COVID MBS items Explainer and FAQs, No. 49, 1 July 2020

01/07/2020

Dear Doctors and Health Care Workers

Welcome to July!

It’s been quiet on the Covid billing questions front for a while, but a good question has come in relating to billing Covid telehealth items for admitted patients.

But first, an announcement…The new MBS Answers website is live, so jump on over there at https://mbsanswers.com.au/ and take a look! You can also access it via the Synapse website here and the AIMAC website here.

We have been overwhelmed by your generous support and amazing messages of thanks in relation to the Covid bulletins. So, as promised, we are continuing this service into the future, though not through Synapse, through my law firm. MBS Answers is officially the website of the only law firm in Australia where you can submit medical billing questions and they will be answered by a practicing Solicitor, specialised in the field, for free.

It’s all self-explanatory, designed much like a wiki, and the About page should tell you everything you need to know.

Being the website of a law firm, you will notice the structure of the answers is more formal than the Covid bulletins. Just has to be that way. However, I have tried to retain simplicity and clarity in the answers to your questions and have started with 12 common questions. I have about 30 more in the queue that I will work through in the coming weeks. The answers of course contain more law and legal reasoning than the Covid bulletins, so they do take a little longer to write. Thank you in advance for your patience.

So, keep the questions coming, and if they are non-Covid related, please submit them via the Ask page of the new website, and let’s work together to improve medical billing literacy and build a new community of clarity around medical billing rules in this country.

So now to today’s Covid question.

1. a) Can we bill Medicare telehealth COVID-19 codes to participating Private Health Funds (PHIs) while the patients are admitted for day rehab?

No. You cannot bill Medicare telehealth services at all for admitted patients, so the PHIs have no role to play at all in this scenario. Medicare telehealth items are restricted to outpatients only.

b) Can we bill items 110/116, or 132/133 or telehealth COVID-19 equivalent codes to the PHIs while the patients are admitted for day rehab?

No, to telehealth Covid-19 codes (see above). Yes, to the other items which require face to face attendance. In fact, most PHIs specifically require that a rehab physician consults the patient and bills the relevant Medicare item, before they will pay the corresponding hospital claim at the applicable day rate.

Thanks everyone

We hope you like MBS Answers and would love your feedback!

Margaret and the Synapse team.

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