BREAKING NEWS 20th October 2014 – Medicare reverses its decision
New Double Dipping Ban is on from 1st November 2014!! If this happens then the read the rest of this article about what you need to think about. For some practices either redeploy your staff or start doing things differently. Let us know what you think!
BREAKING NEWS 2nd July 2014 – Medicare reverses its decision
We are so glad we have kept the original Medicare Press release below on the 30th June 2014. They have now amended the link after howls of protests by nurses, practices, organisations and you. Congratulations to everyone. Publicly complaining still rules.
Below is the original blog we published on 30th June 2014. We kept the original Medicare advice before they amended it on the 2nd July 2014 which appears on the link below.
For further information see:
Our 30th June 20th 2014 Blog
This is the latest Medicare Healthcare Assessment of nursing item numbers advice.
In a nutshell, many practices have claimed separately nursing and doctors time to these healthcare assessments. This is no longer according to these new rules/interpretation.
Medicare has “corrected” rules that may expose practices to claims of over claiming doctor item numbers. Many practices use nursing staff to claim rebates and a medical practitioner is not present for the whole nursing consult. It is not clear whether the practice (if they have charged a service fee against this item number) and or if the practitioner/ must pay back this money.
The matter is so serious we have recently received reports that practices are making nursing staff redundant nursing in response to the latest Medicare bulletin.
The Medicare bulletin states:
“Record keeping requirement for a health assessment (MBS items 701–715)
We have recently reviewed Medicare Benefits Schedule (MBS) Health Assessment items 701 to 707 and the legal requirements to claim those items.
Previously we advised that the time spent by nurses contributing to health assessments could be included with the medical practitioner’s time when choosing the time-based item to bill. This was incorrect.
While a practice nurse may spend time with the patient in helping to prepare a health assessment, it is only the time that the billing medical practitioner spends with the patient that determines the choice of item number.
For example, if a practice nurse spends 30 minutes with a patient to assist with a health assessment, and the medical practitioner then spends 40 minutes with the patient for the health assessment, the correct MBS item number to be billed is MBS item 703, standard health assessment lasting more than 30 minutes but less than 45 minutes.
Note: this information supersedes any contrary MBS itemisation advice that may have been provided to you by the Department of Human Services prior to this notification.”
An interesting view we have received is worthy of discussion.
Mr Jonathan Lee (NSW) former lawyer and current practice manager and consultant in general practice writes:
In my opinion, it is not a correct interpretation.
From the Schedule:
- “Medical practitioners may select one of the MBS health assessment items to provide a health assessment service to a member of any of the target groups listed in the table below. The health assessment item that is selected will depend on the time taken to complete the health assessment service. This is determined by the complexity of the patient’s presentation and the specific requirements that have been established for each target group eligible for health assessments.”
- “MBS health assessment items 701, 703, 705, 707 must be provided by a medical practitioner personally attending upon a patient. Suitably qualified health professionals, such as practice nurses or Aboriginal and Torres Strait Islander health practitioners, employed and/or otherwise engaged by a general practice or health service, may assist medical practitioners in performing health assessments.”
- The health assessment service is one continuous service provided by the doctor with the assistance of a “suitably qualified health professional” (where available).
- The item number will reflect the time taken to complete this continuous service, in which the nurse will be “collecting information” and providing “recommended interventions at the direction of the practitioner”.
- The time taken to complete is determined by the complexity of the presentation and specific requirements of each target group (eg. healthy kids, refugees etc.).
- Assistance is provided in accordance with acceptable practice and under supervision by the practitioner.
- Thus, to consider the nurse’s time and practitioner’s time separately seems to go against the spirit of what this section of the schedule is trying to achieve (ie. collaboration between nurses and doctors to manage complex presentations for specific target groups).”
This comment may have merit that is worthy of your consideration.
What do you think?