Medicare news for Members

Are you billing telehealth correctly?

Throughout the pandemic, the Department of Health and Aged Care (DHAC) increased the number of telehealth MBS item numbers and benefits to provide better access to necessary health care. Numerous changes to these items made it difficult for busy health practitioners to keep up.

We are currently assisting Members with Medicare compliance activities relating to after-hours telehealth items. Some pandemic telehealth item numbers are now inactive, but some of the remaining telehealth item numbers are being claimed incorrectly. These include telehealth item numbers 92210 and 92211 due to confusion between phone consults and video consults. Some items are phone-specific, and some are labelled ‘telehealth’ which, in the Health Insurance Act 1973 (Cth) means ‘video’. 

Definitions

The applicable legislation is the Health Insurance (Section 3C General Medical Services – Telehealth and Telephone Attendances) Determination 2021 which states:

telehealth attendance means a professional attendance by video conference where the rendering health practitioner:

1. has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
2. is satisfied that it is clinically appropriate to provide the service to the patient; and
3. maintains a visual and audio link with the patient; and
4. is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.

phone attendance means a professional attendance by video conference where the rendering health practitioner:

1. has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
2. is satisfied that it is clinically appropriate to provide the service to the patient; and
3. maintains a visual and audio link with the patient; and
4. is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.

Urgent after-hours services (92210 and 92211) are described as a ‘telehealth’ attendance; therefore, video is required. There is no equivalent urgent after-hours phone item.
GPs and OMPs – please be mindful of the ‘12-month rule’ for MBS-funded telehealth services included in the latest factsheet Continuing MBS Telehealth Medical Practitioners in General Practice.

If you are claiming telehealth MBS items, please refer to the item descriptor via MBS Online or the factsheet relevant to your sector at mbsonline.gov.au/internet/mbsonline/publishing.nsf/content/factsheet-telehealth-updates-april%202023

Further information is available in the MDA National Telehealth Toolkit: mdanational.com.au/advice-and-support/library/concise-advice/telehealth-toolkit.

Introducing Natalie Jones – the newest member of the MDA National Medicare Committee. Natalie recently joined MDA National in a newly created role: Risk Adviser – Medicare Compliance. Natalie has a background in business, nursing and medical practice management. She will be focusing on creating new resources, updating older material, and providing advice to our Cases and Advisory team and to you – our valued Members.

We are committed to assisting Members with ‘all things Medicare’. Please contact us with your Medicare queries on 1800 011 255 or email advice@mdanational.com.au.

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