Telehealth

What is telehealth?

Telehealth provides financial incentives to eligible practitioners and aged care services who help patients participate in a video consultation, called a telehealth consultation, with a specialist, consultant physician or consultant psychiatrist.

Telehealth aims to remove some of the barriers to accessing medical services for Australians who have difficulty getting to a specialist or live in rural and remote areas.

Who is eligible to participate in telehealth?

Health professionals

All specialists, consultant physicians and consultant psychiatrists who have a Medicare provider number are eligible for telehealth.

Medical practitioners, nurse practitioners and midwives must have a Medicare provider number and must provide a telehealth consultation to a patient located in an eligible telehealth area.

Practice nurses and Aboriginal health workers can provide services on behalf of a medical practitioner using the medical practitioner’s provider number, as long as the number is located in an eligible telehealth area.

There is no formal application process for telehealth. Health professionals will be automatically considered eligible under telehealth on the successful lodgement and payment of the first Medicare Benefits Schedule (MBS) telehealth item number.

Residential aged care services

Telehealth is available to residential aged care services that provide care and accommodation to residents under the Aged Care Act 1997 and hold a residential aged care service (RACS) ID.

To host telehealth consultations, residential aged care services must:

• • meet the definition above (have a RACS ID)
  • have access to appropriate telehealth equipment, and
  • have a room appropriate for a telehealth consultation.

There is no formal application process for telehealth. Residential aged care services will be considered eligible under telehealth once a telehealth consultation has been hosted at your location.

What is an eligible telehealth area?

For the purposes of telehealth, an eligible area is a location that is outside an inner metropolitan area.

The exception to this is where a patient is:

• living in an eligible residential aged care service
• at an eligible Aboriginal Medical Service (AMS), or
• at an eligible Aboriginal Community Controlled Health Service (ACCHS).

Note: to be considered an eligible AMS or ACCHS, the practice must hold a current exemption granted under subsection s19(2) of the Health Insurance Act 1973. For more information regarding s19(2) exemptions email oatsih19.2enquiries@health.gov.au

The telehealth boundaries are consistent with the More Doctors for Outer Metropolitan program. You can check your location’s eligibility at doctorconnect.gov.au then Search the Map. Select the ‘metro’ box and enter the address of the location you want to check.

What incentives are available?

There are four types of telehealth incentives available.

For health professionals:

• • On Board Incentive—a one-off, lump sum payment available to practitioners upon successful lodgement of their first telehealth consultation claim, and
  • Telehealth Service Incentive—an ongoing, quarterly payment based on the number of telehealth consultations provided by the practitioner during a quarterly period.

For eligible residential aged care services:

• • RACF On Board incentive—a one-off, lump sum payment available to eligible aged care facilities on lodgement of both the On Board application and the claim for hosting a telehealth consultation, and
  • Telehealth Hosting Service Incentive—an ongoing, monthly payment based on total number of telehealth consultations between a specialist and resident conducted within the aged care service during the month.

Do health professionals need to apply to get telehealth incentives?

No. Health professionals will automatically be considered eligible to receive the telehealth incentives. You will be paid your  initial On Board Incentive once the first telehealth MBS item has been successfully lodged and paid by the Department of Human Services (Human Services).

For ongoing quarterly service incentives, Human Services will accrue the number of telehealth consultations you provide over a three month period (Jul–Sep, Oct–Dec, Jan–Mar, Apr–Jun) based on the MBS item benefits paid. At the end of each quarter, you will automatically receive the incentive amount directly into your bank account.

Note: incentives will be paid into the bank account recorded for Medicare claiming purposes.

Do residential aged care services need to apply for telehealth incentives?

Yes. Eligible residential aged care services will need to complete and submit the following forms to receive both the initial On Board Incentive and the Telehealth Hosting Service Incentive payments:

Residential Aged Care Service Application for Telehealth On Board Incentive Payment form [PDF, 140Kb]

Residential Aged Care Service Claim for Telehealth Hosting Service Incentive form [PDF, 143Kb]

Human Services will pay the On Board Incentive once and the Hosting Service Incentive on a monthly basis. The Hosting Service Incentive will be based on how many telehealth consultations are hosted, including both ‘supported’ (a telehealth practitioner was in attendance with the patient during the video consultation) and ‘unsupported’ (the patient was alone during the video consultation) at your location.

Residential aged care services should read the guides below before offering telehealth services:

• Are you an eligible telehealth host facility? [PDF, 112Kb]
• How to register as a telehealth host facility [PDF, 111Kb]
• How to claim the Telehealth Hosting Service Incentive  [PDF, 109Kb]

MBS Item Numbers

Health professionals can access telehealth MBS item numbers which provide benefits for Medicare and Department of Veterans’ Affairs patients.

