COVID MBS items explainer and FAQs No. 1, 16 March 2020

Dear Doctors,

We have been inundated with requests for assistance understanding the new COVID MBS items which we agree are unclear and confusing. Below are answers to the most common questions we have received since Friday. If you have more questions, please send them through and we will endeavour to provide a daily update. Most of the information we provide is for specialists, although the bulk billing information applies to everyone.

Questions

1. I don’t normally bulk bill in my rooms but the new COVID services say I have to. Can the government force me to bulk bill?

This unprecedented move by the Government has raised legitimate concerns, because most doctors know that bulk billing is always optional.

Many doctors would already know and understand the constitutional validity argument arising from this situation, that the Government cannot control their fees and force them to bulk bill. However, this argument is unlikely to see the light of day because the COVID services won’t be around for long, and the exceptional circumstances may muddy any High Court challenge. So, let it go.

We are in the realm of delegated or subordinate legislation here, which is an important and busy part of our legal system, where the Minister delegates authority to someone else to enact things like the COVID Determinations. But subordinate legislation is enacted under a Principle Act. In this case, the Principle Act is the Health Insurance Act 1973 (HIA) and section 20(A) of the HIA makes bulk billing voluntary, supported by a substantial body of case law, including from the High Court.

In the legislative hierarchy, there is a general principle that, to the extent of any inconsistency between subordinate legislation (like the COVID Determinations) and the Principle Act (The HIA), the Principle Act will prevail. There is an abundance of case law on this topic where courts have deemed subordinate legislation invalid.

So, in the present situation, there is a clear and troubling inconsistency between the COVID Determinations and the HIA, and therefore, the requirement to bulk bill may well be deemed invalid if it came before a court. All of this is extremely unfortunate and unhelpful in these difficult times. The last thing you need is to be worried about whether you are billing correctly.

Right now, we don’t know what happens for example, if a doctor decides not to bulk bill a COVID service. We do not know if there is a penalty or even the nature of any offence. So, the best advice we can give is, as always, to bill compliantly based on first principles. In an outpatient setting this means you either bulk bill OR charge the patient a full fee and they claim back their rebate. We do not yet know, and the government has given no clarity, on whether patients will be denied their rebate if a COVID service is not bulk billed. Do not be tempted to bulk bill and charge a separate fee recorded off books, you should all know that is a serious offence any time.

2. Should I continue billing with my usual codes and just add the COVID codes for telehealth?

If you are continuing to see patients face to face, then keep billing your usual codes as you always have. Nothing changes. But if you’d prefer to limit the number of face to face consults you are doing and amongst your patients, there are some who meet the vulnerable patient criteria, then you can use the new COVID codes and consult via telephone/video, even if the patient lives only 5 minutes from your practice.

Here are the vulnerable patient criteria:
Vulnerable/isolated patients are those where at least one of the following apply:

1. the person has been diagnosed with COVID-19 virus but who is not a patient of a hospital; or
2. the person has been required to isolate themselves in quarantine in accordance with home isolation guidance issued by Australian Health Protection Principal Committee (AHPPC); or
3. the person is considered more susceptible to the COVID-19 virus being a person who is:
   • at least 70 years old; or
   • at least 50 years old and is of Aboriginal or Torres Strait Islander descent; or
   • is pregnant; or
   • is a parent of a child under 12 months; or
   • is already under treatment for chronic health conditions or is immune compromised; or
4. the person meets the current national triage protocol criteria for suspected COVID-19 infection.

3. Why don’t I just use my usual telehealth codes like (99, 112, 149 etc) instead of the new COVID telehealth codes?

The main practical difference between the usual telehealth codes and the new COVID telehealth codes is the location of the patient. If you are conducting usual telehealth attendances with patients in telehealth eligible areas, then you should continue to use the usual telehealth codes. For example, claim a 116 with a 112 and so on.

Only use the COVID codes for patients who are not in a telehealth eligible area but need to ‘see’ you.

4. What are the equivalent COVID codes for items 132 and 133?

There aren’t any. Too risky for the Government. Only item 110 and 116 are included. See the table below.
 

5. What’s the difference between telehealth and telephone? Isn’t it the same?

One would have thought so, though for statistical purposes it does make sense for the Government to separate them. So, there are two sets of codes, one for video and another for telephone. The rates are the same for both.

6. I have arrived home from overseas this morning and have to self-isolate for 14 days. Can I keep practising?

Yes. The COVID codes can be used for both vulnerable patients, and health providers in isolation for possible COVID infection.

7. Which codes should I use for telehealth? i.e. Skype, Facetime, WhatsApp
Below are your common codes and their COVID counterparts to use if your patient meets the vulnerability criteria above and the consultation takes place via video.

8. Which codes should I use for telephone?

Below are your common codes and their COVID counterparts to use if your patient meets the vulnerability criteria above and the consultation takes place by phone.

9. What are the rates?

The Schedule fee for each service is the same as the Schedule fee for the equivalent usual service. EG: The Schedule fee for item 110 is the same as for item 91824 and 91834. The difference is the Government is trying to make you bulk bill if you use the COVID services. (See Bulk Billing at Point 1).

10. Does the single course of treatment rule apply?

Yes. You do not get to start with a fresh initial consultation just because you are switching from face to face, to video/telephone. If you have been reviewing your patient for the same condition and now switch to the COVID items your first claim should be for one of the follow up consults, not an initial.

11. I’m a dual qualified Rehabilitation Physician and Pain Specialist. I usually use the Rehab items when I am being a Rehab Physician (110 and 116 etc) and the pain items (2801 and 2806 etc) when I am in that role, because I understood that was the right thing to do. I can’t see equivalent COVID items for 2801 and 2806. What should I do? I have chronic pain patients who need to be seen because I am weaning them off opioids and they will become very unwell if I can’t continue to treat them.

This is unclear, sorry. Best advice is again to return to first principles. As a Rehabilitation Physician you are a fellow of the RACP and can therefore claim physician items 110 and 116 etc, so go ahead and claim their equivalent COVID items for your chronic pain patients if you are not seeing them face to face during this period. You should return to claiming the specific pain items when all of this is over.

12. Can I use the new COVID codes for my admitted patients as well as outpatients?

No. The COVID services apply to outpatients only.

13. Do the Private Health Fund gapcover schemes apply to the COVID services?

No, because the COVID services are for outpatients only and the Private Insurers are not permitted to cover outpatient medical services.

14. Do referral rules apply to COVID services?

Yes. To claim COVID services, the patient has to be referred to you by another specialist or a GP as usual.

15. How long will these codes be available?

Current information is they will be available for 6 months ago.
 

We hope that you have found this helpful. Please feel free to share with your colleagues and keep the questions coming.

Margaret & The Synapse Team.

MORE QUESTIONS ANSWERED

COVID MBS items explainer and FAQs No. 2, 17 March 2020… Read more