Dear Doctors and Health Care Workers
Firstly, we hope you are enjoying the festive season, spending time with loved ones and staying Covid safe.
There are major changes happening to Covid telehealth item numbers from 1 January 2022. The changes have not yet hit the Federal Register, but are definitely coming in just a few days’ time.
Overview
The new requirements are going to be challenging to administer, given the technology constraints we have all experienced over the past two years. Further, with Covid now spreading rapidly throughout the country, it is unclear how hospital-based doctors will manage the competing demands of their employers demanding that they try not to bring patients in for face-to-face consultations (to keep both the patients and the staff safe), yet the new requirements don’t really make telehealth a viable alternative.
To compound matters, an important new rule called the 30/20 rule has been introduced, which concerns volumes of services. If you breach this rule, you will automatically be referred to the PSR, and will find yourself in a world of pain and trouble, so please be careful.
Given there doesn’t appear to be any actual law on the register yet, we are restricted to directing you to the mbsonline website (not very reliable sorry, but that’s all there is at the moment).
Here is a link where you will find the details that relate to your specialty http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Telehealth-Arrangements-1Jan22
Summary of the Key Changes
- Most telephone services have been removed, which means you must use video henceforth. This will obviously be extremely problematic for reasons you all know about already.
- Specialists please take note of the minimum 5-minute requirement on most services, and read the item descriptors. While this has been a requirement since covid telehealth began, this is a good opportunity for a refresher, because it did trip a few people up – because there is no 5-minute requirement on the equivalent items 110, 116, 104, 105 etc. We have already experienced one angry patient who read the rules and said that his consultation with his specialist only lasted 3 minutes and about 20 seconds (call duration is recorded on all our phones these days remember) and he wanted to report the specialist.
- The pre-covid telehealth 50% loading items are gone – mostly items 99, 112 and 149. So, for example, geriatricians, the item 141/149 combination is no longer available. You now have to use item 92623 and the consultation must take place over video not telephone.
- Telehealth services are still available for outpatients only so private health gapcover arrangements do not apply. AND the previous inpatient exception has been removed.
- For surgeons and others who claim items 104 and 105, the only telephone option you will have from 1 January 2022 is the item 105 equivalent – item 91833.
- For physicians who claim items 110, 116, 132 and 133, the only telephone item left for you is the equivalent of item 119. It is item 91836, and the rebate will be $38.60 (same as item 91833 above), and the consultation must still take a minimum of 5 minutes.
- A few more telephone services have been preserved for psychiatrists – principally items 91837, 91838 and 91839 – but there is still a push towards video rather than phone. The old telepsychiatry items introduced in 2002 are also gone – items 353 to 370.
- For GPs, the most common items – 23, 36 and 44 – telephone equivalents are gone. The telehealth equivalents for these services will be video only. There are a few new telephone services though, the most common will be a short consult of less than 6 minutes, and a long consult of more than 6 minutes. These are items 91890 and 91891 respectively. The requirements on having an existing relationship with the patient remain in place, with the same limited exceptions.
- You can charge private fees and any OOPs will count towards the patient’s Medicare safety net.
- There is a new 30/20 rule. Basically, it applies exactly the same as the current 80/20 rule which affects GPs only. So, please take note – if you provide more than 30 prescribed services on more than 20 days in a 12-month period, you will automatically be referred to the PSR to explain yourself! There is no discretion not to refer you to the PSR, so please be careful. We will update more on this in the coming days because ‘prescribed services’ can be a trap. We are just waiting on the legislation to know more.
So not a lot of good news I’m afraid. This will be a difficult transition and we expect you will have lots of excellent questions. We are here and ready to answer them, so don’t hold back.
Thanks everyone, and HNY in advance!
Margaret and the Synapse team.