COVID MBS items Explainer and FAQs, No. 38, 1 May 2020


Dear Doctors and Health Care Workers

Welcome to the month of May and the weekend, though I’m wondering if a weekend is still a thing.

We hope you continue to travel well, and we continue to express our thanks to all of you out there on the front lines, while some of us are fortunate enough to be able to work safely from home offices.

All quiet on the law reform front for the moment, though there are whispers…

Here is the answer to today’s only question, which is likely to resonate with just about everyone.

1.  I am a GP. I did a 90-minute telehealth consultation with a diabetic patient of mine yesterday. This involved taking a full history of her sugars which her husband had to read out as she is blind, and then calculate ALM the insulin she had and go Into a full dietary history for the preceding few days to see where things had gone wrong. I arranged an urgent house call for bloods, contacted the specialist and emailed the specialist all the data I’d painstakingly collected! For all my trouble I charged her the telehealth item no: 91802 which I had to bulk bill as she is over 70. That was $108.82 for 90 minutes of hard work!! Do I have to keep doing this and will I be in trouble if I charge a gap? This patient’s son pays her bills and he has no problem paying our private fee because he is ever grateful for the care they receive. However, in this instance since I have done a telehealth consult, I feel I am compelled to bulk bill. Your opinion would be much appreciated.

We feel your pain!

The key question here is ‘will I be in trouble if I charge a gap?’ and the answer is no-one knows.

No offences or penalties have been described in the new laws, and as I said in the article for AUSPUBLAW, we do not know if the patient simply does not receive their rebate or if a penalty might be imposed on the doctor for not bulk billing.

The main consideration is whether you want to put yourself at risk of being the test case. There are many legal arguments around mandatory bulk billing (on both sides of the equation) and whilst these arguments lean heavily in favour of doctors in my view, the law is imperfect, and outcomes are never certain. You probably don’t want to be the one who goes into battle on behalf of all GPs, plus your MDO will usually not protect you beyond the early rounds with Medicare or the PSR.

So, whilst it is unfortunate, the safest advice is to charge a private fee and bypass Medicare completely. Meaning, charge whatever your usual fee is and do not put a Medicare item number on the invoice so no claim can be made against the Medicare scheme. Hopefully, your patient’s son will understand and will be happy to pay your fee.

The whispers I am hearing seem to be around relaxation of bulk billing for GPs, but it is not law yet.

I hope that has answered your question.

Thanks everyone

Happy non weekend and stay safe!

Margaret and the Synapse team.

COVID MBS items explainer and FAQs No. 39, 4 May 2020…Read more

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