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COVID MBS items Explainer and FAQs, No. 45, 1 June 2020

Dear Doctors and Health Care Workers

Welcome to winter!

Some good questions today about retrospective billing, rejected claims and billing while overseas.

Here’s the answers.

1.  I think it was about 30 March when GP Telehealth items became available for all patients, rather than just vulnerable patients. Someone asked me if it was possible to go back and bulk bill non-vulnerable patients seen by Telehealth just before this change was made. I’m presuming the answer is no. Is that correct?

Correct.  But let me just double check I have understood correctly – You are asking whether you can bulk bill patients seen (via telehealth) between 13th – 30th March who did not meet vulnerability criteria. If that is correct then you are right the answer is no, they cannot be bulk billed because they were not eligible for a telehealth consult at that time.

2.  I conducted several new patient physician consultations each lasting around an hour or more on 1 April 2020 when the telehealth billing was in a state of flux. I usually consult at a coastal (non-rural) centre >100km away but conducted these consultations per phone from home (City centre). I requested they be billed as non Covid telehealth consultations, but they were billed as MBS item 92431 and were rejected by Medicare. Should they be bulk billed as 132+112 telehealth or as 91834?

The item 92431 was correctly rejected by medicare as it didn’t exist at the time. Phew! So, it appears you may be able to rebill those services as item 132+112 because item 132 does not state ‘consulting rooms or hospital’ but there’s a few things to check first:

  1. Patients need to have met the multiple comorbidity criteria (it’s not just time based for these items), and
  2. Were the patients in a telehealth eligible area? You have said non-rural, but I am not clear that excludes them. Check by putting the postcode in at this link

If the coastal area you described that is >100kms away, is outside a Major City (RA1) according to ASGC-RA (RA2-5) then you can claim usual telehealth, so 132+112. If not, then you should claim item 91834.

3.  I am wondering if you can help me! I just received an email from a patient who had a telehealth new appointment with our specialist. We used item number 91834 – equivalent to a 110 face to face. We charged $240 and Medicare sent him a letter with error code 108 saying no benefit payable on this item number. Any idea why this would be? I am so anxious about it and can’t ring Medicare till Monday! It is my understanding this patient should receive $132.30 back…. 

Ok don’t worry. This may simply be a Medicare system error. From what you have said, you have done everything correctly. However, reject code 108 may indicate you billed the service as a patient claim (i.e. charged a gap) on a date of service when the government was still trying to force specialists to bulk bill. Could that be it? We have heard some patients were denied their rebates when this happened, others were not. Best advice is call Medicare and ask them why your patient is being denied their rebate.

4.  If I am overseas (don’t know when I can be), and I video conference a rural patient can I bill Medicare?

No. Never. A medical practitioner was recently jailed for billing while overseas. You can read about it here

5.  If I billed a patient 132 in Feb 2020 and then need to do follow up telehealth, a 133 usually but equivalent to COVID 92423, why is this rejected? It will only let me do 91825. 

Possibly because Medicare’s systems had to be adjusted to Covid telehealth so quickly they really didn’t have time to program the relevant rules. But it could also be a date of service (DOS) issue which is popping up quite a lot at the moment. Remember that item 132 and 133 equivalent Covid telehealth items were only introduced on 6th April 2020. If the DOS is prior to this date, then you will need to use the Covid item 116 equivalent (91825). 

If the DOS is after 6th April, you will need to get on the phone to Medicare and explain you have billed correctly and seek a manual override of the rejection to pay your claim.

Thanks everyone

Margaret and the Synapse team.

COVID MBS items explainer and FAQs No. 46, 3 June 2020…Read more

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