Medicare Benefits Scheme. Under the Connecting Health Services with the Future: Modernising...
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Transcript of Medicare Benefits Scheme. Under the Connecting Health Services with the Future: Modernising...
![Page 1: Medicare Benefits Scheme. Under the Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations initiative.](https://reader034.fdocuments.us/reader034/viewer/2022042822/56649e715503460f94b6ffad/html5/thumbnails/1.jpg)
Medicare Benefits Scheme
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Under the Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations initiative (announced 2010)
Medicare rebates and financial incentives for online consultations across a range of medical specialties.
23 new MBS support items available for patient-end services.
11 new items for specialist services
The MBS Telehealth Initiative
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Telehealth MBS items may be billed where a specialist consultation is conducted via video conferencing with a non-admitted patient who is:
in an eligible Aboriginal Community Controlled Health Service (ACCHS) (regardless of location)
a care recipient at a Residential Aged Care Facility (regardless of location)
located outside Major Cities - http://www.doctorconnect.gov.au – for a map
‘Store-and-forward’ Telehealth consultations (e.g. for dermatology, ophthalmology, radiology) are not funded via MBS at this stage.
What is covered?
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Outside RA 1 areas (major cities)
Eligible areas
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Eligible Staff under MBS item numbers
Doctors
Specialists, consultant physicians, consultant psychiatrists
Practice Nurses and Nurse Practitioners
Aboriginal Health Workers
Note: Under Telehealth, two clinicians may bill the MBS for the same
consultation
![Page 6: Medicare Benefits Scheme. Under the Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations initiative.](https://reader034.fdocuments.us/reader034/viewer/2022042822/56649e715503460f94b6ffad/html5/thumbnails/6.jpg)
Eligible Staff under MBS item numbers
Doctors
Specialists, consultant physicians, consultant psychiatrists
Practice Nurses and Nurse Practitioners
Aboriginal Health Workers
Note: Under Telehealth, two clinicians may bill the MBS for the same
consultation
![Page 7: Medicare Benefits Scheme. Under the Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations initiative.](https://reader034.fdocuments.us/reader034/viewer/2022042822/56649e715503460f94b6ffad/html5/thumbnails/7.jpg)
According to the MBS guidelines an Aboriginal Health Worker:
Holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualifications; or
Is registered, and holds a current registration issued by a State or Territory regulatory authority, as an Aboriginal Health Worker; and
Is employed by, or whose services are otherwise retained by a medical practitioner or their practice.
Aboriginal Health Worker eligibility
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Aboriginal Health Worker eligibility (continued)
• 'Other appropriate qualifications' may be appropriate for individuals who consider their qualification to be equivalent or higher than the qualifications listed above, they will need to contact a registered training organisation in their state or Territory to have the qualification assessed.
• When acting on behalf of a medical practitioner during a Telehealth consultation (items 10983 & 10984) the Aboriginal Health Worker doesn’t require a provider number.
For more information about registration and accessing Medicare as a AHW go to the AHPRA website.
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Medicare incentives (on top of item numbers)
1. On-Board Incentive 2012-13 2013-14
First Telehealth On-Board instalment (after first MBS claim) $1,600 $1,300
Second Telehealth On-Board instalment (after tenth MBS claim) $3,200 $2,600
Total On-Board Incentive $4,800 $3,900
2. Service Incentive 2012-13 2013-14
Specialist service $48 $39
Patient-end service (GP, Nurse, Aboriginal Health Worker) $32 $26
3. Bulk Billing Incentive 2012-13 2013-14
Each time service bulk billed $16 $13
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Medicare rebates – Health Worker or NurseTelehealthMBS Item
Service by attend Aboriginal Health Worker or Nurse
MedicareBenefit
10983 Telehealth patient support service on behalf of a medical practitioner
$31.80
10984 Telehealth patient support service on behalf of a medical practitioner at a Residential Aged Care Facility.
$31.80
Category Payment type MBS payments
10983 MBS MBS -Telehealth support service on behalf of a medical practitioner
$31.80
Incentive - auto Telehealth service incentive, paid quarterly $32.00Incentive - auto Telehealth bulk billing incentive, paid quarterly $16.00
Total $79.80
Example of fees (table below) reimbursed for each 15 minute video consultation with a specialist when the Health Worker/Nurse is present with the patient in the room with the Telehealth Service and Bulk Billing incentives added.
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TelehealthMBS Item
Time Based Service –GP consultation
MedicareBenefit
2100 Level A Telehealth attendance at consulting rooms
$22.052126 Level B $48.052143 Level C $93.202195 Level D $137.10
Category Payment type MBS payments
2126 MBS Telehealth attendance at consulting rooms < 20mins $48.05Incentive - auto Telehealth service incentive, paid quarterly $32.00Incentive - auto Telehealth bulk billing incentive, paid quarterly $16.00
Total $96.05
Example of fees (see table below) reimbursed for each 15 minute video consultation by a patient and GP, with a specialist
Medicare rebates – GP
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The item numbers – Medicare website
Telehealth MBS Item
MBS Group Location of Service
2100212621432195
GROUP A30, SUBROUP 1 At consulting rooms in a telehealth eligible area or at an eligible Aboriginal Medical Service
2122213721472199
GROUP A30, SUBGROUP 1 Other than consulting rooms such as a home visit or other institution in a telehealth eligible area
2125213821792220
GROUP A30, SUBGROUP 2 At a residential aged care facility
Patient-End Services
MEDICAL PRACTITIONER (INCLUDING A GENERAL PRACTITIONER, SPECIALIST OR CONSULTANT PHYSICIAN) TELEHEALTH ATTENDANCES
10983 GROUP M12, SUBGROUP 1 In a telehealth eligible area or at an eligible Aboriginal Medical Service
10984 GROUP M12, SUBGROUP 2 At a residential aged care facility
PRACTICE NURSE OR ABORIGINAL HEALTH WORKER TELEHEALTH ATTENDANCE PROVIDED ON BEHALF OF A MEDICAL PRACTITIONER
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The item numbers (continued)
If you are bulk billing and your patient is under 16, or is a Commonwealth concession card holder (and the person is not an admitted patient) you can also claim MBS item 1090 ($6.00) or 10991 ($9.10)
The latter applies to regional, rural or other specified geographic locations.
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Discussion and Questions
Refer to information sheets