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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

“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

894 896 898 2121 2150 2196 32029 32099 32102 32103 32104 32111 32112
32114 32115 32120 32126 32132 32138 32142 32145 32153 32168 32177 32180 32200
32203 32206 32209 32210 32214 32217 32220 90004 91000 91001 91005 91010 91011
91015 91100 91101 91105 91110 91111 91115 91125 91126 91130 91135 91136 91140
91150 91151 91155 91160 91161 91165 91283 91285 91286 91287 91371 91372 91721
91723 91725 91727 91729 91731 93469 93470 93475 93479 93501 93502 93503 93504
93505 93506 93507 93508 93509 93510 93511 93512 93513 93518 93519 93520 93524
93525 93526 93527 93528 93529 93530 93531 93532 93533 93534 93535 93536 93537
93538 93546 93547 93548 93549 93550 93551 93552 93553 93554 93555 93556 93557
93558 93571 93572 93573 93579 93580 93581 93582 93583 93584 93585 93586 93587
93588 93589 93590 93591 93592 93593 93606 93607 93608 93613 93614 93615 93620
91846 91847 92471 92472 92473 92461 92462 92463 92464 92465 92466 91848 91849
92425 92426 92427 92501 92502 92503 92504 92505 92506 92517 92518 92519 92520
92525 92526 92527 92528 92615 92616 92625 92626 92702 92713 54006 54007 54011
54012 91832 91834 91835 92431 92432 91840 91841 92474 92475 92476 92477 92495
92496 92497 92498 92499 92500 92143 92144 92166 92167 92178 92179 92628 92629
92523 92524 92617 92619 92620 92621 92712 54003 92746 92747

 

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.

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