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COVID MBS items Explainer and FAQs, No. 47, 10 June 2020

Dear Doctors and Health Care Workers

Firstly, thank you all for your ongoing generous words of thanks and support. It is greatly appreciated. I am committed to answering ALL of your questions, yes really. But many are now non-Covid questions all of which are in the queue to be answered on the new website which is only about a week away. So, thank you for your patience and watch this space…

Just a couple of good Covid billing questions over the last few days. Here are the answers.

1.  If I do a fly in/fly out face to face rural specialist clinic and then go to my holiday house nearby at the end of the day, can I video conference a rural patient in another rural area and use the same provider number of my clinic. Do I need a provider number specifically for the holiday house?  

So, provider number law is by no means as clear as many would suggest. Please review Bulletin 9 where we covered provider number law in the Covid context.

The Regulations require that certain ‘prescribed particulars’ must be included on every claim. A relevant prescribed particular is either your provider number or the address of the location from where the service was provided. Regulation 51(2)(c) provides that if you don’t have a provider number at the location from where you provided the service you can use any active provider number and annotate the claim indicating the address from where you provided the service. Not so easy to do in practice of course, because the Eclipse service text note field is only about 20 characters long.

Medicare has also stated the following in their online FAQs:

“Where can I provide the telephone or telehealth consultation from?

Providers do not need to be in their regular practice to provide telehealth or telephone services. Providers who offer their services from home isolation or quarantine should use their provider number for their primary location…”

So, in the current context, yes you can video conference a rural patient in another rural area using your same clinic provider number. There is no need to obtain a new provider number at your holiday house.

2.  I am a rehabilitation physician. I was asked to consult a patient in a private inpatient rehabilitation unit (in an area that may be within a normal telehealth postcode). The consultation lasted 45min and if I were there in person, it would have fulfilled the requirements for an item 132. I arranged the Zoom telehealth consultation and invited the AMO (another rehabilitation physician), the physio, the patient, and a prosthetist. The first 3 were onsite in the hospital. I was 35km away and the prosthetist was 100km away. Am I able to bill the patient (who is in hospital under their private health fund) via the COVID or other telehealth items? It may have even fulfilled the requirements of a case conference, but the billing by me of one of those item numbers can disrupt the billing by the patient’s usual rehabilitation physician.

Unfortunately, neither Covid nor usual telehealth items can be billed in this scenario because both types of telehealth are restricted to non-admitted patients only. This patient was an admitted inpatient in a private facility so I’m afraid absolutely no telehealth can be billed.

Perhaps you could consider claiming the relevant ‘participate’ in a case conference, rather than ‘organise and coordinate,’ so as not to disrupt your colleague’s ability to claim. However the meeting would of course have to satisfy all requirements for a discharge case conference.

I hope that has answered your question.

Thanks everyone

Margaret and the Synapse team.

COVID MBS items explainer and FAQs No. 48, 18 June 2020…Read more

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