COVID MBS items Explainer and FAQs, No. 57, 4 January 2022

Dear Doctors and Health Care Workers

Lots of updates with the new laws now in force.

We received some excellent questions, as expected, and with the legislation now on the register we have the following answers and updates.

Before we start, some legal definitions that are important for everyone to be aware of. A ‘telehealth’ service is now defined as meaning video, while a phone attendance has its own separate definition.

They are tucked away in a new Determination that you can access here, and are copied below.

phone attendance means a professional attendance by telephone where the health practitioner:

(a) has the capacity to provide the full service through this means safely and in accordance with professional standards; and

(b) is satisfied that it is clinically appropriate to provide the service to the patient; and

(c) maintains an audio link with the patient.

telehealth attendance means a professional attendance by video conference where the rendering health practitioner:

(a) has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and

(b) is satisfied that it is clinically appropriate to provide the service to the patient; and

(c) maintains a visual and audio link with the patient; and

(d) is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.

Another important inclusion for GPs is this:

4 Cessation

Unless earlier revoked, Schedule 5 of this instrument ceases as if revoked on 30 June 2023 at 11.59pm.

Schedule 5 includes all of the current exceptions to the 12-month rule. This heralds another change which does not bode well for the future of telehealth more generally, but we can discuss that at a later date.

Now to the questions.

1. From what I can see on the website this is more for doctors whether they be GP’s, specialists, or psychiatrists, rather than psychologists? Have I missed something because none of our professional bodies have mentioned anything. The majority of my telehealth clients are phone because internet connections where they live are too unreliable

You are correct. From what I can see both video and phone attendances have been retained for psychologists under the same item numbers.

2. Will this impact Nurse Practitioners at all? Does the 30/20 rule apply to us?

Nurse Practitioner (NP) item numbers are unchanged. No, the 30/20 rule does not apply to NP services. But please be careful nonetheless. Two NPs providing high volumes of services have been investigated by the PSR and both repaid large sums of money.

3. We are a private surgical practice, and our question is – are we able to charge a 91833 for our initial phone consultations?

No. item 91833 clearly states that the attendance must be ‘after the first attendance as part of a single course of treatment.’

4. Does mobile phone FaceTime for initial consultations equate to the same as video telehealth?

Yes, as long as you meet all of the requirements of the ‘telehealth attendance’ definition above.

5. I am respiratory specialist. Can I clarify the 30/20 rule please? Does it mean no more than 30 telephone consultations each day for 20 days or more per year? Or does it mean 30 telephone consultations altogether in one year? I normally have about 10 consultations on the phone per day and no more about 3 times per week at max.

 If you have about 10 phone consults per day, you should not fall foul of this rule.

Pursuant to the new ‘Health Insurance (Professional Services Review Scheme) Amendment (Prescribed Pattern of Services) Regulations 2021’ please note the following key provisions and definitions (my underlining):

8 Circumstances for medical practitioners for prescribed pattern of services

For the purposes of section 82A of the Act, circumstances in which services rendered or initiated by a medical practitioner constitute a prescribed pattern of services are that:

(a)  the medical practitioner renders or initiates 80 or more relevant services on each of 20 or more days in a 12-month period; or

(b)  the medical practitioner renders or initiates 30 or more relevant phone services on each of 20 or more days in a 12-month period.

relevant phone service means a service specified in any of the following items of the general medical services table:

(a)  an item in any of the following Subgroups of Group A40:

(i)  Subgroup 2;

(ii)  Subgroup 8;

(iii)  Subgroup 10;

(iv)  Subgroup 16;

(v)  Subgroup 20;

(vi)  Subgroup 28;

(vii)  Subgroup 40;

(viii)  Subgroup 41;

(b)  an item in Subgroup 3 of Group A45;

(c)  an item listed in the following table.

Note:          Some services are specified in items set out in determinations under subsection 3C(1) of the Act.

 So, if you claim 30 or more ‘relevant phone services’ on each of 20 days in a 12-month period you will automatically be referred to the PSR. There is no discretion not to refer, and you will get no prior warning before it happens. It is worth noting that 100% of practitioners referred to the PSR are penalised, suggesting there is no hope of mounting a successful defence despite the existence of an ‘exceptional circumstances’ provision.

GPs in particular please be careful and review the items you claims that come within the above definition. If for example you provide a phone consultation related to a patients general health/diabetes/hypertension etc, AND you claim a second item to review a mental health treatment plan, that equates to two ‘relevant phone services’ on that day, not one. You can get to 30 services very quickly if you are not careful.

6. Can you please further clarify what a minor attendance (code 119 /91826/ 91836) is?

Basically, a minor attendance is quick, there is no examination of the patient, and no major changes made to treatment. Here’s the department’s interpretation:

AN.0.21 Minor Attendance by a Consultant Physician (Items 119, 120, 131)

A minor consultation is regarded as being a consultation in which the assessment of the patient does not require the physical examination of the patient and does not involve a substantial alteration to the patient’s treatment. Examples of consultations which could be regarded as being ‘minor consultations’ are listed below (this is by no means an exhaustive list):

• hospital visits where a physical examination does not result, or where only a limited examination is performed;
• hospital visits where a significant alteration to the therapy or overall management plan does not ensue;
• brief consultations or hospital visits not involving subsequent discussions regarding patient’s progress with a specialist colleague or the referring practitioner.

You might like to watch our quick ‘How To Bill’ video on this item number, and the difference between it and item 116. Here’s a link to it https://aimactraining.com/item/watch/

7. Now that the item 112 telehealth loading has been removed, does that mean country and metropolitan patients can participate equally in telehealth services (does not mandate being a certain geographical distance from a metro centre) and expect to receive the same Medicare rebate?

Yes. However, there are some new rural bulk billing incentives, but they are for primary care, diagnostic imaging, and pathology, as has always been the case. Specialist care is excluded because the rebates are already much higher.

 Thanks everyone

 Margaret and the Synapse team.