There are 23 MBS item numbers that let medical practitioners, nurse practitioners, midwives, practice nurses and Aboriginal health workers provide support to a patient during a consultation.

There are also 11 derived fee item numbers available to specialists, consultant physicians and consultant psychiatrists that, when claimed with an existing attendance item number, let that consultation be claimed as a video consultation.

More information on MBS item numbers is available at www.mbsonline.gov.au.

Claiming information

Specialists, consultant physicians and consultant psychiatrists

You must lodge telehealth MBS item claims to Human Services separately from any other claims. For example, you can only claim the base consultation (Item 104) and derived fee (Item 99) together.  This is to make sure the derived fee item number is allocated to the correct corresponding base consultation item.

All item numbers claimed must include the amount being charged, including telehealth derived fee item numbers. This is a requirement under Regulation 13 of the Health Insurance Regulations 1975.

Note: telehealth derived fee items can't be lodged through Medicare Easyclaim

Bulk billing

A new option is now available enabling patients who have a telehealth consultation with a specialist to assign their right to a Medicare benefit to the specialist by email instead of signing the Bulk bill assignment form.

This new option recognises that during a telehealth consultation the specialist and the patient are not at the same location and is an alternative to the patient physically signing the Bulk bill Assignment form at the time of the telehealth consultation.

In order for a patient to assign their right to a Medicare benefit to a specialist via email, the specialist will need to complete the following process:

Step one

At the time of the telehealth consultation, the specialist advises the patient that:

• to bulk bill Medicare for the service they need to verbally agree to assign the benefit, and
• an email will be sent to their nominated email address confirming the details of the service and seeking agreement to assign the benefit, which they must reply to.

Step two

Before lodging the claim, the specialist must send an email to the patient that includes:

• the details of the service:
  • item numbers or description of services
  • benefit amount for both the base and derived fee items
  • date and time of services
  • patient’s name (Medicare card number must not be included)
  • practitioner’s name (provider number must not be included), and
• the following statement:
  • If you (the patient) agree to the assignment of the Medicare benefit directly to the provider (bulk bill), reply to this email including:
    • the word ‘YES’ in the body of the reply email, and
    • your (the patient’s) name.

Note: due to privacy reasons, the Medicare card number and the provider number must not be included in the email.

Step three

Once the specialist has received a reply email from the patient and the correct information is provided, they must:

• complete a Bulk bill assignment form noting ‘email agreement’*  in the signature block
• submit the claim to Human Services in accordance with the Medicare Benefit Schedule (MBS)
• provide a completed copy of the Bulk bill Assignment form to the patient, and
• keep the email containing the patient’s consent and email signature (in hard copy or electronic form) for audit purposes for a period of two years from date of service

*For manually lodged claims only. For electronically lodged claims, the email signature does not need to be noted in the transmission but you must keep the patient’s email consent on file.

Note: When you note ‘email agreement’ on the manual Bulk bill Assignment form, you are acknowledging that you have completed the requirements as detailed in this process.

This option does not override all other options of obtaining a signature, such as:

• sending the assignment of benefit form to the patient for signature and the patient returning it to the specialist for lodgement with Human Services, or
• asking the supporting practitioner (if in attendance) to complete the assignment of benefit form and seek the patient’s signature on the specialists behalf and forward it to the specialist for lodgement with DHS.

To meet the legislative requirements of a signature being needed to assign a Medicare benefit, this new process has been developed to comply with Section 10 of the Electronic Transactions Act 1999 which outlines the steps to be taken for an electronic signature to be recognised.

Example email

Medical practitioners, Aboriginal health workers and practice nurses

There is no requirement to lodge telehealth claims separately from other claims.

Claims should be lodged using a Bulk bill claim form for general practitioners.

Nurse practitioners and midwives

There is no requirement to lodge telehealth claims separately from other claims.

Claims should be lodged using a Bulk bill claim form for general practitioners.

Payment Information

Health professionals

Telehealth incentive payments and claims will be paid into the bank account you have registered with Human Services.

You can register your details using the Provider registration for EFT payments form.

When you register bank account details against a provider number, all Medicare payments will be made via EFT into this bank account.

Residential aged care services

Telehealth incentives will be paid, into the bank account where your usual aged care payments are made.

Where can I get more information?

Detailed information on telehealth is available at www.mbsonline.gov.au then Telehealth including:

• telehealth program guidelines
• Q&As for patients and health professionals
• maps on eligible telehealth geographical areas
• MBS telehealth items, and
• contact information for policy enquiries.

For general information about telehealth call 132 150*. For information specifically relating to incentive payments call 1800 222 032** or email telehealth@humanservices.gov.au

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Last updated: 22 February, 2012

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