Dear Doctors and Health Care Workers
We hope you have all be keeping well, and to our colleagues in Victoria, please know that we are thinking of you.
This, our 50th Covid bulletin, heralds huge changes affecting GPs from Monday, and the relevant Determination hit the register this afternoon. Here’s the link and below is the drum:
WHO CAN CLAIM?
From next Monday, 20th July 2020, GP telehealth services will be restricted to the ‘patient’s usual medical practitioner’ with some exceptions.
The first point of confusion will be use of the term medical practitioner instead of GP. However, the restricted services are GP item numbers only and specialists are named exclusions (see below), so this change does not apply to specialists.
The definition of the ‘patient’s usual medical practitioner’ is as follows:
“patient’s usual medical practitioner means a medical practitioner (other than a specialist or consultant physician) who:
(a) has provided at least one service to the patient in the past 12 months; or
(b) is located at a medical practice at which at least one service to the patient was provided, or arranged by, in the past 12 months; or
(c) is a participant in the Approved Medical Deputising Service (AMDS) program if:
(i) the AMDS provider has a formal agreement in place with a medical practice to provide services to its patients; and
(ii) the medical practice has provided, or arranged, at least one service to the patient in the past 12 months.
For the purpose of this subsection, service means a personal attendance on the patient and excludes telehealth and phone attendances.”
Key points:
- To be eligible, there has to have been a face to face (F2F) service provided to the patient in the last 12 months
- The GP or one of the other GPs in the same practice must have provided that F2F service to the patient in the last 12 months
- Approved after hours deputising services with formal contracts with GP practices can continue to claim as long as they have provided or arranged a F2F service with the patient in the last 12 months
WHICH PATIENTS ARE EXCLUDED?
Patients who are currently excluded from the 12 month F2F requirement are:
“(a) a person who is under the age of 12 months; or
(b) a person who is experiencing homelessness; or
(c) a person who is in a COVID-19 impacted area; or
(d) a person who receives the service from a medical practitioner located at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service”
This will of course mean that patients living in postcodes in Victoria that are currently under the 6-week lock down can continue to access any GP and those GPs can continue to claim the Covid telehealth items.
Here are the relevant definitions of ‘experiencing homelessness’ and ‘Covid impacted’:
person who is experiencing homelessness means when a person does not have suitable accommodation alternatives they are considered homeless if their current living arrangement:
(a) is in a dwelling that is inadequate; or
(b) has no tenure, or if their initial tenure is short and not extendable; or
(c) does not allow them to have control of, and access to space for social relations.
person who is in a COVID-19 impacted area means a patient who, at the time of accessing the telehealth service, has their movement restricted within the State or Territory, by a State or Territory public health requirement applying to the patient’s location.
AN IMPORTANT EXCLUSION RELATING TO URGENT AFTER-HOURS SERVICES
The items in subgroup 29 and 30 do not have to be provided by the patient’s usual medical practitioner. These items are the urgent after hours attendances, including items 92210, 92211, 92216 and 92217.
A WORD OF WARNING: Please be very careful claiming the urgent after hours services as they have been the subject of numerous PSR investigations. Determining urgency is going to be very challenging in this period when the telehealth items are available, but you cannot physically examine the patient over the phone. The wording of the items uses the phrase ‘requires urgent assessment’ which was changed after the Nithianantha decision from ‘requires urgent treatment’ and the PSR has adopted the position that you can only determine urgency once you examine the patient not on an initial phone call which, prior to Covid, was not claimable – but now it is! Not easy, but the safest option is that if you respond to an urgent phone call that turns out was not urgent, don’t claim these items. The only option would be to charge the patient a private fee and not bill through Medicare.
That’s probably enough to introduce the changes but if you have questions, send them through. We are here and ready to support you.
Thanks everyone.
Margaret and the Synapse team.
COVID MBS items explainer and FAQs No. 51, 20 July 2020…Read more