Oncology and Haematology

If a patient presents at a public hospital outpatient clinic with a named referral from their GP and needs admission but wants to go to a private hospital, is a new referral required?

27 September 24

If I see patients referred to me in the public clinic, and they are unwell and require admission to hospital at presentation to the clinic as patients with chronic disease sometimes are, do I need a separate referral from the referring GP or other senior doctor to admit them to the private hospital?

Can I bill to Medicare when a patient is in Australia but I am overseas?

8 January 21

Doctor A asked what happens when the treating doctor goes overseas for a week of conference leave while the patient is midway through a course of treatment such as chemotherapy or radiotherapy. The patient cannot stop or delay the treatment because it is required to be administered via incremental doses at set intervals. The doctor wanted to know if billing could continue from overseas under the supervision arrangements.

How do I bill for a 3 day course of chemotherapy delivered via a pump?

18 December 20

This very common scenario is billed by oncologists and haematologists when delivering chemotherapy via an infuser pump such as a folfox. The typical scenario is that the patient comes in on day 1 to have the pump connected and loaded, is home on day 2 and returns for the disconnect on day 3. Usually the entire course of treatment is billed under supervision arrangements with the medical practitioners not usually attending the patient at all. Oncology nurses typically administer the entire regime. Here are some examples of reported confusion around the correct billing of this course of treatment using item 13950. 1. Doctor A had received advice that Item 13950 can be billed on all 3 days even when the patient was at home on day 2. 2. Doctor B had received advice that she could bill item 13950 on day 3 when the pump was disconnected, but could not bill item 14221 on that day. 3. Doctor C was advised he could bill item 13950 everyday while his patients were admitted and receiving a continuous chemotherapy infusion, even if he did not attend the patient (that this could be supervised). This was also not only legally incorrect, but alarming.

In a public hospital outpatient clinic does a referral to “Dear Specialist” enable Medicare bulk billing?

21 September 20

Question: If a clinic receives a referral to “Dear specialist” can this be used by anyone in that practice? Or if it comes to a named specialist, can that validly be used by another provider in the same practice? These are privately referred non-inpatient in a public oncology setting that is bulk billed.

Do you get one item 132 and two item 133’s every 12 months?

31 August 20

Doctor A worked in a public hospital outpatient department where they exercised a right of private practice. They thought that they were not automatically permitted to bill item 132 every 12 months but had received contrary advice. Further, they were unclear about whether item 133 applies twice in the first year only or twice every year. They had been further advised that 133 can be billed twice during a 12 month period and therefore, for a patient of 20 calendar years that would mean they could bill item 133 40 times.

Can oncologists bill item 14206 and does it come under the supervision rules?

17 August 20

A practice manager for an oncology practice asked whether the oncologists can claim item 14206 even though it is in the assisted reproductive technology (ART) section of the MBS, because it accurately describes a service the oncologists provide, being “HORMONE OR LIVING TISSUE IMPLANTATION by cannula.”

Can a group of specialists operating under a single brand, but with their own separate practices, agree to charge the same fees?

1 August 20

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.

If a patient is having chemotherapy at a hospital and the doctor goes on holiday, can we still bill for treatment under that doctor’s provider number because they created and approved the treatment regime?

1 August 20

Question: Wanting to confirm that if a patient is on a chemotherapy regime at a hospital and the doctor goes on holiday, can we still bill the treatment under the doctor’s provider number, as they created and approved the treatment pathway? For example: A patient has chemotherapy scheduled on Thursday, their doctor goes on holiday on the Wednesday, so the covering doctor sees the patient and bills for a consultation. The patient’s usual doctor (who is on holiday) is still allowed to bill for the treatment code though, as they created the pathway. Is that correct?

If a specialist sees a non-admitted patient in an approved private emergency department, can they bill to Medicare and is the patient entitled to a rebate?

10 July 20

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.

Can I bill using my provider number when a locum is covering for me?

10 July 20

Doctor A was an oncologist who understood that when on leave with a locum covering, Doctor A could continue billing as usual, even though Doctor B was acting as a locum and was providing all services to Dr A’s patients. Doctor A would reimburse Dr B for the locum services under an agreement they had reached.

Can we co-claim a consultation every time we do a bone marrow biopsy?

3 July 20

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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