Dear Doctors and Health Care Workers
Here are answers to today’s questions
1. Why does the MBS exclude the item number combination 342 and 288, is it explicitly stipulated anywhere?
Yes, the item 342 and 288 combination is explicitly restricted in the General Medical Services Table, copied below and you can access here:
|Group A8—Consultant psychiatrist attendances to which no other item applies|
|288||Professional attendance on a patient by a consultant physician practising in the consultant physician’s specialty of psychiatry if:
(a) the attendance is by video conference; and
(b) item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or 352 applies to the attendance; and
(c) the patient is not an admitted patient; and
(d) the patient:
(i) is located both:
(A) within a telehealth eligible area; and
(B) at the time of the attendance—at least 15 kms by road from the physician; or
(ii) is a care recipient in a residential care service; or
(iii) is a patient of:
(A) an Aboriginal Medical Service; or
(B) an Aboriginal Community Controlled Health Service;
for which a direction made under subsection 19(2) of the Act applies
In terms of why this restriction exists, it probably relates to an underlying pre-COVID policy objective to limit telehealth to individual patient services rather than group therapy.
2. Today’s insane question. Love it already 😊 Today we tried bulk bill a 141 COVID number (I know we can now do an out of pocket cost, but since we quoted this patient a bulk bill last week we are going to stick to that arrangement) What we observed was we are only going to get 85% back. Who gets 100%? Do GPs? Why does the government do this?
GPs rebates were increased to 100% in 2005 to improve access to primary health. It is a regulated arrangement where only specific item numbers are on the 100% rebate list. What has happened during COVID is that, as a result of the parliamentary adjournment, it is not possible to add items to the 100% list, even for GP services. You should find that you are being rebated the same amount for a new COVID service as you would for the equivalent usual MBS service, which for specialists was always 85% for outpatients and 75% for inpatients. If I have totally confused you, please let me know.
3. I have a patient who is currently stuck in NZ and wants to have her baby here if restrictions allow. We are hoping to do essentially a shared care type arrangement until she arrives here. Can I use Medicare item numbers for telehealth if she is not physically in Australia? She is Australian and has a Medicare card.
This may well be in the running for question of the week!
To be an eligible person under the Medicare scheme the patient has to be physically in Australia at the time the service was provided. This is provided for in Section 6 of the Health Insurance Act which you can read here.
So, no Medicare claiming permissible for this patient until she is back in Australia.
Margaret and the Synapse team.