MBS ANSWERS

The “clinically relevant service” test applies to all MBS services. Does the same standard apply to DVA services?

Context

What is the threshold standard for a DVA claim - “clinically relevant”, “clinically necessary” or something else? Medicare benefits are only payable for a “clinically relevant” service, which has a specific statutory definition. What is the equivalent threshold for services billed to DVA? Is a DVA-funded service required to satisfy the Medicare “clinically relevant” test, or does DVA apply a different “clinically necessary” test? If the standards differ, what is the DVA standards and what is the practical difference between them?

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Health Insurance Act – Cases and Commentary by Bruce Topperwien

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