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

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.