Dear Doctors and all Health Care Workers
Lots of excellent questions today, many of which will be relevant to all practitioners because they deal (again) with the bulk bill issue, correct use of provider numbers and an update from the Department about signing bulk bill vouchers.
Please be careful believing stories about new COVID services being available, such as for physios, inpatient services and so on. All fake news I’m afraid. The law has not changed since the 23rd March.
And remember, as at right now, you cannot just keep billing your usual services via telehealth. Face to face is still a requirement for the majority of attendances.
Hopefully we will hear positive news tomorrow when Stage 4 is announced, see Bulletin no.7.
Here are answers to today’s questions.
1. We are NOT a bulk billing GP practice and actually do not have the technical capability to bulk bill. So, if it is mandatory that we do not apply a private gap fee on the COVID telehealth consults, are we allowed to charge the patient the equivalent Medicare rebate and put it through to Medicare like we do now? The rebate will be in the patient’s account next day and they will not be out of pocket.
Well! Haven’t you poked a hole in the Government’s bulk bill strategy. There are two answers here, the legal one and the pragmatic one.
a) The legal answer to your question is that the process you have described is not bulk billing. Bulk billing is the process described in Section 20A of the Health Insurance Act, wherein no cash changes hands. Even though you are charging the patient the same amount as if they were being bulk billed, the patient is not ‘assigning’ their rebate to you under a Section 20A agreement. Instead, the patient is paying you under a private contract and then claiming back their rebate. I know it seems ridiculous but it’s actually completely different from a legal perspective. Think of it like as stark as the difference between a viral vs a bacterial infection. The COVID services include a bulk bill requirement as you know but see Bulletin 1 regarding the legalities around this.
b) The pragmatic answers to your question are twofold:
i) Get yourselves online to bulk bill ASAP. I think your software should be able to do this because you said you can submit claims to Medicare for patient rebates, which means the system is connected to Medicare online. Check with your software vendor.
ii) Explain the situation to the patient and tell them that you are charging the amount of the Medicare rebate. Suggest that the patient then submits the claim to Medicare and demands their rebate.
2. I am a physician and work for the same organisation from two separate private rooms locations. The organisation has made it a policy that we can only attend one rooms location, to reduce the risk of cross contamination. They have advised us we will be required to do telehealth consultations from home. All our patients are high risk – oncology. Can I bill a telehealth consult if the patient is at my rooms to receive treatment and I am at home?
Yes, you can as long as you can tick off both of the following:
A) Your patients meet the vulnerable patient criteria, which I expect they would pursuant to subsection (c) (v) underlined below.
patient at risk of COVID-19 virus means a person that:
(a) has been diagnosed with COVID-19 virus but who is not a patient of a hospital; or
(b) has been required to isolate themselves in quarantine in accordance with home isolation guidance issued by Australian Health Protection Principal Committee; or
(c) is considered more susceptible to the COVID-19 virus being:
(i) at least 70 years old; or
(ii) at least 50 years old or over if of Aboriginal or Torres Strait Islander descent; or
(iii) pregnant; or
(iv) a parent of a child under 12 months; or
(v) a person under treatment for chronic health conditions or who is immune compromised; or
(d) meets the current national triage protocol criteria for suspected COVID-19 infection.
B) You meet all of the regulated COVID Determination telehealth requirements:
telehealth attendance means a professional attendance by video conference where the rendering health practitioner:
(a) has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
(b) is satisfied that it is clinically appropriate to provide the service to the patient; and
(c) maintains a visual and audio link with the patient; and
(d) is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.
There is no legal requirement that either you or the patient are in a specific place, so you could both be in your respective homes. One of Medicare’s factsheets, which you can read at this link http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB states clearly “Providers do not need to be in their regular practice to provide telehealth services.”
The relevant COVID item numbers would be 91824 / 5, the equivalents of 110 and 116.
3. I am a Rehabilitation Physician who does shared care of admitted rehab patients at rural and remote private hospitals, supported by local General Physicians. Due to travel restrictions and greatly reduced flights I would assume telehealth would be the best way to continue. Who can I contact to try and ensure this facility is made available?
Currently, inpatient services are completely excluded. I would suggest lobbying via the RACP and the AMA, but hopefully when Stage 4 is announced this issue may be resolved.
