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COVID MBS items Special Edition Nurse Practitioners, No. 19, 4 April 2020

Dear Doctors and Health Care Workers

Following on from yesterday’s bulletin, as promised, this is an explainer on the law around who can request COVID pathology tests.

We have been informed that some pathology companies, who are probably themselves struggling to keep up with the rapid pace of legal changes to the requesting provisions, have been refusing to provide COVID testing services when the request has come from a Nurse Practitioner (NP).

So, this is for all the NPs out there and also all Pathology companies. Please share it widely. We want patients to be tested for COVID when appropriate and not refused because of ignorance of the law.

It’s actually quite simple. Here goes…

First the Law

Pathology services must be requested by the ‘treating practitioner’ and section 16A of the Health Insurance Act 1973 sets out who is a ‘treating practitioner’. It clearly provides that nurse practitioners are ‘treating practitioners’ able to order pathology tests. Here it is (my underlining):

16A  Medicare benefits in relation to pathology services

(1)  A medicare benefit is not payable in respect of a pathology service that has been rendered in relation to a person unless:

(a)  the service (whether a pathologist‑determinable service or not) was determined to be necessary by a practitioner (in this section referred to as the treating practitioner) whose patient the person was; or

(ab)  the service (whether a pathologist‑determinable service or not) was:

(i)  determined to be necessary by a participating nurse practitioner (in this section also referred to as the treating practitioner), acting in his or her capacity as a participating nurse practitioner, whose patient the person was;

Secondly, the Departments’ interpretation of the law in the MBS online

“A participating nurse practitioner can request items in the range 65060 to 73529 (inclusive).”

But of course another section of the MBS has a different number range (don’t worry, there are a lot of these inconsistencies right across the scheme). It provides:

“MN.14.16 Requesting requirements

Nurse practitioners may request MBS pathology items 65060 – 73810 (inclusive). Requesting pathology services must be within the nurse practitioner’s scope of practice.”

There are a few other instruments in between the Health Insurance Act and the MBS interpretation of the Act that close various regulatory loops, but they don’t need to concern us for now.

The new COVID pathology services were intentionally positioned within the scope of NP practice to support the department’s “whole of population” solution driven by Primary Care providers.

In a nutshell – the pathology COVID test items are in the range 69476 to 69496 all of which fall within NP scope of practice.

As I said at the start, not too hard this one. Please share with pathology providers to remove barriers for patients and let NPs get on with their jobs.

Stay safe.

Margaret and the Synapse team

COVID MBS Billing News Flash! No. 20, 5 April 2020…Read more

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