Forum
On this Page:
- Current Issue: Winter edition 2008
- Budget at a glance
- Do you currently receive payments from Medicare Australia by cheque?
- Electronic claiming—convenient for you and your patients
- Practice payments for the transitional support package
- End of era for Medicare’s first electronic claiming channel
- Education resources supporting your learning journey
- Collect your Continuing Professional Development (CPD) points now
- New Dental Health program 1 July 2008
- Instant support to help you understand your patients
- Important MBS changes
- 90 day pay provider cheque scheme for electronic claiming
- Medicare claims history information is now online
- Dr Peter Sexton—your voice in Medicare
- Doctor’s Bag supplies - order your 2008–2010 book now
- Letter to the Editor
- Useful contact details
In this section
Forum is a quarterly newsletter covering Medicare and related issues for medical practitioners and practice staff.
Current Issue: Winter edition 2008
Key story: 2008-09 Budget
Budget at a glance
The 2008-09 Budget
provides $236 million over the next four years for the following Human Services portfolio measures to:
- improve service delivery
- address fraud and non-compliance.
Electronic Medicare claiming
Streamlining electronic Medicare claiming
To increase the number of medical practices where patients can receive their Medicare rebate electronically, without the need to visit a Medicare office, the Australian Government is providing $8.6 million over four years.
When: Work will start immediately, in consultation with stakeholders including providers and software vendors, to develop the streamlined electronic claiming processes.
ECLIPSE system stays
Medicare Australia will maintain the continuing operation of the Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE) system.
ECLIPSE allows private patients to seek estimates from Medicare Australia and their private health fund and helps determine likely out-of-pocket expenses before they seek treatment in hospital. ECLIPSE also lets specialists and hospitals submit claims for in-hospital treatments to Medicare Australia and private health funds in a single transmission.
When: Ongoing.
New incentive payments
Incentives for services in Aged Care
A new two-tiered service incentive payment for eligible general practitioners will be introduced to increase services in residential Aged Care facilities.
When: From February 2009, with payments backdated to July 2008.
eHealth incentive payment for general practitioners
A number of incentive payments provided under the Practice Incentives Program will be simplified by the introduction of a single eHealth incentive payment to encourage practices to adopt electronic decision support systems.
When: From August 2009.
New to Medicare and the PBS
For a full list of changes to the MBS, see Important MBS changes
Medicare Teen Dental Plan
The new Medicare Teen Dental Plan provides for up to $150 per person towards an annual preventative dental check for around 1.1 million teenagers aged 12–17 in families receiving Family Tax Benefit A, and teenagers in the same age group receiving Youth Allowance or ABSTUDY.
Families will receive a voucher from Medicare Australia as proof of the teenager’s eligibility for presenting
to their dentist.
When: From 1 July 2008—subject to legislation.
Reversal of elective sterilisation under Medicare
Restrictions on sterilisation reversal will be removed to allow Medicare benefits to be paid for this procedure. Currently, Medicare benefits are only available for sterilisation reversal procedures necessitated by clinical need and are not available for fertility restoration.
When: From 1 July 2008.
Reduced collection fees for pathology services
To exclude specimens collected at co-located licensed facilities, the existing Patient Episode Initiation (PEI) fee will be amended. A new item number in the MBS will be created for specimens collected at these facilities, at a lower item rate.
When: From 1 July 2008.
Same-sex couples and their children registered for Medicare and PBS Safety Net
Subject to the change in legislation, same-sex couples will be able to register for the Medicare and PBS Safety Net. Currently, Medicare and Pharmaceutical Benefits Safety Net thresholds do not recognise same-sex couples for the purpose of establishing a family threshold.
Amendments to the definitions surrounding couples and families in Commonwealth laws† will mean people in same-sex relationships, and their families, will have access to the same financial entitlements as couples who are either married or in de-facto, opposite-sex relationships.
†For purpose of Medicare, the Health Insurance Act 1973 and the National Health Act 1953.
When: From 1 January 2009—subject to legislation.
Increased compliance audits
The Australian Government is moving to further protect the integrity of Medicare by boosting the Medicare compliance program. The government is increasing audits on MBS services to ensure that doctors are fulfilling the requirements of relevant MBS item descriptors.
This will increase Medicare Australia’s audit coverage to about four per cent of the provider population, compared to the current coverage of less than one per cent.
This means there will be an increased chance that you may be audited by Medicare Australia. For those of you selected, there will be limited work in collecting necessary evidence to substantiate your MBS claims. The evidence Medicare Australia will be seeking is generally contained in records that you already keep—you will not be required to keep additional paperwork.
