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Medicare Australia - Australian Government
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September 2008
Forum and Bulletin Board

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Forum

Forum is a quarterly newsletter covering Medicare and related issues for medical practitioners and practice staff.

Current Issue: Spring edition 2008 [PDF, 781Kb]PDF reader required

Key story: Medicare Australia’s compliance program strikes a balance

Medicare Australia's compliance program strikes a balance

Medicare Australia has released the National Compliance Program 2008–09 which explains our compliance activities and approach for the year ahead.

The National Compliance Program 2008–09 sets out how Medicare Australia will manage compliance risks for 2008–09. It outlines what risks we will focus on, how we will manage and treat these risks and what compliance activities we have planned for the coming 12 months.

Medicare Australia’s compliance approach is based on finding an appropriate mix of education, support, deterrence and enforcement in order to encourage high levels of voluntary compliance.

To help practitioners get it right our National Compliance Program 2008–09 includes our commitment to enhancing our education and information services and products, as well as increasing convenience and accessibility. The Program also identifies the areas of focus for our compliance activities, which include reviewing:

  • specialist attendances
  • Practice Incentive Program payments
  • care plans
  • prescribing of medicine outside PBS restrictions and authority requirements.

We will also examine items at risk of upcoding, including those relating to skin lesions, flap repairs and time-based attendance items.

Medicare Australia understands that the complexity of the MBS and PBS can create the potential for innocent mistakes and opportunities for abuse. When honest errors occur, practitioners will be given a fair opportunity to explain or rectify their mistake—however deliberate misuse of the system will not be tolerated.

National Compliance Program 2007–08 - snapshot of outcomes:

  • We provided face to face education to more than 2200 new practitioners and more than 2700 others in the health care sector.
  • We launched two online Medicare education products.
  • We completed reviews of 329 practitioners and referred 50 to the Director of Professional Services Review for potential inappropriate practice.
  • We identified incorrect payments totalling $6.82 million and undertook recovery of this amount from 513 individuals/organisations.
  • We finalised almost 600 investigation cases and referred 74 individuals to the Commonwealth Director of Public Prosecutions for criminal prosecution.
  • The Commonwealth Director of Public Prosecutions successfully prosecuted 51 individuals—one medical practitioner, four pharmacists and 46 members of the public.

Your voice in Medicare Australia with Dr Peter Sexton

Dr Peter Sexton

Medicare Australia recognises the increasing importance of GPs, specialists and allied health professionals working together to improve health outcomes for patients with the introduction of the Enhanced Primary Care initiative, and the more recent item numbers for chronic disease management.

Recently, a colleague of mine recalled a story they had about care plans and I thought that this would be good to share with you.

A 35 year old woman, who was a regular patient at the practice, presented for her care plan review. She had previously seen her usual GP (who was now on leave) to establish a plan to improve the care and outcomes of her Type-2 diabetes.

Her usual GP had established a multidisciplinary care plan and team care arrangement involving allied health professionals as well as regular visits to her GP for medication and check-ups, claiming MBS items 721 and 723.

Six months later, the patient was keen to see how she was tracking towards her clinical goals of Hba1c of <7, BP < 130/80 and cholesterol < 4 mmol/l as well as her personal goals of reduced lethargy and increased physical activity to assist with a 5 kg weight loss. The patient booked in with another GP at the same practice, and this GP was going to deliver this service under Item 725 (as there was no collaboration with the other members of the multidisciplinary team, she could not claim Item 727).

The new GP understood that Item 725 should only be claimed by the usual GP. Unsure of what to do, she first checked with Medicare Australia and was pleased to learn that the definition of the usual GP included a GP who worked in the same practice.

This case highlighted to me the importance of seeking clarification from Medicare Australia if you are ever unsure about which Item number to use. Using the incorrect Item number/s, especially when working on a multidisciplinary care plan, can cause headaches for you and all health care providers involved with the patients care.

For more information about chronic disease management: Medicare Benefits ScheduleExternal link (see Explanatory note A.30.43)
Or call 132 150*

Regards
Dr Peter Sexton
yourvoice@medicareaustralia.gov.auEmail

Provider Strategy update

Thank you to everyone who participated in the consultation process to help us develop our Provider Strategy.

Your feedback has been greatly appreciated, and by focussing on your needs we will deliver greater choice, increased convenience and more personalised services.

The Provider Strategy is important to us, and we have now integrated the Provider Strategy into our business planning this financial year.

We want to continue to build our working relationship, plan in partnership with you and further increase your trust and confidence in the programs we deliver. For this reason, the Provider Strategy is a live document, and we will continue to refer to it and update it on an ongoing basis. We welcome your feedback about the strategy, so that it remains relevant to you.

We will bring you further updates in future editions of Forum.

