COVID MBS items Explainer and FAQs, No. 41, 11 May 2020


Dear Doctors and Health Care Workers

Welcome to another week and the promise of long-term telehealth. Good or not so good? Only time will tell.

Some really great questions today. Complex and common. Here are the answers:

1.  Electronic consent for DVA telehealth – is this process the same as the bulk billing consent per the Bulletin 3 link? So, are Medicare and DVA interchangeable for bulk billing process purposes (apart from the variation in rebates)? We’re not really set up for bulk billing but have a lone DVA patient that we inherited and need a process to accommodate n = 1?

This is actually a very good question!

Medicare and Veterans Affairs are completely separate. Medicare administers Veterans claims but that’s where the similarities end. They each have separate laws, separate departments, separate rules and requirements, different rates, separate agreements with State Governments regarding the billing of patients in public hospitals, and the list goes on. It is another very poorly understood area of the whole medical billing puzzle.

Veterans are dealt with under the Veterans Entitlements Act 1986 which enables ‘Treatment Principles’ (TPs) and the current legislated TPs includes the following clause.

“4.3.2  In relation to any occasion of service to an entitled person under these Principles, a general practitioner or specialist shall bill only: 

(a)   the Department; or 

(b)   the Commission; or

(c)    the Department of Human Services,

and that bill shall be for full settlement of the account for the service provided to the entitled person.

This is very similar wording to Section 20A of the Health Insurance Act which requires practitioners to accept the Medicare rebate in full payment’ for the service rendered.

Best advice – yes the same rules apply and if you choose to bulk bill your n=1 Veteran (you don’t have to), you cannot charge extra fees and should accept the DVA rebate in full payment/settlement for the service you have provided.

2.  We run a multidisciplinary pain clinic in a public hospital where GPs can refer patients privately to named pain specialists. As many are vulnerable, are we able to utilise the covid19 item numbers? Can we use 91824, 91825 and 91834,91835. There is confusion as to whether pain specialists are allowed to use these item numbers. advice from MBS today advised that we are not able to use these numbers, but other pain services have had contrary advice.

Good question and one that we dealt with early in the Covid journey.

Pain specialists are usually either Physicians and RACP Fellows, or Anaesthetists and ANZCA Fellows. The latter cannot claim items 110 and 116 or their Covid equivalents, and there have been no anaesthetic or pain specialist item equivalents included in the Covid telehealth suite. So, for example, there is no item 2801 Covid equivalent.

So, the answer is – any of your pain specialists who are not RACP (usually anaesthetists) cannot claim the Covid items.

Please see bulletin 1 and bulletin 2 to read more about this.

Top tip – if you have heard on the grapevine that all your pain specialist anaesthetic colleagues have been successfully billing Covid items, just ask them to do a quick check to see how many of the Covid claims submitted for items 91824, 91825 and 91834,91835 have been paid. Submitting a claim or putting it on a tick sheet is one thing, but getting it paid is quite another. Unless Medicare has been unable to block payment, I expect 100% of submitted claims by anyone for those item numbers who is not an RACP Fellow would have been correctly rejected. But do let me know.

3.  All this talk of telehealth has made me realise that some patients that I am now contacting via videoconferencing may actually be in telehealth eligible areas and so I will be able to continue this into the future. The only problem I have is finding out what are the government approved telehealth areas. I have tried following links in MBS online without much success. I find maps with unclear keys. Do you have any advice on where to find such information easily?

The Modified Monash Model is what you need and below is the link to the postcode searcher. Once on this page, all you have to do is enter a postcode and you will see whether that area is eligible. Have to be MMM 2-7 to come within the ambit of usual telehealth.

4.  We run a multi-disciplinary pain clinic from a public hospital and routinely bill telehealth items 2801 + 112. Can we adapt this using the Covid items?

Oh dear!

Firstly, you cannot bill items 2801 + 112 ever. Go back and check your billings. I expect 100% of your claims have been correctly rejected by Medicare, and your department has not been paid.

AND, if you are not actually seeing your patients face to face you should not be billing item 2801 ever via telehealth as it is not permitted. That item requires personal F2F attendance.

The physician pain specialists who are RACP Fellows, can use the item 110/116 Covid equivalents in the interim as per the above links to previous bulletins.

That’s all for today. 

We hope you are all managing well out there and to the doctor who asked the excellent multi-pronged question about public patients in private hospitals, I will spend some time on that one tomorrow, because it’s really complex. 

Thanks everyone

Margaret and the Synapse team.

COVID MBS items and explainer No. 42, 13 May 2020…Read more

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