The Government is also introducing legislation to compel medical practitioners to produce evidence to substantiate their Medicare billing. This new legislation will:
- improve the clarity of your obligations when audited
- provide you with certainty on the evidence you need to supply
- streamline the audit process
- increase the efficiency of the audit process.
When: Audit activity will increase from 1 January 2009 and changes to legislation should be effective from 1 July 2009 following a period of extensive consultation.
Listing of Sensipar on the Pharmaceutical Benefits Scheme
Cinacalcet hydrochloride (Sensipar) will be listed on the PBS as an authority required item for patients with end-stage renal disease receiving dialysis with uncontrolled secondary hyperparathyroidism.
When: From July 2008.
More efficient arrangements for chemotherapy medicine
More efficient funding arrangements for chemotherapy infusions will reduce wastage, with providers reimbursed for the amount of the active ingredient used. Currently, funding is based on the number of vials used.
A new program will be developed under Section 100 in the Schedule of Pharmaceutical Benefits (the Schedule) for these chemotherapy items, which will replace the listing of these chemotherapy items in the general Schedule (Section 85).
When: From 1 July 2009.
Other changes
Expansion of the Bowel Cancer Screening program
The National Bowel Cancer Screening program will be extended to people turning 50, 55 and 65 years of age from January 2008 to December 2010 for one-off screening.
When: Pre-invitation letters will be sent to eligible people turning 50, 55 and 65 years of age from 1 July 2008. Invitation packs, including a test kit, will be sent to this group from 7 July 2008.
After hours medical services—streamlining grants funding
The After Hours GP Services program will be streamlined by removing start-up grants and restricting the program to supplementary grants and operating subsidies.
When: From 1 July 2008.
For more information about Budget measures affecting Department of Human Services and its agencies
Do you currently receive payments from Medicare Australia by cheque?
Medicare Australia is moving to replace cheque payments (excluding pay doctor via claimant cheques) with payments by Electronic Funds Transfer (EFT).
This means you can access your money faster without having to wait for a cheque to arrive, be deposited and the funds to clear.
Register now for payment by EFT directly into your nominated bank account.
Some payments, such as those under the transitional support package, can only be made by EFT. Medicare Australia needs your bank details to make payments if you are eligible.
What do I need to do?
It’s simple—just complete this form and return it to us at:
Medicare Australia
GPO Box 9822
In your capital city
For more information or call 1800 700 199 **
Electronic claiming—convenient for you and your patients
Last edition we advised you how we are making electronic Medicare claiming easier for you by encouraging patients to register their bank account details with Medicare Australia. This means when you help your patients claim through Medicare Online you do not have to ask them for their bank account details.
We have been listening to the feedback from practice staff who are helping their patients claim using either Medicare Online or Medicare Easyclaim, and it’s been overwhelmingly positive.
Currently more than 8000 practices are using electronic Medicare claiming. Of these, 2150 offer Medicare Online patient claiming to their patients and more than 184,000 patients have been saved a trip to a Medicare office through Medicare Easyclaim.
The practices offering electronic patient claiming have told us that it is very straight forward, quick and easy, and has become part of their ‘natural processes’ suggesting it’s not an extra burden for them. By providing electronic Medicare claiming for your patients, you save them a trip to a Medicare office. This is particularly helpful for parents with young children, the elderly and the disabled.There are also benefits to your practice; in particular, you can be certain that claims for pay doctor via claimant cheques have been lodged.
Practice manager, Dianne Symonds, from Western Australia, says that Fulham General Practitioners has been using Medicare Online for a number of years.
“I love it,” Dianne confirms. “It’s a fabulous concept for claiming! Electronic patient claiming is easy to use and reduces the need for chasing payments.
“Medicare Online and the 90 day cheque scheme have made a difference to our practice. Our patients also appreciate the convenience.”
The Government has recognised that medical practices offering electronic patient claiming are providing an additional service, and may also incur costs in the transition period. As a result a financial transitional support package is available that provides an incentive calculated with reference to the number of claims lodged using either Medicare Online or Medicare Easyclaim. More detail about the transitional support package is covered in Practice payments for the transitional support package.
For more information on electronic Medicare claiming, contact one of our business development officers on 1800 700 199**or go to Claiming choices
Practice payments for the transitional support package
The transitional support package is available for general practitioners and specialists (excluding pathologists) to take up electronic Medicare claiming (Internet-based Medicare Online or EFTPOS-based Medicare Easyclaim).
