Dear Doctors and Health Care Workers
Here are answers to today’s questions.
1. Is it permissible to get credit card payment prior to a telehealth consult? For example, a few days before when the appointment is set up, or earlier on the day of the consult, can you take a credit card payment? Is it different for inpatients vs outpatients?
This is an important question and I’ve heard a few worrying responses around this issue over the past few weeks. Let’s break it down.
- A Medicare rebate is only payable after a service has been provided.
- There is really no difference between inpatients and outpatients because the relevant sections of the Health Insurance Act apply to both. However, the impact of private health insurance confuses people, because when using known gap schemes in the inpatient context, the known gap amount can be collected pre surgery, as can full private fees. But all of the following points still apply to these types of claims.
- There is no legal barrier to collecting pre-payment for any service (inpatient or outpatient) as long as you provide informed financial consent, and
- If you collect prepayment do not put a Medicare item number on the invoice. Predictive billing is extremely unwise and not recommended in any circumstances as it is a contributor to serious non-compliance. You cannot know with certainty what your service will be until you have provided it. And what if the patient cancels or is a no show on the day but already has a paid invoice that they can submit to Medicare to obtain a rebate for a service never provided. It happens.
- IMPORTANT: if you are bulk billing COVID services do not be tempted to collect a pre-payment or any form of gap payment the day before or on the same day (irrespective of what you call it) and then bulk bill the service. The reason is that, based on legal precedent, and noting we have not had a case dealing with this specific scenario because we have not experienced a pandemic before, the extra fee you charge would very likely be categorised by a court as a fee ‘in respect of’ the bulk billed service – because there is no other service. COVID telehealth billing is single item number billing, so the extra fee can only be a fee ‘in respect of’ the single COVID service you bill because it can’t be in respect of anything else when there is nothing else. Not too difficult for a Judge to work out. Bulk billing and charging a gap for the same service is one of the most serious offences under the Medicare scheme. We discussed this in bulletin 5 point 2
- If you are set up with appropriate merchant facilities a better option than pre-payment may be to record and hold a patient’s credit card and only debit it post appointment. Like when you check-in to a hotel and they take your credit card details but don’t debit the card until you check out. There are banking/finance rules around this so you will need to check with your merchant provider to ensure you have appropriate permissions before doing it.
The COVID telehealth services are legislated to auto-sunset on 30 September 2020, after which time they will turn off like a light switch. If you try to bill them on 1 October, they will be gone. Give the government a reason to keep them.
2. I am a psychiatrist and I have been billing patients on Items 91830 and 91840 for Telehealth consultations, replacing 306 and 316. I have now been told that when the patient changes from 306 to 316 I cannot use Items 91830 or Items 91840 either for bulk billing or charging a gap. Is this the correct interpretation of the Covid regulations?
No. This is incorrect. Medicare is a fee for service scheme. You can (and must) choose the relevant MBS item number for each separate service you provide, and they can all be billed differently. You can bulk bill a patient one day and not the next, do telehealth via phone one day and video the next. You can see patients face to face and then via COVID telehealth depending on what is most appropriate clinically. So, you can definitely switch from 306/316 to the COVID services 91830/91840 and back again if appropriate.
3. I am a Specialist Geriatrician and did a teleconference yesterday at a nursing home which satisfied all criteria, lasting one hour. I have looked at the MBS and Item 92623 appears appropriate. In pre-COVID times I would have used 145. Can you give me any advice?
Yes. COVID item 92623 is the correct substitute based on your description, but you can also bill 141 + 149 using usual telehealth. Please let us know if you would like some further information about this.
4. How do I search the bulletins? Thank you so much for all this detailed info for the variety of specialists. I recall something about providing Telehealth from home and whether or not a new provider number is needed. It appears Medicare need a printed form application rather than usual quick PRODA online application for working from home or a school. Can you please direct me to the bulletin relating to consulting from home?
Oh no! Really? Has Medicare imposed a barrier to provider number access now? We have certainly covered this in various bulletins but if you have an active provider number at a place where you would normally have seen patients, use it. Provider number law is not as simple as most people think and you actually can use a provider number linked to location A for services you provide at location B – there are of course exceptions. Have a look at bulletin 9, point 4.
And I’m chatting with IT right now about a search function…
Margaret and the Synapse team.