Changes to the General Practice Immunisation Incentives (GPII) scheme —Budget update

In the 2008–09 Budget, the Australian Government announced that the GPII Service Incentive Payment (SIP) would stop from 1 October 2008.

A GPII SIP of $18.50 is currently paid to GPs for notifying the Australian Childhood Immunisation Register (ACIR) of a vaccination that completes one of the age-appropriate immunisation schedules.

The GPII SIP will continue to be paid for vaccination services given until 30 September 2008, provided the notification of a completed schedule is received by the ACIR before 9 January 2009.

The Australian Government will continue to support GPs to administer and report immunisation services by providing Medicare rebates, the ACIR information payment and the GPII outcomes payment.

Helping you to ‘get it right’—tips to help you in your practice

When to write an indefinite referral

GPs can write indefinite referrals for the ongoing treatment of patients with chronic conditions.

An indefinite referral is appropriate where a chronically ill patient is in the continuing care and management of a specialist or consultant physician for a specific condition, for example, glaucoma. If an indefinite referral is already in existence, the specialist should not request a new referral and a referring practitioner should not issue one, unless a new condition has developed.

Important:

  • The renewal of a referral for the same condition does not indicate the start of a new course of treatment where the specialist can itemise another initial consultation.
  • In the continuing management and treatment of the condition, the new referral is to facilitate the payment of benefits at the specialist or consultant referred rates, rather than the unreferred rates. However, there is an exemption (see explanatory note 6.7.4 of the MBS Book).

Where do I go for more information?

Tips—complete medical services in the MBS

Each professional service listed in the MBS is a complete medical service. Understanding the requirements of each medical service in the MBS will help you to select the correct item number for your patients.

  • Some professional services are more complex than others. If a service is described in one item in general terms and in another item in specific terms, then you should bill the item that describes the service in specific terms.
  • If a professional service is also a component of a more comprehensive service covered by a different item, the benefit for the comprehensive service will cover the former.
  • Where only one service is rendered, only one item should be billed.
  • Where more than one service is rendered on one occasion of service, the appropriate item for each discrete service may be billed, provided that each service fully meets the item descriptor.

Chronic Disease ManagementExternal link

Medicare Australia is working to increase awareness and correct use of MBS items relating to Chronic Disease Management (CDM) among GPs, practice staff and eligible allied health professionals.

During a recent Drivetime Medical audio programExternal link, Senior Medical Adviser, Dr Robert Menz, outlined some key points to consider when developing GP Management Plans and Team Care Arrangements:

  • Include the patient’s goals and targets (both qualitative and quantitative) when writing your plan.
  • Include the patient’s actions. Patients who are involved in their care have better outcomes than patients who rely solely on the health care professional.
  • Collaboration between health care professionals is very important and ideally done in real time, via face to face interaction or over the telephone. If this is not practical, a two way exchange of information by fax, email or letter is essential.
  • Don’t forget to set a review date.

Did you know?

If you want to check whether your patient has an existing Enhanced Primary Care (EPC) plan in place, call Medicare Australia to find out. Medicare Service Officers will be able to tell you:

  • whether the patient has a current EPC plan in place, but not the actual item number
  • whether an allied health professional can claim their service
  • how many allied health or dental services have already been claimed for a particular calendar year.

Where do I go for more information?
Call Medicare Australia on 132 150*

Streamlined authority process—the importance of getting it right

Under the streamlined authority process, prescribers are allowed to prescribe an ‘Authority required (STREAMLINED)’ medicine, for list quantities and repeats, without prior approval from Medicare Australia.

How do I prescribe ‘Authority required (STREAMLINED) medicine’?

The authority required (STREAMLINED) code is available in the Schedule of Pharmaceutical Benefits, which is available in hard copy or onlineExternal link.

It is important to write the streamlined authority code (not the PBS Item code) on the prescription so that a pharmacist can dispense the medication as a PBS benefit.

The streamlined authority code is a four digit number and is found beside the authority restriction criteria. To display the streamlined authority code and applicable restriction/s, click on the button.

In the example, the streamlined authority code is 1392, not 8090T. If you are prescribing increased quantities and/or additional repeats above those specified in the PBS schedule, prior approval from either Medicare Australia (e.g. z1234ab) or DVA (e.g. DVA4567cd) must be present. A streamlined authority code will not be accepted.

Important:

  • your patient must meet the PBS restriction criteria for the medicine
  • the prescription must be written on an authority prescription form
  • the prescription must include the streamlined authority code corresponding to the PBS restriction that your patient meets (some medicines have multiple restricted uses, therefore care should be taken that the correct code is chosen).

For more information go to streamlined authority process or call 1800 888 333**

Education for health professionals

For information and resources designed to help you get it right
Our content is updated regularly so save our webpage as a favourite bookmark and check it out for yourself!

