COVID MBS items Explainer and FAQs, No. 24, 8 April 2020


Dear Doctors and Health Care Workers

The constantly shifting billing goal posts are beginning to take their toll, with providers becoming understandably more and more confused about what is or isn’t compliant billing during COVID times. Please hang in there. You are all doing an amazing job navigating all of this, evidenced by your excellent questions. What is clear is that everyone is trying to get it right and that’s not easy.

Just to throw another spanner in the works, I am again reliably informed that the recent changes to bulk billing will be changed again soon, with further lifting of the requirements. It appears the department may be realising the mess they are making and are starting to understand how Medicare works. Better late than never I suppose.

Here are the answers to today’s excellent questions

1.  I am a Psychiatrist and all my patients have mental health issues. Are they all considered vulnerable? If so, does this mean that I can only bulk bill telehealth?

Probably yes and yes (but note our previous content regarding the legalities around forced bulk billing).

‘Vulnerability’ in this context means patients who are at greater risk of COVID as described in the Determination. This includes anyone being treated for a chronic health condition. We touched on how to decide whether a condition was chronic in an earlier bulletin. It is really a matter that requires the exercise of your clinical discretion, but certainly, the definition of ‘chronic condition’ accepted by the Department of Health includes ‘mental illness.’ You can read it here

2.  I am a Geriatrician. For a patient living in a nursing home, what’s the difference between 141 + 149, versus 92623?   

141+149 = usual, non-COVID telehealth billing where the patient must be located in a telehealth eligible area, such as an aged care facility

92623 = a stand alone COVID telehealth service where both you and the patient could conduct the consult from your respective homes.

3.  Regarding forced bulk billing, can physicians continue to bill vulnerable (i.e. sick) private outpatients non-rebatable telehealth fees? (Sorry to bang on about this – trying to keep the doors open).

Yes, and don’t be sorry. You can do this and may have no option if your practice is collapsing.

4.  I am a (confused) physician. Taking into account the new laws passed on 6 April, if a patient does not meet the definition of a COVID vulnerable person but they don’t meet the old laws for telehealth (ie greater than 15 km from me and outside the metropolitan area) and I still do a telehealth appt with them to minimise foot traffic into private rooms, do I:

a)  Charge them a 110 with a gap like I would do pre COVID (+/- 112?)? – No, because they don’t meet usual telehealth criteria 

b)  A COVID item number plus a gap? – Yes. The patient should pay your usual fee upfront and then can claim back their rebate, or you can submit the claim for them. Just like usual. 

c)  Am I obligated to charge a COVID item number with no gap? – No, you are not in these circumstances. You don’t have to bulk bill if your patient is not vulnerable, over 70 etc. 

I’m sorry this is confusing. I hope this helps – option 2 is the correct answer.

5.  In relation to the 06.04 changes: If a patient meets the COVID 19 vulnerability criteria and I do a telehealth appt with them, but they live in an area where I would otherwise charge them the pre COVID telehealth item number (in my case as a physician a 110 and a 112), Can I still charge them a 110 and 112 and a gap or do I have to bulk bill a COVID item number?

You can use usual telehealth in these circumstances, so 110 + 112 plus a gap.

There are occasions when both COVID and non-COVID telehealth options may apply. Choose usual telehealth when you can because usual fees and billing arrangements apply and you don’t have to worry about whether you can charge your usual fees or not – you can.

6.  As a geriatrician, I review demented patients in my clinic over the phone with the relative rather than patient (who is in an aged care facility). Can I still bill a 116 even if I’m not speaking to the patient? 

No. All attendance items require attendance on the patient. You cannot claim for speaking with relatives as a general rule. There are some exceptions such as family conferences and certain psychiatry items.

7.  I am a consultant physician caring for patients with chronic diseases. Great to see that new COVID-19 items equivalent for 132/133 have been added. I know the restriction in using 110 for already known patients if they haven’t been seen for >9 months and presenting for a new issue. What about 132? What is the view of Medicare on billing a 132 again if you do a full review and assessment of a complex patient >12 after the last billing of 132? Assuming that all other criteria (>45 min, full assessment, etc) are fulfilled? 

I think we answered this question earlier today in bulletin 23. Have a look and let us know if anything is still unclear.

8.  I am a Physician and did a telephone consult with a patient on Monday (116 equivalent). The patient actually has no Medicare card (Malaysian resident); is it legal to send a private account to the patient at this time, obviously with no rebate? Usually my understanding is that this would not be legal, given that it is not a F2F appt, but is it ok at present, with the COVID rules as they are?

Yes, you can issue a private bill to the patient, with no Medicare item on it. Assume you discussed fees with the patient, so they know to expect a bill.

9.  I am a Psychiatrist. Almost all of my consultations are item 306.  I now see some patients in rooms and for others I am using telehealth. I understand that initially, if I used telehealth, and the patient qualified, I could only bulk bill the consultation. The Medicare rebate would then go to me. And this would represent a very significant reduction in my fee for this service. 

I am a little unclear what the very recent changes to this system entail. Am I correct in assuming that if I now use telehealth, (and noting the restrictions) I can bill my patients the same private fee that I use for patients consulting me in my rooms, and with the Medicare rebate now going to the patient?

Yes, this is correct, except don’t forget the return to vulnerability criteria and see the answer to question 1 today around whether all of your patients may fall within this category.

But this raises important questions that illuminate why the attempt to force bulk billing is failing. In the current partial forced bulk billing environment, how will the department determine whether to accept or reject a claim made by a patient, after the patient has paid your private fee? If the patient is not over 70, under 16 or a pensioner, how will the department decide the patient should be denied their Medicare rebate because you didn’t bulk bill? Do they decide vulnerability based on your specialty of psychiatry or is that decision exclusively yours to make? As you can see, forced bulk billing and worse, forced bulk billing based on interpretive criteria, is not compatible with the current scheme. Hang in there. They’re slowly working this out.

And if this is the case, do I use item 306 or one of the telehealth COVID-19 item numbers?

For patients you continue to see F2F in your rooms use 306, for telehealth use COVID and note the restrictions.

10.  Is there any change to the time limit to the referral expiry? I have not been able to see some of my patients in the last few weeks and the referrals have expired (1-year GP referrals). This was mainly due to not been able to attend home visits. Do I need a new GP referral to see these patients?

Yes, you do need new referrals unfortunately. There have been no changes to referral law.

Thanks everyone

Till tomorrow.

Margaret and the Synapse team.

COVID MBS items explainer and FAQs No. 25, 9 April 2020…Read more

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