulk billing patients. The question said that the practice needed to charge this fee to cover the cost of consumables, but the doctors also wanted to bulk bill and be able to claim the full bulk bill incentives. The practice is in a regional area where the bulk bill incentives are highest.
read more >Can vocationally registered (VR) GPs claim any non-urgent after-hour attendance item numbers for admitted inpatients? For example, the “in-consultation room” items 5020/5040. Or are we restricted to items 4/24/37/etc?
read more >When a podiatrist has received a referral from a GP to be involved in a coordinated care plan, can their receptionist sign the acceptance of the referral?
read more >At our practice we do not hold the billing, and we charge item 723 on the same day as the GPMP (721). I have heard of other practices who withhold the 723 billing until signed faxes are exchanged with team care members so that it is all documented before charging.
read more >The question asked was: Is there any way to do outpatient billings where the patient pays the gap only on the day, and then the clinic submits a claim for the unpaid Medicare rebate? Currently the patient pays us the gap only as cash on the day, and we need to then bill Medicare for the unpaid rebate. Medicare sends a cheque for the rebate amount to the patient, and they then have to send it to our practice. It takes a lot of time chasing the cheques. Is there was a way to get the cheques addressed to us rather than the patient such as by changing the billing address recorded at Medicare maybe? Also, can we get the 90-day cheque reimbursement from Medicare directed to us so we can follow up on rejected claims?
read more >A general practitioner has asked whether they can claim item 41764 given they have appropriate surgical training to perform the procedure, which is a nasendoscopy/sinoscopy.
read more >Annual enrolment or membership fees have become a controversial feature of bulk billing GP practices in recent years. One example was the now defunct National Health Co-op in the ACT, which publicly charged a $100 per year membership fee and a $30 sign up fee in return for bulk billed services. It was even awarded State based grants to support this business model. However, there is debate around the legalities of these arrangements with the Federal Government expressing the view that such arrangements breach the bulk billing law.
read more >A group of haematologists in private practice, who operate across various locations under a single brand with a central point of contact, asked if they could agree to all charge the same fees. Behind the brand, they each operate their own private practices with separate legal entities, separate ABNs and so on. They also asked if anything changed if they all agreed to bulk bill everyone.
read more >A haematologist said that he and some colleagues were considering personally performing bone marrow aspirates and trephines (items 30084 and 30087) and explained that the MBS rebates for these procedures barely covered the cost of consumables, let alone the time taken, so they would have to charge gaps. However, he had heard that they could also claim an item 110 or 116 consultation item number at the same time as every aspirate procedure, because they review the patient’s appropriateness for the procedure, and obtain their consent.
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