COVID MBS items Explainer and FAQs, No. 53, 10 September 2020


Dear Doctors and Health Care Workers

As we approach the legislated Covid item sunset date of 30 September 2020, the question on everybody’s lips is – are the Covid items going to continue beyond that date?

No formal announcements yet, but we hear on the grapevine there will be an extension and forced bulk billing may finally be scrapped altogether. We will obviously be keeping a close eye on developments as the date draws closer and will keep you posted.

In the meantime, a great question from a busy GP clinic in a border town, caught in the State/Federal border closures crossfire, and another relating to a Specialist and Nurse Practitioner telehealth service.

1.  We are a private GP medical practice in rural Victoria who has been undertaking asymptomatic COVID testing for essential workers who require this to be undertaken every 7 days to be able to cross state borders, particularly into South Australia.  We are offering this service as there are a number of people requesting it, and there was nowhere for them to have this done.  My question is should the employer be billed for the GP service?  The GP/Nurse are obtaining the swab directly.  The service is employment related.  Otherwise can the GP bill the patient a Medicare claimable item number for the service?  My way of thinking is that the employer is responsible for the cost due to it being employment related, but a train driver has presented me with a document that states they should not have to pay. This document is called Freight Movement Code for the Domestic Border Controls – Freight Movement Protocol and is from the Australian Government.  I have tried to contact Medicare and in particular askMBS as I wanted a definitive answer in writing, but it has been three weeks and I still have no answer.  We have also undertaken asymptomatic swabbing of patients who have been required to have a swab for peri operative assessment prior to surgery.

This may well be in the running for the Covid billing question of the year!

There are quite a few overlapping laws, protocols, and codes here, and I’m not surprised you haven’t heard back from askMBS. Border arrangements are in a very fluid state that is ongoing.

The Federal Government is currently funding over 120 GP respiratory clinics (GPRC) in which the clinic is reimbursed a set fee per Covid test. That fee is much higher than the fee for usual GP attendance items. Some of the GPRC were existing GP clinics that converted to become GPRC, while others popped up and are continuing to provide testing services. Relevant pathology is also subject to a negotiated agreement with the government. Your clinic appears to be effectively providing GPRC services without being a GPRC.

On 24 July, national cabinet agreed on a freight movement protocol and on 7 August it implemented a code to support the protocol. Stay with me…

An enforceable measure under the code is “Evidence that a COVID-19 test has been carried out within a period no less than 7 days since the time of arrival into a state or territory and not exceeding a rolling 14 days”

Implementation under the code puts the onus on the State to put in place testing facilities which will be free of charge to workers requiring tests. Neither Medicare nor the MBS are mentioned in either the protocol or code.

Not a lot to go on, but what is clear is that for the workers you are testing who are crossing the border, you should not charge them a private fee, nor should you send a bill to their employer because the operation of the protocol and code makes clear any relevant testing costs have not been shifted to employers.

The question is, can you bill these services to Medicare, noting it seems you won’t meet the threshold requirement of clinical relevance because patients are asymptomatic. Bear in mind though that the pathology you have been sending off is all being billed to Medicare.

Section 19(3)(a) of the Health Insurance Act prohibits billing to Medicare for services where the ‘medical expenses in respect of that professional service were incurred by the employer of that person.’ However, these medical expenses were not incurred by the employer due to the operation of the protocol and code.

Section 19(2) also prohibits billing to Medicare where the service is “in respect of a professional service that has been rendered by, or on behalf of, or under an arrangement with:
(a)  the Commonwealth;
(b)  a State;”

However, if a patient has voluntarily sought out your services in a private capacity, this usually operates to negate this provision, in the same way it makes Medicare billing in public hospital outpatient departments legal.

No-one expects you to be doing this work for free, and on balance I think you can bulk bill these services to Medicare, because patients are voluntarily coming to you in a private capacity requesting a service, which would enable the billing of the relevant attendance item. The service is not excluded under the employer provisions, nor the Section 19(2) State/Commonwealth provision, based on accepted operation of that clause.

However, a better option may be to obtain GPRC status, because that more accurately reflects the important service you are providing. If you would like to find out more about that please let me know and I’ll see if I can put you in contact with someone who may be able to help.

One final point is to of course ensure you obtain signatures on DB4 forms etc, which I assume you have done.

2. I have a regional colleague, in this case a nurse practitioner, who has referred a patient for a telehealth consult (likely a 141) and wants to sit with the patient as part of teleconference? Can additional item numbers apply given that two clinicians are together and would I or the colleague bill separately or together (thus one making a payment to the other).

Yes. The NP can claim the relevant patient end telehealth item from the range 82220 – 82225.

Thanks everyone

Stay well and fingers crossed for a telehealth extension announcement soon.

Margaret and the Synapse team.

COVID MBS items Newsflash! No. 54, 18 September 2020…Read more

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