Electronic Medicare claiming—Spring update

More convenient claiming—you can bank on it

To help make on-the-spot claiming at your practice easier, we are encouraging the public to give us their bank account details to make sure that they can claim from you at their next visit. Currently, we are receiving about 2600 registrations a day.

Practices using Medicare Online for patient claiming do not need to collect patient bank account details. Patients register their bank account details with us, and they can do this either online, over the phone, at their local Medicare office or by completing a form.

Also, Medicare Online lets you submit claims even when you don’t have patient bank account details. Simply select ‘cheque’ as the payment method and we will take care of the rest.

For more information go to Electronic Medicare claiming
Or call our Business Development Officers on 1800 700 199**

First transitional support payments made

To help you support claiming choice and convenience for your patients, the first instalment of the transitional support incentive was paid on 26 June 2008.
Around 25 000 general practitioners and specialists who use electronic Medicare claiming received more than $6.4 million in payments for the period 1 September 2007 to 31 March 2008.

The transitional support package is designed to help GPs and specialists (excluding pathologists) take up electronic Medicare claiming, giving them a choice of the internet-based Medicare Online or EFTPOS-based Medicare Easyclaim.

Did you know?

GP and specialist (excluding pathologists) practices who have taken up electronic Medicare claiming are eligible for the lump sum practice payment.
If you haven’t filled out the application form, download a copy

Further instalments, calculated with reference to each bulk bill and patient claim transmitted between 1 April 2008 and 31 December 2009, will be made to an account nominated by the practice. Over the coming months, Medicare Australia will be contacting practices to confirm future payment arrangements.

Translated information for your patients—helping patients claim their rebate from your practice

Do you offer translated information about on-the-spot claiming for your patients?

To help more of your patient’s understand how to claim their rebate directly from your practice, we have translated brochures available in Arabic, Chinese, Greek, Italian and Vietnamese.

Order copies for your practice.

ECLIPSE—a one-stop-shop for in-hospital claims

ECLIPSE (Electronic Claim Lodgement and Information Processing Service Environment) is the private, in-hospital claiming extension of Medicare Australia’s online claiming system that lets practices lodge Medicare bulk bill and patient claims over the internet. Support for ECLIPSE has increased by more than 400 per cent over the last 14 months, with 65 000 claims processed during May 2008 (up from 15 000 claims during March 2007).

To help support the take up of electronic Medicare claiming, specialist practices that take up ECLIPSE are eligible for financial assistance under the government’s transitional support package.

Designed to make it easier for you, ECLIPSE offers:

  • faster payments
  • less manual intervention—fewer errors, speedier resolutions
  • clearer error messages with a single point of contact for problem resolution
  • online patient verification of Medicare enrolment and health fund membership
  • one system for all health funds
  • no transaction costs for medical claiming.

For more information go to ECLIPSE
Or call Medicare Australia’s eBusiness Service Centre 1800 700 199**

Saving patients a trip to Medicare— on-the-spot claiming is quick, easy, secure and convenient

In March 2008, the Airlie Women’s Clinic and Family Medical Centre in Victoria wrote to 8200 of their patients to let them know they can now claim their rebate directly from the practice.

The mail out, organised by the practice, let patients know that claiming their rebate directly from the practice is easy—all they need to do is register their bank account details with Medicare Australia first.

The mail out has proven to be extremely successful, so far more than 4320 patients have claimed their rebate on-the-spot after they paid their account.
‘Our patients love the convenience of claiming their rebate directly from our practice. It’s great we’re able to offer our patients more claiming choices with great benefits like not having to visit a Medicare office’ said Karen Goldman, Practice Manager, Airlie Women’s Clinic and Family Medical Centre.

To find out how your patients can claim directly from your practice, call one of our Business Development Officers on 1800 700 199**

Medicare Electronic claiming tips

Claimant is a minor

One of the most common claim rejections in Medicare Easyclaim is ‘Claimant is a minor’ (return code 9638).

This happens when you select a child (12 years old or younger) as the claimant. The patient is the person who received the medical service and the claimant is the person who is paying the bill.

For example, if 10 year old Mary is your patient, the claimant is likely to be her mum, dad or aunty.

Changes to the retention of assignment of benefit forms

From 1 July 2008, practices using Medicare Online will no longer have to retain a copy of each assignment of benefit form for a period of two years. This policy change is part of Medicare Australia’s initiative to reduce red tape for providers.

Teen Dental

On 1 July 2008, the Australian Government introduced the Medicare Teen Dental Plan. The dental benefit is for up to $150 per calendar year for each eligible teenager to receive a preventative dental check.

Around 1.1 million teenagers aged 12–17 years in families receiving Family Tax Benefit Part A (FTB(A)), Youth Allowance or Abstudy will be eligible for the Medicare Teen Dental Plan each year.

