Dear Doctors and Health Care Workers
First an update further to our news flash yesterday. The new law implements the following from today:
- Specialists and allied health providers no longer have to bulk bill Covid items
- GP bulk bill incentive items 10990 and 10991 have been replaced by 10981 and 10982
- The government wants GP services to continue to be bulk billed
- There are new items which mirror the following MBS items:
- Psychiatry group psychotherapy (items 342-346)
- Public health physician consults (items 410-413)
- Neurosurgeon consults (items 6007-6015)
- Practice nurses and aboriginal and Torres Strait Islander Health providers (items 10987 and 10997)
Here’s answers to today’s questions.
1. I am a psychiatrist who sees veterans. Can I combine item 342 and 288 for each patient and run a country veterans group online (up to 9 patients) and bill with the 288 loading, if not can I just bill 342 as an online group for country patients? I could use Microsoft teams as I’m familiar with this for work meetings.
There are a few parts to this question.
No. You cannot bill items 342 and 288 together.
Yes, you can run an online group as long as you meet all requirements of the item 342 equivalent – item 92455 is video and 92495 is phone.
In regards using Teams – please review our previous bulletins regarding privacy and security requirements.
2. Any palliative care updates?
3. Regards “No.30 April 2020” seems a welcome advancement. I have been looking to do private geriatric telehealth into RAC. I was thinking of billing an initial 141+149 (as per Bulletin 26 Q7) and now not bulk billing. If for example, there was another healthcare worker (nurse practitioner, allied health worker or GP) assisting the telehealth consultation with the patient, what additional item numbers could be billed for, either by the other healthcare worker or myself?
So, no further items beyond 141+149 for you. You are permitted to charge usual fees and not bulk bill. That is up to you.
In regards patient end services, the usual telehealth items for other health practitioners are in the range 2100 to 2220. Have a look and let us know if they don’t fit your circumstances.
4. I am an Obstetrician Gynaecologist. Our usual practice is to provide our Obstetric patients with all of their financial/privacy consents at the beginning of pregnancy. These consents cover the whole pregnancy and postpartum period (see more info below). I was hoping you could clarify few issues for me in relation to Telehealth/Telephone consultations.
a) Assignment of Medicare Benefit. We provide our patients with Financial Consent for the whole pregnancy and postpartum period. All patients have to sign this once at the beginning of pregnancy. This mentions total costs, Medicare rebates and out of pocket costs for the whole pregnancy. It states that routine antenatal visits are billed to Medicare. Is it sufficient to add to this Financial Consent that Telehealth/Telephone appointments will be bulk billed to Medicare? Will signing this document by the patient be considered assignment of Medicare Benefits for all Telehealth/Telephone Consultations during that pregnancy/postpartum period? Or do we have to get the patient to assign Medicare Benefit for each individual appointment (which is not what we currently do for our antenatal/postnatal appointments)?
No. This is not permitted. Medicare is a fee for service scheme and consent must be obtained for each bulk billed service for each patient. This is a critically important safeguard against fraudulent billing. If it were permissible to obtain some form of overarching, ongoing consent, providers could bulk bill anytime for any patients for who they held Medicare details, whether the patient was present or not.
b) Patient Consent to Telehealth/Telephone appointments, including understanding limitations, etc Once again, is it okay for patients to sign this Consent once at the beginning of their pregnancy only? This Consent will then cover the whole pregnancy/postpartum period.
This is not strictly a billing question. Please discuss with your MDO.
c) In relation to Gynae patients, private billing vs bulk billing may change depending on each individual consultation, so the Financial Consent/Assignment of Medicare Benefits can be done with each consultation. However, is it still ok for patients to sign a Consent when they first attend the practice stating that some consultations may be provided via Telehealth/Telephone, etc (this means that they are only signing this Consent once)
So insofar as Medicare billing goes it is not acceptable to obtain a single, long term bulk billing consent (see above). You need to obtain the appropriate consent each time you bulk bill. In regards ongoing consent to telehealth/telephone please contact your MDO.
d) Telehealth Video versus Telephone. I understand that Video is preferred over Telephone. However, some patients actually prefer Telephone even though they have video capacity. Is it okay to give patients a choice of video or telephone and document it?
Yes, it is ok to use telephone if the patient prefers it. However, always exercise clinical discretion when making these choices and be sure to document well.
e) Consultation time. I have heard at another presentation of requirement to document start and end time of consultations. How crucial is this? We do not currently do this for face to face consultations so why is this required for Telehealth/Telephone? Or is this only important for consultations that have consultation length inbuilt in their description? I don’t think our obstetric item numbers do not have consultation length as a requirement for billing.
There is no legal requirement to document times. This is incorrect. However, it is a good idea when you are claiming time-based services. Please see bulletin 13 to read more about this.
5. So, it is ok to sit at a computer and consult a community patient, but it is not ok to sit at a computer to consult a hospitalised patient. Is this correct?
Yes. Covid billing services are restricted to non-admitted patients only. It is expected that hospital- based practice will continue face to face.
6. Is it correct for consultant physicians/geriatricians that the requirement to bulk bill COVID-19 telehealth services was removed from Monday 20 April?
Margaret and the Synapse team.