Rehabilitation Medicine

Do specialists need a valid referral to claim referred services for every private patient they bill?

30 September 24

I am a rehabilitation specialist working in a private hospital doing Day Rehab (patients are inpatients as they are admitted for the day). Usually, I see patients on the day they attend therapy (inpatient) however sometimes it is necessary to see them on another day (outpatient). I have access to their inpatient notes, but often there is not a formal referral (e.g., discharge summary states ‘For Day Rehab’). I have read a source that seems to suggest I don’t need a formal referral if I am billing them privately. However, I have read elsewhere that I need a valid referral for every patient (signed, dated, by a specialist or GP etc.). Which is correct?

Should I bill an initial consultation or a follow-up the first time I see a patient in day rehab whose admission was under one of my rehab colleagues?

30 September 24

I am working in a day rehabilitation setting at a private hospital (patients are admitted for the day for allied health interventions mostly after joint replacements and are inpatients when I see them). For patients who have come from an inpatient admission under another rehabilitation specialist, can I charge 110 when I first assess them, or would it be a 116?

Should I bill an inpatient case conference or a community case conference when I organise and coordinate a case conference on a day when the patient is not admitted?

30 September 24

My question is regarding clarification of billing case conferences for day rehab patients. These patients are ‘admitted’ as inpatients on the day they attend. However, I perform the case conference with the team on a day they are not coming in for day rehab. For example, a patient may attend day rehab on Monday and Friday, but I do their case conference on a Wednesday when all the team members are present. Billing options: 880: inpatient case conference 825: community outpatient case conference. Up until this point I have been billing an 880 regardless of whether the patient has been admitted that day or not, but should I be billing an 825 instead? I don’t have a preference either way, but I think the 880 sounds more reasonable to me. Hopefully that makes sense but clarification around this would be great.

Do I need a specific referral to admit the patient privately for every episode requiring admission?

27 September 24

No additional context was provided.

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 item 11714 (ECG) be co-claimed with item 17610 or 17615 (pre-anaesthetic consultations) prior to admission?

24 February 21

The question posed was: If an ECG is performed during a pre-admission consultation (MBS Item 17610 or 17615) and the criteria of item number 11714 is met, is it permissible to claim both?

If a public inpatient is discharged and then referred back to the hospital outpatient clinic by the GP (so, no previous Medicare billing), can I bill item 132 if I spend more than an hour with the patient?

28 January 21

A hospital billing manager asked: If we have a public inpatient that is discharged from the brain injury unit to the outpatient clinic for follow up (at this point no previous Medicare billing would have taken place as they were a public patient) and the GP writes a specific referral for the patient to see a specialist post inpatient discharge (different specialist from their inpatient stay). The patient is seen in the outpatient clinic for > 1 hr. Can we bill a 132, given that no previous billing has occurred? The factors here are that the patient is referred to a new service by a GP; no previous 132 has been raised.

Can rehabilitation physicians claim items 170-172 for family meetings?

28 January 21

Dr A was a rehabilitation physician who wanted to know if they could claim items 170, 171 and 172 for family meetings. Dr A understood that geriatricians and other physicians use these items in circumstances when the family meetings are not usual case conferences or MDT meetings with allied health practitioners.

Can I take over a named referral in a public hospital outpatient setting if I am of the same specialty?

22 January 21

Doctor A was a rehabilitation physician working in a public hospital day rehabilitation unit. Prior to patients commencing the day rehab program (where they are admitted inpatients on each day they attend), they have an initial outpatient visit to determine their eligibility for the program. The referrals from the GPs always name one of the rehabilitation specialists. Doctor A wanted to know whether Doctor B could see the patient for the initial outpatient assessment even though the referral was to Doctor A.

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.

Are inpatient and outpatient episodes considered as separate for billing purposes, so that when a patient is discharged a new episode of care automatically commences?

26 August 20

Question: If the same treating rehab physician sees a patient following discharge in their outpatient rooms, can this be billed as a 132 (obviously with a relevant referral), or is it a 133/116 depending on other factors? I’m just not clear if the inpatient and outpatient episodes are to be considered in isolation of each other.

When I am covering another physician’s inpatients and it’s the first time I see the patient, can I bill an initial consultation?

27 July 20

When one physician covers anothers’ inpatients who have already been admitted, but are new to the doctor covering for the weekend, Dr A wanted to know if it is acceptable to bill a 110? Dr A’s instincts were that all encounters should be billed as 116 since they are generally part of the same episode of care, (even if provided by a different physician) but she had received conflicting advice.

Can we bill to Medicare for public inpatients in public hospitals?

10 July 20

An administrator in a public hospital had been advised that they could start billing to Medicare for inpatient services including case conferences.

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Topics

Specialities

Rehabilitation Medicine

Do specialists need a valid referral to claim referred services for every private patient they bill?

Should I bill an initial consultation or a follow-up the first time I see a patient in day rehab whose admission was under one of my rehab colleagues?

Should I bill an inpatient case conference or a community case conference when I organise and coordinate a case conference on a day when the patient is not admitted?

Do I need a specific referral to admit the patient privately for every episode requiring admission?

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?

Can item 11714 (ECG) be co-claimed with item 17610 or 17615 (pre-anaesthetic consultations) prior to admission?

If a public inpatient is discharged and then referred back to the hospital outpatient clinic by the GP (so, no previous Medicare billing), can I bill item 132 if I spend more than an hour with the patient?

Can rehabilitation physicians claim items 170-172 for family meetings?

Can I take over a named referral in a public hospital outpatient setting if I am of the same specialty?

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

Are inpatient and outpatient episodes considered as separate for billing purposes, so that when a patient is discharged a new episode of care automatically commences?

When I am covering another physician’s inpatients and it’s the first time I see the patient, can I bill an initial consultation?

Can we bill to Medicare for public inpatients in public hospitals?

Topics

Specialities

Rehabilitation Medicine

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