Dear Doctors and Health Care Workers
An important question today, relating to billing for Australian Medicare eligible persons who are overseas at the time the service is provided. Here’s the answer.
1. I saw in a previous Billing FAQs that you cannot bill Medicare if the Doctor is overseas – is it the same for if the patient is away? So, if a patient’s home residence is QLD and she has a Medicare number, but is holidaying/working in Canada, and at the time the service is provided the doctor is in Australia, can we still claim a 91823?
No. You can never bill to Medicare while an Australian Medicare eligible person is overseas, and you definitely cannot bill item 91823 in the circumstances you have described.
Please review Bulletin 46 for a more detailed explanation.
Also, Australia does not currently have a reciprocal health care agreement with Canada, meaning even acute care needs of Medicare eligible Australians are not covered while in Canada.
The only way to legally bill for the service you have provided to an Australian in Canada is to issue a private invoice for the full fee and not claim through Medicare.
And remember, data matching is here, including cross matching of Medicare data with Home Affairs data, so this is very easy for Medicare to audit.
Margaret and the Synapse team.