At a minimum, the preventative dental check must include an oral examination. Where clinically necessary, and if required, x-rays, scaling and cleaning and other preventative services can be provided, including:

  • radiological examination and interpretation
  • removal of plaque and/or stain
  • topical application of re-mineralising agent
  • dietary advice
  • oral hygiene instruction
  • fissure sealing.

Did you know?

Any dentist registered or licensed under relevant state or territory law, with a current Medicare provider number can provide the preventative dental check.
Dental hygienists and therapists can perform some or all of a preventative dental check on a dentist’s behalf in accordance with accepted dental practice, and under appropriate supervision.

What do I need to do?

Medicare Australia will send all eligible teenagers a voucher. This voucher must be presented to the dentist at the time of the preventative dental check.

Download the new dental assignment of benefit forms

Provider stationery— easy ordering online

Re-order all of your Medicare Australia related stationery online.

You were asked— overall how do we rate?

We surveyed over 800 practice managers, GPs, specialists and allied health professionals in this years’ Annual public and provider satisfaction research and asked, ‘How do we rate?’

Results show that Medicare Australia is performing well and continues to improve.

What you are telling us

  • 91 per cent of practice managers, GPs, specialists and allied health professionals are satisfied with lodging bulk bill claims electronically.
  • 89 per cent of practice managers and 86 per cent of GPs, specialists and allied health professionals are satisfied with our service delivery.
  • You want timely and effective education and training on problem areas, changes and new services or initiatives.
  • We need to improve our consistency and clarity of advice about claim rejections and online services.
  • You are busy and your cash flow is important to you, therefore our programs and services need to serve you efficiently and accurately.
  • Forum remains the most preferred channel for information and education, followed by electronic channels like emails and the website.

We would like to thank everyone who participated in this year’s survey. Your input is invaluable and helps us identify where we are performing well and where we can continue to improve to meet our goal of making things easier for you.

We will keep you informed about the improvements we make as a result of this year’s findings.

Letter to the Editor

To: Editor

If the incorrect streamlined authority code is placed on the prescription, how will my patient be affected?
Regards
Dr P

To: Dr P

Thank you for your question. Streamlined authority codes are only valid on prescriptions for items marked ‘Authority required (STREAMLINED)’ in the Schedule of Pharmaceutical BenefitsExternal link. It is important that you place the correct four digit streamlined authority code on your patient’s authority prescription relating to your patient’s condition.

If there is no code or the incorrect streamlined authority code is placed on your patient’s prescription, the pharmacist dispensing the medication may either return the prescription to your patient, or not issue the medicine on the PBS. Your patient will then have to pay the full price for the drug.

Pharmacists have been advised to return prescriptions that have not been endorsed with a correct streamlined authority code.

To: Editor
I’m a Consultant Physician—do I need a new referral for Item 132 for an existing patient?
Regards
Dr H

To: Dr H

That’s a good question—no, Consultant Physicians don’t need a new referral number for Item 132 as an existing valid referral is adequate.

For more information:

Tell us what you think!

We want to make Forum better for you. Send us your comments, questions or suggestions.

Medicare Australia,
PO Box 1001,
Tuggeranong DC ACT 2901

editor.forum@medicareaustralia.gov.auEmail

Useful contact details

Practice Incentives Program  1800 222 032**

General Practice Immunisation Incentives Scheme 1800 246 101**

Rural Program 1800 010 550**

PKI customer service centre 1300 660 035*

Australian Government Services  Fraud Tip-off line 13 15 24*

Aboriginal and Torres Strait Islander Access Line 1800 556 955**

Medicare

Practitioners and staff (schedule interpretation, Medicare numbers, claim enquiries, Medicare advisers)
13 21 50*

Online claiming and ECLIPSE enquiries   1800 700 199**

Medclaims enquiries (electronically transmitted claim enquiries and EFT payment enquiries) 1300 788 008*

Medicare/DVA form enquiries      1800 067 307*

Medicare/DVA form orders (fax)   02 6230 0477

Practitioners’ email medicare.prov@medicareaustralia.gov.auEmail

PBS

PBS general enquiries    13 22 90*

PBS information line (for general public)   1800 020 613**

Authority prescription approval     1800 888 333**

DVA authority prescription approvals        1800 552 580**

Travelling with PBS medicine enquiry line             1800 500 147**

Prescription Shopping information            1800 631 181**

Email    pbs@medicareaustralia.gov.auEmail

For business information

Online   www.business.gov.auExternal link

TTY or hearing impaired:                         1800 552 152**

TIS translating interpreting service:          13 14 50*

* Call charges apply

** Call charges apply from mobile or pay phones only

Some documents on this page may require the free Adobe PDF reader.

Last updated: 9 September, 2008

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