Dear Synapse Network,

A Welcome to our Winter 2024 newsletter.

There’s been a lot happening across all our locations recently. It was a very busy Autumn!

We’ve been involved in national media stories, had world conferences to attend, made huge advances in our AI clinical coding opportunities, and continued to receive wonderful feedback from our clients.

So, we thought it was a good time to update you all and reinforce our passion for the work that we continue to do, through first-class service delivery, technology and deep-rooted knowledge.

Happy reading.

In this issue

Payment Integrity Update

AI Assisted Coding

ISPRM 2024 World Congress

Medicare Billing Course

Read on for these articles and more…

ABC 4 Corners

Most of you would be aware of our involvement in the recent 4 Corners Program “Pain Factory” and the associated online articles.

We continue to be enormously proud of our work promoting payment integrity because no universal health coverage system can survive without a robust, effective, rigorously enforced payment integrity system, and this is currently lacking in Australia.

However, once again, the reaction to some of the reporting highlighted the low levels of legal literacy that are endemic around correct use of Medicare billing codes. It is such an obvious problem that urgently needs addressing.

For example, some doctors mistakenly believed that attendance items only require that they “attend” a patient and do nothing else – wrong and naively so! Others thought Medicare is concerned with factors external to the patient such as nursing shortages, so they can admit patients to ICU and bill expensive ICU items in those circumstances – sadly wrong again – Medicare has no interest in workforce shortages or anything external to the clinical needs of patients. And many anaesthetists thought their anaesthetic start time was when they first introduce themselves to the patient, rather than later when they induce anaesthesia – also plainly wrong no matter how sedating that consultation might be!

We thought that you, our valued clients, might be interested in hearing directly from us about one very poorly understood area of our involvement in the program, which caused some consternation.

Specifically, some practitioners raised questions about our analysis using a fluoroscopy code and its relationship with surgical procedure time. Our analysis was and remains correct, but here’s a step through for anyone who is interested in understanding the detail:

1. First, read the item code. The code in question was 60506 which says this: “60506 – Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting less than 1 hour.” Think it through. If anything about this was unclear it would surely have been amended during the MBS Review Taskforce. However, the radiologists on the taskforce did not change the description, and we can take from that that the meaning is clear to the practitioners who bill it (more on that shortly).
2. Second, when seeking advice on interpretation of a billing code, always go to the most authoritative source, and of course that means the Federal Court judgments. Interestingly in a new book authored by long time senior legal counsel of the PSR, Bruce Topperwien, the principles of MBS interpretation (referencing court decisions) are clearly articulated. Applying those principles, the correct legal interpretation of fluoroscopy code 60506 is that the code has 2 elements. The first and most important is the surgical procedure time, and the second is that there must have been a fluoroscopy done during that procedure time. So, the fluoroscopy code is directly related to the surgical procedure time.
3. Third, the only people who know how these items are interpreted are those who regularly bill them. That is, the back-room billers of the major radiology companies. Here’s their process – using the daily theatre lists they bill item 60506 for short surgical procedures and 60509 for any procedure that will take an hour or more. The billers are trained to know which are short and which are long procedures – simple.
4. Fourth, the Federal Court always takes the operation of the wider Medicare scheme into account. So, those who incorrectly suggested that the fluoroscopy code had nothing to do with surgery time, effectively accused the entire radiology industry of widespread fraud. This is because, despite probably 99% of these screening fluoroscopies for spinal surgeries taking less than an hour (including set-up and reporting), there were thousands of the higher paying item 60509 billed across the data. Item 60509 says this: “60509 – Fluoroscopy using a mobile image intensifier, in conjunction with a surgical procedure lasting 1 hour or more.”
5. The data makes it abundantly clear that the radiology industry is billing items 60506 and 60509 correctly based on surgical procedure time. One of the rationales behind these codes is that the radiographer sometimes has to return, and the codes acknowledge the need for the fluoroscope to remain available for the duration of the procedure.

So, as you can see Medicare billing and interpretation is complex and technical. It’s hard enough to become familiar with technicalities of the codes that you bill, let alone try and be across the other several thousand that you don’t.

And while you only need to understand the codes you bill, there is much to be gained from improving your general knowledge of correct Medicare billing. It allows you to feel confident about your own billing practice and reduce the risks of compliance investigations. So, we urge you to consider doing the new Leo Cussen Medicare Billing Course.

All the doctors, allied health professionals and senior legal counsel who have done the course as testers in recent weeks have said it was fantastic, they enjoyed it, and they all learnt a lot!

More on this below.

AI assisted clinical coding with Accenture

We have been collaborating with Accenture for over a year now in the area of AI assisted clinical coding, building a robust integrated system that will transform this area of health administration.

We thank the leadership team at Accenture for their presentation of our joint work at the HIMAA workforce summit on the future of clinical coding in Australia. This is an important national topic that is key to the dialogue about the future of healthcare information in Australia.

We are facing a critical shortage of clinical coders at a time of rapidly growing demand for health services. Accenture’s presentation explored how AI assisted approaches can help solve this ‘wicked problem’ together with partners Synapse Medical and Microsoft.

You can read more here.

There will be lots more updates around this area of our business in the coming months.

ISPRM 18th World Congress, Sydney

We were delighted to exhibit at the 18th World Congress of the International Society of Physical and Rehabilitation Medicine in Sydney last week.

The week was a resounding success for a few reasons, key among them being an opportunity to bring some of our senior management team from across the globe together which is always fantastic. We caught up, refreshed, planned our strategy for the months ahead and enjoyed a long overdue meal together!

Our CEO, Dr Margaret Faux, also presented at the conference on ‘The development of an outpatient case mix system for the organisation and funding of Rehabilitation Services in the Kingdom of Saudi Arabia – an Australian- Saudi Collaborative Project’, with esteemed colleagues Kathy Eagar & Saeed Algarni. The presentation was very well received with a number of our Australian colleagues commenting that such a project is needed in Australia. If anyone would like to hear more about this work, then please get in touch.

But perhaps the biggest highlight of the week was being able to speak (in real life!) to so many of our Rehab Physician clients, many of whom have been with Synapse for more than a decade. Our Business Development Director, Thom Soutter, and Chief Operations Director, Guru Krishnamurthy loved receiving the feedback about our service, billing and technology. We’ve come a long way… and there’s still more to come!

Leo Cussen

As mentioned, there is a desperate need in Australia for legally accurate education about Medicare billing, and we have been proud to assist Leo Cussen in putting together a course that will deliver just that.

This is a foundation course for anyone who bills to Medicare, so not just doctors. Allied health practitioners, nurse practitioners, and indeed everyone with a medicare provider number will benefit from this course. Dr Margaret Faux has been collaborating with Leo Cussen on a pro-bono basis for many years to make this happen. This is because, as you know, Margaret is passionate about compliance, payment integrity and sustainable universal health coverage. She understood years ago that this education needs to be provided by an independent, leading legal education provider with no vested interest in Medicare billing. That’s Leo Cussen in spades and the fact they are a not-for-profit organisation is a bonus.

We hope you will support Leo Cussen and be one of the first to enrol.

Find out more

That’s all for now but as always, if you have any questions about anything in this newsletter our customer service team will be delighted to hear from you at cs@synapsemedical.com.au