There are two main elements to the package:
- a practice payment of $750 for metropolitan areas and $1000 for regional/rural areas for practices taking up Medicare Online or Medicare Easyclaim between 1 September 2007 and 31 December 2009
- an incentive of 18 cents calculated with reference to each transaction for electronic bulk bill and patient claims transmitted between 1 September 2007 and 31 December 2009. ECLIPSE transmissions will also attract this incentive payment.
To register to receive the practice payment:
If you are eligible for a practice payment you should receive an application form in the mail. You will need to return the application to Medicare Australia for assessment to receive the payment.
Forms are available from Transitional support package
call 1800 700 199** or email ectransition@medicareaustralia.gov.au
End of era for Medicare’s first electronic claiming channel
30 June 2008 marks the end of an era for Medicare Australia as it switches off Medclaims—its first electronic claiming channel.
Practices using Medclaims need to switch to an alternative electronic claiming channel to continue doing business with Medicare Australia from 1 July 2008.
Medicare Australia is continuously improving its systems by introducing new electronic claiming channels—Medicare Online and Medicare Easyclaim—providing practices with more secure, efficient and flexible service. Medclaims was introduced in 1992 as the first electronic claiming channel for providers to submit bulk bill claims. Medclaims relies on what is now outdated technology, as it offers a lower level of security and requires practices to send paperwork to support the claim.
Over the past six months, our business development staff have contacted every practice still using Medclaims, to remind them that they need to switch to an alternative electronic claiming channel. Many practices have already switched to Medicare Online or Medicare Easyclaim, or are in the process of doing so.
Practices migrating from Medclaims to Medicare Online or Medicare Easyclaim are eligible for financial incentives to assist with transitional costs during this period.
Medicare Australia is providing support to Medclaims practices so that they can avoid having to revert to manual claiming. Call our eBusiness Service Centre on 1800 700 199** to obtain assistance in switching to electronic Medicare claiming.
If your practice is in a position where it is not ready to switch to the convenient electronic claiming options, and must revert to manual claiming, this is what you will need:
The approved claim forms and Assignment of benefit which can be obtained using the stationery reorder form
Provider cards containing practice details for imprinting stationery, available by calling Medicare Australia on 13 21 50*.
Imprinters are available from Leigh-Mardon, Medicare Australia’s stationery supplier by calling 1800 067 307**.
Additional information about manual claiming is available in Section 5 of Mediguide: A guide to Medicare and other Medicare Australia health programs
Important: minimum payment times for manual claims are 14 days.
More information about switching to Electronic Medicare claiming—convenient for you and your patients.
Education resources supporting your learning journey
Recently we launched PBS and You resources for optometrists to add to our existing library of learning and reference material, which are available to download from the Medicare Australia website.
Our active engagement in your professional development enables us to identify and develop resources tailored to your needs. We aim to simply explain Medicare and PBS requirements to all health care professionals through a range of channels:
- letter mailouts
- updates in Forum
- manuals
- brochures
- information online.
We understand you have different learning needs depending on your experience with the health system. That is why we offer a collection of online resources targeted at new and experienced health care professionals, allowing you to access learning modules at your own pace and at a location suitable for you.
Feedback from participants is extremely positive since a high percentage of participants achieve their learning goals and outcomes.
“ I was really glad I could complete the PBS education online, that just fits into my schedule and I do love the idea of the ongoing learning process.”
“This is a very appealing way to learn more about the very important aspects of prescribing, even though I have been practising for quite some years now. I look forward to learning new things and reviewing the basics.”
Visit www.medicareaustralia.gov.au/provider/pbs/education regularly to stay connected with our education updates and availability of new resources.
Collect your Continuing Professional Development (CPD) points now
Go online to complete Medicare Australia’s Online PBS Education Accredited for Royal Australian College of General Practitioners CPD and the Australian College of Rural and Remote Medicine PDP, the program allows you to refresh your PBS knowledge in small ‘15 minute bytes’.
There are 17 topics available and you can complete what you want, when you want. Some of the topics available include:
- Assess your risk
- Medicines: what do my patients pay?
- Musculoskeletal pain—making sense of PBS subsidised indications
- Generic v branded medicine costs: what’s in a tick?
- The PBS: what does it cost?
Online PBS Education is a must for experienced medical practitioners. Many have already completed the program and found it to be of great benefit to their practice.
“ Many thanks; I really got a lot out of this session. It is also great to now know where to find more info on the web about many of these prescribing issues.”
“ It is a great program. I wish I had gone through it earlier.”
“ Lots of surprises from something that I’ve always thought I possessed a good knowledge of.”
New Dental Health program 1 July 2008
On 19 June 2008, the Senate disallowed the Government’s Health Insurance (Dental Services) Amendment and Repeal Determination 2008.
