COVID MBS items Explainer and FAQs, No. 61, 30 June 2022

Dear Doctors and Health Care Workers

We have waited till the last minute to send this bulletin, and we’re glad we did because a revised 1 July MBS file landed in our inbox at 4.50pm today. Ten minutes before the official EOFY! Take a moment to think about that and what it means for software vendors like us. We all have to have the new file loaded into software systems ready for you to use from midnight tonight, after having installed a different 1 July file we all received on Tuesday. So now we all have to ditch (uninstall) that file and replace it with the new one with only hours to spare. We once received two separate files, the later updating the former, on the same day! Causes chaos. But such is Medicare life…

So, here’s a summary of MBS changes from tomorrow.

Summary of key changes

• Most telephone items have been removed for specialists. Only the very short services remain, with a few longer ones for psychiatrists;
• The long GP telephone item 92746 has been removed, but the two shorter telephone consults remain;
• Most services will be indexed;
• There are a few new and changed items for colorectal surgeons, radiologists, and pathologists, which you can read about here;
• The 30/20 rule commences, which applies to all medical practitioners not just GPs, and
• The 80/20 rule, which almost exclusively affects GPs, will be reapplied to include telehealth services. Here is the relevant content from the new regulations:

“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”.

The key words in the above regulation are ‘relevant services’. For the 80/20 rule relevant services are almost exclusively GP services, whereas the parameters of relevant services under the 30/20 rule includes specialist phone services.

This means that if you provide 30 or more services claiming items like 91800 (105 equivalent), 91836 (119 equivalent), or 91837 (300 equivalent), on 20 or more days in a 12-month period you will find yourself in front of the PSR.

So please be careful. The 80/20 and 30/20 rules are deeming provisions. If you breach them, you are automatically deemed to have engaged in inappropriate practice meaning there is no legal discretion to not send you to the PSR.

To make it easier for you to know exactly what is disappearing, below is a summary table taken from the MBS website listing all items that will be removed from midnight tonight.

Deleted Items

Please let us know if you have any questions. We are ready to help you settle into this new phase of the telehealth journey.

Stay well

Margaret and the Synapse team.