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COVID MBS items Explainer and FAQs, No. 35, 24 April 2020

Dear Doctors and Health Care Workers

The end of another COVID week. We hope you are all travelling well and I’m sure some of you are very relieved to be heading back to the operating theatres next week with elective surgery recommencing. Please be sure to PPE-up (assuming there is PPE available for you).

Following on from yesterday. Here is the link to my article published on the AUSPUBLAW Blog today.

It’s tantalisingly titled…Frenetic law making during the COVID-19 pandemic: the impact on doctors, patients and the Medicare system.

Hmm. So, in it, I have drilled down into the constitutional arguments around mandated bulk billing, (which don’t really hold up) as well as examining the impact of fast paced, unscrutinised law making during COVID. I conclude that mandated bulk billing may increase rather than decrease patient out of pocket medical costs during COVID, and may end up being of rhetorical effect only, unable to be policed or prosecuted in a meaningful way.

A word of warning, it was obviously written for a legal audience, but I promise it’s an easy read ?

Not so much a rip-roaring yarn, but still packed with intrigue, some stunning court decisions against doctors and the history of Medicare in three paragraphs. Have I sold you? It’s a perfect weekend read of about 12 minutes. No? Still prefer to read Malcolm Turnbull’s book instead? OK, I forgive you ☹

Here are the answers to today’s questions

1.  How does the DB4 form logic work, as the patient can’t sign them?

This has been a recurring theme through these bulletins, so much so that we did a special edition just on this topic. Have a read of it here and let us know if you have any further questions.

2.  a) Are the Covid telehealth items still only for vulnerable patients?  

No. See Bulletin 31 in particular but may we suggest you read through all our bulletins as there have been many changes implemented rapidly, sometimes only a few days apart. I think my AUSPUBLAW article may also help you to understand where this is all up to.

b) If someone has chronic disease but is not on a GP chronic disease plan can the Covid telehealth item still be used?  Are they still seen as meeting Covid vulnerable criteria?

Not easy to answer I’m afraid, as we have no current agreed, settled, legally unchallengeable definition of a chronic condition as it relates to the COVID items. We have covered this in a few bulletins but also in the AUSPUBLAW post today. Once you have read through everything let us know if you are still unsure. Ultimately it would appear that determining whether a patient meets the ‘vulnerable’ criteria will be a matter for the exercise of your clinical discretion on a case by case basis. I’m sorry it cannot be made clearer.

c) If someone is not from a telehealth claimable region is there another way to still claim with telehealth?

Yes. You can claim using COVID telehealth providing all service requirements are met. It’s not easy to summarise quickly so perhaps start by reading through the bulletins and then come back to us with any questions.

d) Regardless of items used we are free to claim a gap with telehealth now, correct?

Yes, if you are a specialist. No, if you are a GP. The government still wants GPs to bulk bill for certain services. We announced this change in Bulletin 31 which you can read here.

Thanks everyone

Stay safe over the weekend.

Till next week.

Margaret and the Synapse team.

COVID MBS items explainer and FAQs No. 36, 27 April 2020…Read more

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