Medicare will continue to deliver the Medicare Chronic Disease Dental Scheme.
The Australian Government’s new Dental Health program will be introduced from 1 July 2008. As a result, from 30 June 2008 the Medicare dental scheme will close, meaning Medicare benefits will no longer be available for dental services provided to people with chronic conditions and complex care needs.
Arrangements for the closure of Medicare dental scheme items 85011–87777
The Medicare dental scheme will be closed to new patients after 30 March 2008.
If you have patients that have started treatment under the Medicare dental scheme (receiving dental services between 1 November 2007 and 30 March 2008) they will be able to continue to receive Medicare benefits for dental services provided up to and including 30 June 2008.
No Medicare benefits will be payable for these dental services provided after 30 June 2008.
For more information about the discontinuation of the Medicare dental items, please call 13 21 50* (providers) or 13 20 11* (patients) or go Dental services under Medicare
The discontinuation of items 85011–87777 does not affect a dentist’s or dental specialist’s registration with Medicare Australia.
Instant support to help you understand your patients
A handy new booklet about the Prescription Shopping Program (PSP) is available to new prescribers.
The PSP offers convenient access to information and advice to assist you in managing patients who may be obtaining more PBS medicine than they need. The Prescription Shopping Information Service (PSIS) is available 24 hours a day, seven days a week.
The new PSP booklet provides clear, easy to access information about:
- how to register for the PSIS
- using the PSIS
- helping patients
- travelling with PBS medicine
- your privacy obligations.
To register for the PSIS call 1800 631 181**
Important MBS changes
A number of changes to the MBS, detailed below, will come into effect on 1 July 2008. For more information on these and other changes, or to subscribe to receive email updates, visit www.mbsonline.gov.au
|
Category |
Item number |
Changes from 1 July 2008 |
|
Regional or field nerve blocks |
18292 |
Allows claiming in association with items 18354, 18356 and 18358, to assist children with cerebral palsy to access Medicare benefits where an injection of a neurolytic agent is also required as part of their treatment with botulinum toxin. |
|
Therapeutic nuclear medicine |
16018 |
Allows access to all cancer patients (not only those with carcinoma of the prostate and breast) to this radioisotope treatment for the relief of bone pain caused from secondary bone metastases, where other forms of treatment have failed. |
|
Anaesthesia—Relative Value Guide (RVG) |
Various |
Improves MBS RVG to ensure that the RVG continues to reflect current clinical practice. 16 new items will be introduced and three existing items amended. Changes will improve the MBS RVG and continue the general principle of more complex anaesthesia services, generating a greater number of RVG units. |
|
Ophthalmology |
42741 |
Introduces injection with the use of a therapeutic substance† for posterior juxtascleral depot, allowing for the treatment of subfoveal choroidal neovascularisation due to age-related macular degeneration. †The substance must be registered with the Therapeutic Goods Administration or listed on the PBS. |
|
Orthopaedics |
49503 and 49506 |
Ensures these items are more reflective of the original intent and not open to misinterpretation. |
|
Pain pumps |
General explanatory note 13.5 |
Clarifies that the use of post-operative pain pumps, such as the Pain Buster, cannot be billed under any MBS item (see General explanatory note 13.5). |
|
Reversal of sterilisation procedures |
35700, 37616, 37619 and 59736 |
As announced in the 2008–09 Federal Budget, Medicare benefits have been reinstated for people who wish to have a previous elective sterilisation procedure reversed. |
|
Autism |
135 and 289 |
Introduces referred consultation items for assessment, diagnosis and development of a treatment and management plan by a paediatric consultant physician and a consultant physician in psychiatry. |
|
Healthy kids check |
709 and 711 |
Introduces healthy kids check assessment items for a child who is receiving or has received their four year old immunisation. |
|
Diabetes type 2 |
713 |
Introduces diabetes type 2 risk evaluation for a person aged 40 to 49. |
|
Radiation oncology |
15700 and15705 |
Introduces radiation oncology treatment verification items. |
|
Brachytherapy |
15800 and 15850 |
Introduces brachytherapy treatment verification items. |
|
Allied health pervasive development (Autism) |
82000, 82005, 82010, 82015, 82020 and 82025 |
Introduces allied health pervasive developmental disorder services (Autism) items for children under 13 years to assist the referring practitioner with diagnosis, and new allied health treatment items provided to a child under 15 years. |
|
Pathology |
73920 |
Introduces one new patient episode initiation item for specimens collected in an approved collection centre co-located with an approved pathology laboratory. |
90 day pay provider cheque scheme for electronic claiming
Subject to legislation, the 90 day pay doctor cheque scheme will be extended to specialists, including pathologists and radiologists, where an unpaid or partially paid patient claim was lodged electronically.
