Dear Doctors and all Health Care Workers
A new week of COVID MBS billing questions answered. We hope you are all managing OK out there on the frontline.
In addition to questions from specialists, we are now receiving questions from GPs, Nurse Practitioners and Allied Health practitioners which is most welcome. So please share this daily bulletin with your colleagues and keep the questions coming. We want to help.
Below are the responses to questions over the weekend up to 4.00pm today. Great questions, some of which are relevant to all practitioners.
1. I conduct a consultation via telehealth. The patient does not know if they are COVID-19 positive or not.
a) They have some symptoms and are seeking medical advice. As the GP, I apply the triage protocol criteria. If I find that they meet the national triage protocol criteria for suspected COVID-19 infection, can I bulk bill them?
Yes, you can. This meets the provisions of Criteria D) for vulnerable patients and you can bulk bill the relevant COVID MBS item. See Bulletin 1.
b) If I find that they do not meet the criteria, can I bulk bill them if they have, say, come back from Italy in the past 48 hours but are asymptomatic?
The key thing to remember here is that the overarching principles of Medicare billing remain in force. So only clinically relevant services attract Medicare benefits.
A clinically relevant service is one that a body of your peers would deem necessary for the treatment of the patient.
So, the question to ask yourself is this: Would a body of my peers think it was necessary to provide a service to this patient who has no symptoms?
This one is very much an exercise of your clinical discretion, though charging a private fee would seem to be worth considering. See point 4 below.
2. I am a GP and wondering if I can bill 2715, 2717 mental health care plan numbers via telehealth if my patient needs an updated referral to their psychologist? Or will they have to book in to see someone else in person to get this done?
Unfortunately, items 2715 and 2717 require physical attendance, so you can’t bill them using telehealth.
BUT, SEE THE NEWS FLASH AT THE END OF THIS BULLETIN. THIS MAY HAVE CHANGED BY TONIGHT.
3. Can I use phone or telehealth for inpatients? So, if I review an inpatient eg for diabetes management, is it possible to do remotely via phone or video using the new item numbers?
No. All of the COVID Determinations include the following text which specifically prohibits the use of COVID items for inpatients:
“the patient is not an admitted patient” and the definition of an admitted patient is:
admitted patient means a patient who is receiving a service that is provided:
(a) as part of an episode of hospital treatment; or
(b) as part of an episode of hospital substitute treatment in respect of which the person to whom the treatment is provided chooses to receive a benefit from a private health insurer.
Note: hospital treatment and hospital-substitute treatment have the same meaning as defined in the Health Insurance Act 1973.
4. I am working from home to avoid risk, unnecessary travel and foot traffic at the day facility. I do not wish to come in to see just one new patient (that does not fit COVID criteria). It would probably be an item 132 due to complexity and time. So, if it is a non-COVID issue but urgent, eg thrombosis or bleeding, that can be managed with a tele consult and review of results, how can I bill for this? Are there any non-COVID options?
Because of the Government’s unprecedented attempt to force bulk billing, the answer to the “non-COVID options” part of this question requires an answer to a bigger question which is this:
What are the legalities around billing a private fee without an MBS item number?
Here’s the answer in a nutshell with a bit of legal context.
High Court comments, Wong v Commonwealth 2009
His Honour Justice Michael Kirby, obiter comments (my underlining) said:
“Whilst fully disqualified, a medical practitioner would not be prevented from rendering medical services for which no Medicare benefit was payable – such as statutory services to veterans, services to workers’ compensation patients, overseas visitors, patients in public hospitals, in the defence services, cosmetic surgery, health screening and so on. As well, the medical practitioner could carry on non-fee services, such as in medical journalism and administration as well as services for those patients who are “prepared to pay the practitioner’s fee without claiming on Medicare”. But the agreed facts accepted the unsurprising conclusion that “to provide services solely on this basis would rarely be economically practicable”.
Whilst the High Court comments related to a disqualified practitioner, they apply to all practitioners. The underlying reasoning being no practitioner in their right mind would voluntarily choose not to enable their patients to access Medicare benefits, because patients would just go elsewhere to find another practitioner who did. So, following on from this and Bulletin 1 re the COVID bulk bill issue, there is no legal barrier to billing a private fee without an MBS item number. Here’s our best advice as to your options:
- Use a relevant COVID item number if all criteria are met, and bulk bill.
- Charge a private fee for an applicable COVID service and submit the claim with the COVID item number to Medicare for the patient, just as you always would, and see what happens. Even though the item descriptions include a bulk billing requirement see Bulletin 1 regarding the legalities around this. No offences or penalties have been included in the relevant Determinations, and we don’t know if the Government will deny the patient their Medicare rebate, though it seems likely.
- A “non-COVID option” is to charge a private fee for your ‘tele consult’ service (such as your usual fee for item 132) but do not put an MBS item number on the invoice. If you are planning to proceed in this way, best practice is to ensure you inform your patient before you provide the service. The patient needs to know there will be no Medicare rebate and your invoice will not have an item number on it.
Important: I cannot stress enough how important it is not to put an item number, such as 132, on the invoice. The patient will probably submit it to Medicare despite your advice, and you have not fulfilled the criteria for item 132 if you did not see the patient face to face for 45 minutes. This is a serious offence. Just itemise your invoice with words like “Non-Medicare telehealth review”
Ultimately it is your call how you choose to manage your billing during this period and the bulk bill issue has certainly confused matters because it doesn’t fit within Medicare’s existing legal framework. But then, these are extraordinary times. Just stay compliant and the best way to do that is to be transparent. The Government needs to know how practitioners are responding to the new COVID services so they can adapt. But, do not be tempted to record illegal off books transactions when bulk billing.
5. I made claims under the original COVID items when first released and then the Government changed some of the criteria without telling us, and now I am worried I have claimed incorrectly. What should I do?
Do nothing. Just do your best to apply and interpret the Determinations correctly (I know that is hard) and remember that any claim is subject to the law in place on the date of service. Keep in mind also that this is a very volatile situation, and a genuine billing error when the law is changing literally every day, is unlikely to get you into trouble.
6. NEWS FLASH!
The Federal Health Minister has just made an announcement of the expansion of telehealth services which you can read here.
Here is the key quote from the press release:
“From today, the Government will enable all vulnerable general practitioners and other vulnerable health professionals who are currently authorised to use telehealth item numbers, to use telehealth for all consultations with all their patients.
This includes health care providers who are:
- aged at least 70 years old
- Indigenous and aged at least 50 years old
- a parent of a child under 12 months
- immune compromised.
- have a chronic medical condition that results in increased risk from coronavirus infection.
This change will help protect the most vulnerable members of our health care workforce, while allowing them to continue to provide much needed medical care and advice to their patients.”
It appears ‘usual’ telehealth services may be included in this latest initiative. Can’t see this enacted into law yet but we are on it and will provide details as soon as they are to hand.
Margaret and the Synapse team.