Dear Doctors and Health Care Workers
Here’s answers to today’s questions:
1. For usual rural telehealth we usually email the patient asking for their electronic “yes” to assign their Medicare benefit to the practitioner who cared for them but I have recently read we do not then need to “keep copies” of these documents. Therefore, I am confused about whether we need to send these in the first place if they are then not needing to be kept on file.
Completely understandable confusion, and very common. Hopefully we answered your question today with our special bulk bill signature edition available at this link https://synapsemedical.com.au/news/2020/03/31/covid-mbs-items-faqs-no-14-31-march-2020-special-edition-bulk-bill-signature-explainer/
Whilst Medicare does not require it, best advice is to continue to retain the signature as you have been doing because it will be valuable evidence in the event of an audit and is best practice.
2. I spoke with Medicare who said they will not pay items 104 or 105 for palliative care as a specialty with telehealth. I usually claim items 3005 and 3010 but they are not included in the COVID services as yet. What can I claim if I also cannot claim physician items 110 and 116?
The item numbers you are able to claim are directly linked to your AHPRA registration. Items 104 and 105 are claimable by surgeons and various other proceduralists such as dermatologists.
Unfortunately, your only options right now are to either claim the ‘other practitioner’ items which we set out in bulletin number 2, point 2 or continue seeing patients face to face and claim items 3005 and 3010.
Hopefully palliative care will be included when Stage 5 is announced.
3. I am a general and palliative physician, mainly in public, and currently offering telehealth for rural and remote patients through the public outpatient system. I also provide inpatient consultations to private hospitals locally.
a) With local inpatient referrals, can I use FaceTime/WebEx/Zoom with the patient that has been referred for a gen med consult? If so, what number can I use?
No. You cannot bill for these services at all unless you are seeing patients face to face. All inpatient services are currently excluded from COVID telehealth billing.
Both the usual telehealth services available for rural and remote patients, as well as the new COVID MBS services are for outpatients only.
b) Can the same be applied to palliative medicine? Can we do rural and remote private telehealth consultations for inpatients and community?
As for inpatients – See above. You cannot bill COVID telehealth/phone or usual telehealth for inpatients. It is prohibited.
As for the community – yes you can provide both COVID telehealth as well as usual telehealth services for rural and remote outpatients in the community.
4. Are we still fine to use the AMA codes for the funded clients such as iCare, when the appointment occurs via telehealth?
Our best advice is not to use COVID codes for workers comp and third party claims because it is just too messy with no AMA equivalents. Have a look at bulletin 3, point 1 and let us know if that answers your question. It would also be advisable to call iCare.
5. What are the psychiatry telehealth codes and their equivalent MBS numbers?
Here are the basic items currently available using COVID.
face to face
|COVID-19 Telehealth items
|COVID-19 Telephone items – for when video-conferencing is not available|
|Consultant psychiatrist. Consultation, not more than 15 minutes, fewer than 50 attendances||300||91827||91837|
|Consultant psychiatrist. Consultation, 15 to 30 minutes, fewer than 50 attendances||302||91828||91838|
|Consultant psychiatrist. Consultation, 30 to 45 minutes, fewer than 50 attendances||304||91829||91839|
|Consultant psychiatrist. Consultation, 45 to 75 minutes, fewer than 50 attendances||306||91830||91840|
|Consultant psychiatrist. Consultation, more than 75 minutes, fewer than 50 attendances||308||91831||91841|
6. My question is in relation to the second part of question 4 yesterday that the “seen in 12 month” rule does not apply to NPs. The GP clinic I work in feels a community obligation to continue to take on new patients. Does this mean, as an NP, I can use the COVID items numbers to do initial consultations with new patients?
Yes, you can.
7. I’m a child psychiatrist and have been seeing families for treatment over many years, using item 344 and 346 as each member has been referred. I am transitioning to telehealth, one family by phone, the other yet to decide phone or video. Is there an equivalent telehealth number for 344 an 346. If not, can I charge on the single item for 306 tele-equivalent for at least one of the members of the family? Or am I to see them free of charge?
We had another of your colleagues ask this same question. Have a look at bulletin 10, point 2 and let us know if that answers your question.
8. I am a Geriatrician and have been doing nursing home visits and bulk billing 122/128. Is there a telehealth equivalent to this?
There are no COVID equivalents of items 122 and 128, but you can use usual telehealth services if you are seeing patients in nursing homes, because nursing homes meet the usual telehealth criteria. So, for example, you can continue to claim item 141 or 143 +149. Let us now if you need more information here. Happy to help.
9. Previously, we could charge a 112 (telehealth) in conjunction with 110/116//119/132 or 133. With the new MBS Covid-19 item numbers, it makes no mention or not being able to bill the new numbers in conjunction with the above. Can you confirm if we can bill the new telehealth numbers in conjunction with any other item numbers?
No, you can’t. COVID item numbers are effectively stand alone, single item number billings.
For further clarity, have a look at bulletin 3, point 6
10. Do you think they will start to approve 291 psychiatric initial assessment for telehealth or phone? As it stands for a new patient bulk billing, we have had a 50% drop in income.
I know. Many Psychiatrists and other Specialists are experiencing similar challenges out there at the moment. Keep lobbying your colleges and we hope for some reprieve when Stage 5 is announced.
Thank you everyone. Till tomorrow. Stay safe!
Margaret and the Synapse team.