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COVID MBS items Explainer and FAQs, No. 26, 14 April 2020

Dear Doctors and Health Care Workers

Welcome to another week in isolation and more COVID MBS questions answered. As we launch into the new week, we just want to say again how much we are enjoying being able to provide this service for you, our front line health workers. It is a privilege.

And something to flag is that I am again reliably informed that more legal changes are coming, though not till next week. But there is cause for some optimism.

Here’s answers to questions up to 4.00pm today

1.  In your last release, I read this: “Yes, you can bill item 91832 for a fit healthy patient with no COVID risk who is 5 minutes from your office. And you can charge your usual fees for this patient”.

I thought this (COVID-19) service can only be bulk billed. So how can one “charge your usual fees for this patient”?  Unless you mean charging usual fees and not submitting a 91832 fee to Medicare. I am a physician and my relevant numbers are 91824/34, 91825/35 and 92422/31 and 92423/32 follow the same principle.

The relevant law changed on and from 6th April 2020, after which time only patients meeting the COVID vulnerability criteria had to be bulk billed. Normal billing was returned for all other patients. Given the patient described in this scenario was a ‘fit, healthy patient, with no COVID risk’ then bulk billing was not mandated, and usual fees could be charged.

The law is changing very rapidly at the moment. What applied two weeks ago may not be in force today. Have a look at bulletin 22 and let us know if you are still unclear about anything.

2.  I am a Nurse practitioner working at GP clinics, I see my own patients. I am also working weekends and after hours. I don’t have any weekend or after hours item numbers. Are we going to get any in future?

I don’t think so, sorry ☹

Remember you can always charge a private fee with no Medicare item number.

3.  Most psychiatric patients could be classified as ‘vulnerable’ and must be bulk-billed if seen using the new regulations for Covid19 telehealth item numbers (now expanded beyond 300 to 308). This sounds like the government is forcing doctors (in our case, psychiatrists) to bulk-bill. So, I am interested in how forcing psychiatrists to bulk-bill ‘vulnerable’ patients can be done without breaching the Constitution. Perhaps you can explain whether this is legal? Or would the MBS just deny the ‘vulnerable’ patient privately billed by the psychiatrist their Medicare rebate?

This is an excellent question which is actually the question that started these bulletins. Have a look at bulletin 1 where we provided information about the Constitutional issue and the more relevant issue of the role of subordinate legislation.

This is extremely complex. I cannot stress that enough. I am working on a separate blog on the issue having delved deeper into the provisions of the Biosecurity Act and the Biosecurity Emergency which the Governor General declared in March. These are the factors I mentioned in bulletin 1, which complicate all other legal arguments including the Constitutional argument.

I would just add that this may become a purely academic argument very soon. Nothing more than a brief blip in history when Medicare tried to force bulk billing.

However, during this period there are various options which we have outlined in other bulletins. Have a look at bulletin 6 which sets out billing options without using a Medicare item number.

4.  I am a psychiatrist in private practice. I am writing to seek further clarification re the COVID-related definition of “chronic condition” which you have already addressed in FAQ 24, question 1. This question was also asked last week during an information session for GPs and the department response seems to suggest that a mental health condition per se would not be deemed a chronic condition…Are you able to offer some further thoughts re this?

Interesting response from the department and thank you for sharing it.

Although this is obviously nuanced and something that would need to be considered on a case by case basis, my concerns are that firstly the advice is somewhat inconsistent with content on both the Department of Health website which we linked to in bulletin 24, as well as the MBS (relevant section copied below).

“AN.0.38…A chronic disease or condition is one that has been or is likely to be present for at least six months, including but not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, mental health conditions, arthritis and musculoskeletal conditions.”

But more importantly, verbal advice from the department is notoriously unreliable in the event of an audit. Even written advice can no longer be relied upon. In the recent case of Nithianantha v Commonwealth of Australia [2018] FCA 2063, the PSR Committee rejected written advice from the Provider Services Branch of the Department of Human Services that had been submitted in evidence, saying the advice was “not correct”. The medical practitioner had attempted to rely on the written advice from the department to justify a medical billing decision but was unsuccessful, because the PSR Committee effectively said the advice from Medicare was wrong.

I would exercise extreme caution relying on verbal advice from the department, particularly given the advice appears to have been for GPs and not your specific craft group. Hopefully bulk billing restrictions will be lifted soon and remember you can always charge a private fee and not use a Medicare item number.

5.  Is it possible to have a provider number where the location is a PO Box. This is a provider number I would use for telehealth only bit I don’t want to use my home address or existing practice provider number?

No. Provider numbers are linked to physical street addresses.

6.  I am a GP. There is a list of people who must be bulk billed if Covid item numbers are used.

If someone has a chronic disease and is between the ages of 16 and 70 but has no concession card, am I able to add a 10990 to the direct billing to Medicare?

There is no ‘list of people’ as such who have to be bulk billed. The current provisions are that anyone meeting the ‘vulnerable’ criteria must be bulk billed. Have a look at bulletin 22 for the legal definition of ‘vulnerable.’

In response to the second part of your question, the answer is no. The usual rules apply to use of the bulk bill incentive items 10990-10992.

7.  When I visit nursing homes to see patients, I bill them a 145 and then for short follow ups I bill 128. As I can’t visit nursing homes now during Covid, I’ve recently done an initial telehealth assessment which I’ve billed a 141+149 for. However, I’m not sure how to bill my subsequent short follow up visit. I can’t bill 128 with a 149 loading. Would I have to bill the Covid telehealth equivalent of 116? How were short telehealth consults by Geriatricians done before Covid?

You can bill 143 + 149 as long as you meet all of the criteria for 143, so it has to be over 30 minutes. Or 116 + 112.

Thanks everyone

Till tomorrow.

Margaret and the Synapse team

COVID MBS Special Confusion Edition, No. 27, 15 April 2020…Read more

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