4. I propose to conduct telephone consults from home for my vulnerable medical oncology patients (Per Bulletin 2, item 6 and Bulletin 8, item 5) and have remote access to records etc. I do not have a provider number registered at my home address. Can I use the outpatient rooms provider number where I usually see the patient for billing in this situation?
This is an important question, applicable to everyone.
Provider number law is poorly understood. It is widely assumed that a provider number attached to a location can only be used at that location. Well, the law is quite a bit more convoluted than that. Here’s a quote from a paper from my PhD published in the Journal of Law and Medicine on this issue (my underlining). If you’re interested in 15,000 legal words about Medicare billing (hahaha) here’s the link https://www.ncbi.nlm.nih.gov/pubmed/31682343:
“Medical practitioners are required to bill using personal identifiers called ‘provider numbers,’ which are central to the integrity of the Medicare scheme. Collection of provider number data ensures the department is able to track the identity of providers of professional services, analyse service delivery patterns and monitor compliance. However, the law pertaining to provider numbers, though recently revised, has failed to accommodate the realities of electronic billing – now the main form of bill submission – which was introduced in 2002.
Section 19(6) of the HIA refers to prescribed particulars to be included on accounts and the newly revised 2018 Regulations describe those particulars as including the practitioner’s name and practice address, or the practitioner’s provider number. In similar fashion to the definitions already described, the wording of the provider number definition adds further ambiguity to claiming hurdles which medical practitioners must navigate. The regulations state that a provider number ‘…identifies the person and a place where the person practices the person’s profession’, it does not state that a provider number ‘identifies the person and the place where the service was provided’, though this is the advice Medicare provides to medical practitioners, despite it often not being possible.”
Here’s the drum: The law has always stated that a ‘prescribed particular’ is either your provider number or the address of the location from where the service was provided. Recent changes to the Regulations, specifically, Reg 51(2)(c), provide that if you don’t have a provider number at a location where you provide a service, you can use any provider number and include a statement that you provided the service there.
Exceptions to this are IMGs. If you are an IMG on a restricted, single provider number, this does not apply, and you must not use any other provider number anywhere.
So, best advice is to use the provider number at the rooms where you would normally have consulted these patients. If that is not possible, use any active provider number and annotate the claim with the address from where you provided the service. Practically you have about 20 characters in the claim notes field to do this, so you’ll need to be concise!
If you can, jump onto Proda https://proda.humanservices.gov.au/ and see if you can get a new provider number linked to your home address quickly, and then start using that.
5. What are the COVID telehealth items for Addiction Medicine specialist codes?
There aren’t any. If the specialists are FRACP they will be eligible to claim the COVID equivalents of items 110 and 116. If not, they will need to use the ‘other medical practitioners’ COVID items. If they are Psychiatrists, there are also psychiatry COVID codes they can avail. See Bulletins 1 and 2.
6. A further email update from Medicare arrived this afternoon regarding details around signing DB4 forms. Here it is:
“Further to the advice provided on 20 March 2020 regarding printing of forms, particularly for the assignment of benefit:
Under these exceptional and temporary circumstances, for the COVID-19 items only, the practitioner’s documentation in the clinical notes of the patient’s agreement to assign their benefit as full payment for the service would be sufficient.
This means that agreement can be obtained through one of three options being in writing, by email, or verbally through the technology with which the attendance is conducted. This agreement can be provided by a patient, or another person, such as the person’s carer or family member. The practitioner should keep their own record that the patient agreed or acknowledged that the service was provided, and that the Medicare benefit could be paid directly to the practitioner.
The Department of Health may investigate potentially fraudulent claims by seeking to verify that the service was provided to a patient. However, the Department is not intending to undertake compliance activity directly focused on whether the assignment of benefit process aligned with the usual requirements.
Previous Services Australia advice stating providers no longer have to print and retain bulk bill forms was incorrect.
We apologise for any confusion this has caused.
Should you have any questions regarding this advice, please contact the OTS Liaison team via email at email@example.com.”
This about face by the Department states that the retention of DB4 forms is only waived for COVID-19 Items. It will probably change again tomorrow when the bigger telehealth rollout is announced. But let’s see. As always, keep as much evidence as you can that the service took place, that you met the item description and that the patient consented to bulk bill. But see Bulletin 2, point 8 as to this requirement generally.
Looking forward to a weekly wrap for you tomorrow and hopefully some good news about Stage 4 from the Department. Keep up the great work managing life on the front line, while we fortunate folk work safely from home.
Margaret and the Synapse team.