Dear Doctors and Health Care Workers
Is it still acceptable to say, ‘happy Friday?’ Or is that now so pre-COVID?
Before answering today’s questions, we at Synapse just want to end the week by saying we hope you are all travelling well, and we thank you again, over and over, for your work on the front lines of this pandemic.
Last night I participated in a webinar on telehealth for the Australasian Gynaecological Endoscopy and Surgery Society. As you would expect, my bit was all about Medicare billing and the new COVID item numbers. However, listening to the panel discussion and Q&A afterwards on some of the practical challenges on the COVID frontlines was, quite frankly, humbling. Hearing stories of Obstetricians telling partners that if they attended the birth of their child they would have to decide between staying by their partner’s bedside post birth until discharge, or go home (maybe to attend to other young children) but not come back due to COVID hospital visitor policies, really brought home some of the difficulties being navigated out there on the ground. So, we thank and salute you for your work.
Just a few excellent questions today.
Here’s answers to today’s questions.
1. I am an O&G. My practice has opted to charge a telehealth fee and issue no item numbers to avoid having to make multiple changes and inadvertently break rules despite best intentions. This works for us as the telehealth fees we are charging are the same as the patient’s out of pocket fees would have been for new patients (so they accept it) and we can manage the loss of the Medicare rebate as the consult is a bit shorter because they are not examined. However, if they then do need to come in for a physical examination, we bill this part to Medicare, meaning the net amount we draw from Medicare is also unchanged.
a) I just wanted to check – If I have done the history by telehealth (so started the consultation) but then the next day they attend for the physical examination – am I correct in billing Medicare a 104 for the physical visit (given I have not billed Medicare for that patient before, and is it still part of their initial assessment from the referral) – or would this now be a second visit in a course of treatment and thus a lower rebate.
Great question, but a surprisingly easy one to answer.
By operating completely outside of the Medicare scheme initially, you have not invoked the provisions of the Health Insurance Act. Relevant referral law is only invoked once you claim against Medicare.
So, when you review your patient for the first time F2F, there is no legal barrier to claiming an item 104.
b) If they attend on the same day it is easier – we just charge a normal 104 fee when they attend.
This is not a second visit (see above). This is an initial visit and you can claim item 104.
c) As an aside, for our antenatal patients who we telehealth, because we don’t bulk bill they lose their rebate. But the telehealth gynae reviews who are not in a risk group (because they are not pregnant) can now get their Medicare rebate. So, in our situation, the incentives are perverse…
Completely understand. This is yet another example of the current partial forced bulk billing arrangements (which are based on interpretive requirements unable to be enforced) causing negative consequences for Medicare eligible Australian tax payers.
2. Am I right that the answer to this is found under “COVID MBS items explainer and FAQs No. 2, 17 March 2020”, Question # 8? There is a legal requirement that patients sign the DB4 form when being bulk billed, to evidence their consent. There is a convoluted method for doing this for telehealth consults via email. Does this apply for the COVID services as well?
Yes, the bulk bill signature is required for COVID services. But please review our special edition bulk bill signature bulletin that put this issue to bed.
Thanks everyone. Hopefully we will bring you good news next week as the COVID Medicare law continues to evolve.
Until then, stay safe.
Margaret and the Synapse team.