It is expected that from 1 November 2008, where Medicare Australia has sent the patient a cheque made payable to the provider and it has not been presented within 90 days, Medicare Australia will automatically make the payment into the provider’s bank account via Electronic Funds Transfer.
A provider will be able to participate in the new scheme if they:
- are practicing as a medical practitioner and/or general practitioner
- submit the Medicare claim electronically.
The scheme does not extend to optometrists, allied health professionals and dentists.
There will not be any additional registration requirements for medical practitioners to access the new scheme, provided the original claim is submitted electronically by the provider on behalf of the patient. However, GPs who are not claiming electronically will still need to register under the existing scheme.
The legislation amendment was introduced into the Parliament on 19 March 2008. We will continue to provide you with updates about this scheme in Forum.
Medicare claims history information is now online
Do you ever receive questions from your patients about their Medicare claims history? They may want to know when they last saw you or another health professional.
Our new online service lets Australians view Medicare claims history information for themselves and any dependants aged under 14 years, for up to 12 months from the date of request.
This service helps Australians keep a record of their medical claims history. It is also useful for those interested in knowing when they last saw a doctor and the benefits they received.
If your patients ask you about where they can access this information, direct them to our Online Services or to visit any Medicare office.
If your patients have additional questions, they can call us on 13 20 11*.
Dr Peter Sexton—your voice in Medicare
The Medicare Australia provider strategy aims to build on our working relationship, and further increase your trust and confidence in the programs we deliver. We are continuing our consultation process with providers to develop a service improvement program with clearly defined priorities and actions, which is based on your feedback.
Our research shows that the landscape, roles and interactions with Medicare Australia are changing for all health professionals.
We acknowledge that:
- Increasingly, your practice managers and administrative staff are the coal-face in business dealings with us.
- You want us to recognise this constantly evolving business relationship.
- You want the right tools, processes and systems to ensure optimal delivery of payment and information services.
- You want consistency in the information and education we deliver to support our systems
and processes.
Some of the things we will focus on:
- electronic Medicare claiming
- streamlining processes by reducing red tape
- improving our partnership/relationships
- targeted communication
- education and access to practical consistent advice.
We would like to thank those people who have provided input into the development of this strategy.
To find out more about the provider strategy and the areas of improvement we are focused on delivering, please go online. I look forward to keeping you updated regarding provider strategy initiatives in future Forum editions.
Regards
Dr Peter Sexton
yourvoice@medicareaustralia.gov.au
Doctor’s Bag supplies - order your 2008–2010 book now
If you have not yet ordered your 2008–2010 Emergency drug (Doctor’s Bag) book, please complete an order form as soon as possible.
A specific list of pharmaceutical benefits is provided without charge to practitioners who in turn supply them free to patients for emergency use. These are known as ‘Doctor’s Bag’ benefits. General practitioners who have a prescriber number are entitled to access these benefits.
To order Doctor’s Bag supplies you need an Emergency drug (Doctor’s Bag) book, which is updated every two years. Order forms are located in your 2006–2008 Doctor’s Bag book. If you do not have a form, please call 13 22 90* and select option 2.
Please forward your completed form to:
Pharmaceutical Benefits Branch
Medicare Australia
GPO Box 9826
In your capital city
For more information about Doctor’s Bag supplies.
Letter to the Editor
Dear Editor
Where do I find a plan template for items 721 and 723?
Regards
Dr S
Dear Dr S
When preparing and claiming for a GP Management Plan (721) or Team Care Arrangement (723), you must document the plan in a way that addresses all Medicare requirements.
A sample template is available for you to use on the Department of Health and Ageing website. This provides optional tools to assist you with the patient assessment and preparation of the plan.
Item 721 covers the preparation of a GP Management Plan for patients with a chronic or terminal medical condition who will benefit from a structured approach to management of their care needs.
Item 723 is for patients with a chronic or terminal medical condition with complex care needs and who require ongoing care from a multidisciplinary team of their GP and at least two other health care providers.
Regards
The Editor
If you have a letter to the Editor, please send it to editor.forum@medicareaustralia.gov.au
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.au
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.au
For business information
Online www.business.gov.au
Feedback
We welcome your feedback about Forum.
Write Medicare Australia
PO Box 1001
TuggeranongDC ACT 2901
Email editor.forum@medicareaustralia.gov.au
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: 7 July, 2008