COVID MBS items Explainer and FAQs, No. 46, 3 June 2020


Dear Doctors and Health Care Workers

Just one question today requesting a clarification about the legalities around billing while overseas.

Here is the original question and answer posted on 1 June 2020.

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

Here is the subsequent question and answer.

I think you have a wrong interpretation of this question and case…the doctor was jailed because he did NOT provide the services claimed NOT because he provided services over telehealth while overseas as the question asked.

Firstly, apologies for not providing enough detail. I can completely understand why, in 2020, one may think it really makes no difference where the doctor and patient are physically located when billing telehealth services to Medicare. But as a taxpayer funded scheme, the government does need to keep in place certain key controls.

Whilst it is true that Dr Bakare may not have provided telehealth services while overseas, I have been unable to find any evidence of Dr Bakare raising suggestions that, even though he was overseas, he called the patient, or supervised a nurse providing a service to a patient. It follows therefore that one of the substantive issue for determination by the court would have related to billing while overseas generally, not being overseas and providing a service – whether by telehealth or by any other method, such as using the supervision rules. I will stand corrected if other information is to hand.

That said, your question is a good one and thank you for asking it, but the answer stands – You can never bill to Medicare while you or your patient are overseas. Medicare benefits are only payable for services rendered IN Australia and the relevant interpretation of this provision has always been that both the doctor and patient must be physically present in Australia at the same time when the service is provided. Let’s walk through the law.

First the relevant provision of the Health Insurance Act 1973

Section 10, Entitlement to Medicare benefit

(1)  Where, on or after 1 February 1984, medical expenses are incurred in respect of a professional service rendered in Australia to an eligible person, medicare benefit calculated in accordance with subsection (2) is payable, subject to and in accordance with this Act, in respect of that professional service.

Second, interpretation of Section 10 by the Department in the MBS

AN.0.6 Patient Eligibility – Medicare covers services provided only in Australia.

GN.12.31 Services rendered on behalf of medical practitioners – Supervision from outside of Australia is not acceptable.

Third, the new Part VIIIA of the National Health Act 1953

Late in 2019 the Federal Government successfully passed new data matching laws, giving Medicare power to match data across various agencies, one of which is Home Affairs. The stated objective of matching to this particular dataset was as follows:

“Data matching with records held by the Department of Home Affairs that indicate whether a person is overseas will allow confirmation that both the healthcare provider and patient were in Australia at the time of their claimed services.” You can read it here.

I hope this has clarified the issue for you. You can read more here or feel free to submit another clarification question.

Thanks everyone

Margaret and the Synapse team.

COVID MBS items explainer and FAQs No. 47, 10 June 2020…Read more

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