COVID MBS items explainer and FAQs No. 5, 20 March 2020

20/03/2020

Dear Doctors

Below are the responses to today’s questions, some great news from the Department and a weekly wrap up. Let’s start with some very welcome news from Medicare.

Questions

1.You no longer have to print and retain bulk bill forms AND will not be audited in relation to this during this period. Here is a verbatim copy of the email just in from the Department.

Services Australia has advised that the mandatory requirement to physically print forms for patients will be suspended until further notice due to the COVID-19 pandemic.

The following forms will be exempt from current mandatory printing requirements:

  • Bulk Bill Assignment Advice (DB4 form)
  • Department of Veterans Affairs (DVA) Printed Statements (D1216S)
  • In-patient Medical Claim (IMC) Patient Claim Consent and Declaration
  • Lodgement Advice
  • Patient Claim Interactive (PCI) Statement
  • Online Eligibility Check (OEC) Disclaimer
  • Statement of Claim and Benefit Payment
  • Pathology Combined Request form – Patient Claiming
  • Simplified Billing Assignment Claim form

 These forms should be signed, printed, stored or sent electronically where possible. There will be no audits conducted during this period.

So, retain electronic copies where possible, but otherwise you can relax at least about this one component of your bulk billing. For questions about this please email directly to otsliaison@servicesaustralia.gov.au. Thank you Medicare.

2.My nurse will be attending a patient tomorrow (>70 at risk but not symptomatic) and will call me to facilitate a telephone conference on the patient. I plan to bill the relevant COVID code for this consultation, but plan to separately charge for the nurse visit. So, this will be two separate transactions for two separate services. The COVID claim for my consultation will be bulk billed to Medicare. Her service does not attract a Medicare rebate, but the patient is happy to pay. Is this legal?

Not an easy answer to this question I’m afraid. The starting point is that bulk billing and charging a separate fee is illegal, no matter what the fee is called. The only exception is for some vaccinations not listed on the PBS that relate mostly to GPs. Further, it is not just a little bit illegal; it is potentially a very serious offence and depending on the circumstances, may be a crime. You may want to tune in to Pomegranate Health to hear about this in the episode called Billing in Byzantium,

All of the provisions of Section 20A of the Health Insurance Act 1973 remain in force in relation to the COVID codes. The basic bulk billing law has not changed, and you must accept the Medicare rebate ‘in full payment’ for your fee ‘in respect of’ the professional service you provide.

So, the question to ask yourself is this: is the nurses fee a fee ‘in respect of’ the bulk billed service? If the answer is yes, then you should not charge it.

Courts have interpreted ‘in respect of’ incredibly broadly, to include things like booking and administration fees and even counselling and theatre fees when patients had counselling before a planned procedure that some did not proceed with. It’s complex, and based on what you have said, I would not adopt this as a modus operandi.

If the nurse visits your patients separately, alone, and it has nothing to do with a service you later provide then that may be OK, but if the nurse is there essentially to facilitate your telehealth consult then in my opinion that would likely be characterised as a fee ‘in respect of’ the professional service you are planning to bulk bill and would be illegal.

3.Weekly wrap

So firstly, thank you all for engaging and we are glad we have been able to help. The feedback we have received has been overwhelmingly positive so thanks.

To summarise, the main areas of confusion this week were:

1.  How to get the patient signature on the bulk bill form – well now you don’t have to. Hooray 😊

2.  Confusing the usual telehealth items with the new COVID items and when to use which – they should be viewed as completely distinct from each other. You EITHER use usual telehealth services and only if your patients are in a telehealth eligible area and you meet all the usual criteria, OR you bill the COVID services and it will be a single item number, which the government wants you to bulk bill. BUT see Bulletin 1, Point 1 for the legalities around this.

3.  Assuming ALL consult items had an equivalent COVID item. They don’t. There are a restricted number of new COVID services that are all slated to expire on 30 September 2020. See Bulletins 1 and 2. They cover the lower paying base level services only. Too risky for the government to open up the high paying services at this stage, though this may change.

4.  Thinking you could just continue using your usual item numbers if you didn’t find a COVID equivalent. You cannot and must not do this. It is a very serious offence. For example, you cannot claim item 132 as a video consult for a patient in a non-telehealth eligible area, because it requires personal attendance. An exception may be WC and TP patients but speak with the payer first. See Bulletin 3.

5.   There was quite a lot of confusion from physicians who thought they could only avail the COVID items if they had seen the patient in the last 12 months, which was incorrect. The 12-month requirement only applies to GPs not physicians/specialists.

We will continue to update daily next week so please keep the questions coming. We will also provide alerts and bulletins when we receive relevant information from the Department such as the bulk bill announcement today. We have compiled these updates on our website at this link https://synapsemedical.com.au/news/category/covid-mbs-billing-faqs/ so please feel free to share it with your colleagues.

Stay safe everyone. Till next week.

Margaret and the Synapse team.

COVID MBS items explainer and FAQs No. 6, 23 March 2020… Read more

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