COVID MBS items Explainer and FAQs, No. 59, 25 January 2022


Dear Doctors and Health Care Workers

Before we answer the few questions received in recent days, I thought I would take a moment to say that there has been quite a lot of misinformation spread about the Covid telehealth changes. I saw incorrect information that the 12-month previous relationship rule was removed for GPs, that all the GP telephone services had been reinstated, and that the 30/20 rule had been repealed before it was.

It serves as a salient reminder that what is on the Federal Register of Legislation is the only thing you can rely on – it is the law! I do apologise for banging on about this but…well…Medicare misinformation is a problem I have spent the best part of a decade writing a PhD thesis on. The rumours and Chinese whispers method by which billing information is disseminated gets doctors into trouble and needs to stop.

This is the reason why I only report to you from the Federal Register, or specifically advise when I have no option other than to reference something unreliable, like the MBS website.

Anyone interested in learning more about the problems caused by the lack of reliable information and advice about Medicare might like to read this academic article that was published in PLOS ONE over the weekend. It’s a chapter of my thesis, and I’m very proud that my co-authors and I have had it published in such a prestigious academic journal. I think the many quotes from your colleagues will resonate. OK, rant over!

Now to the questions.

1.Is there any provision for billing if a consultation was intended as video, but needs to convert to phone partway through due to IT or internet issues?

 This common scenario has not changed since the Covid items began. Your records are key here. Just write as much as you can about how long you were on video, what happened, when it cut out and so forth. In terms of which item to bill, best advice is to use the phone rather than video items if you and the patient were not visually linked the whole time.

2.The item 91836 we have been telling patients they will received a rebate of $45.40. Now our accounts are seeing they are receiving $38.60. Is that correct? 

 All physician attendances have always been rebated at 85%. Only GP services have ever been rebated at 100% of the schedule fee.

Item 91836 is a physician attendance so yes, $38.60 is and was always the correct rebate.

3.Do the physician telehealth and telephone item need to be bulk billed (as was the case initially with covid relief) or can a gap fee be charged?

 No, you do not have to bulk bill. There is no legal requirement to do this.

4.If I do an inpatient consult from home what are the documentation requirements? 

The overarching requirement to keep ‘adequate and contemporaneous records’ remains in force. No changes there. Best advice is to also add a note to the effect that you were isolating or subject to a government imposed Covid order, and provide as much detail as you can. If audited, it will be necessary to prove why you did the consultation from home, rather than in person at the hospital. Given the inpatient items are very tightly restricted, please exercise caution, as you can become a statistical outlier and therefore subject to an audit quite easily, I would think. We are not seeing a lot of the inpatient items being billed.

Thanks everyone

Margaret and the Synapse team.

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