June 2008—Australian Optometry article
Can I bill Medicare if I see more than one member of a family on the same day?
Yes. There are legitimate reasons why you may bill Medicare for seeing more than one family member on the same day but it is your responsibility to ensure that the services billed to Medicare for each family group member are clinically relevant.
Family servicing is defined in the Director of Professional Services Review Report to the Professions: 2006-07 as 'seeing more than one family member on the same Medicare card on the same day'. The report goes on to say:
'While on most occasions this will be quite legitimate, there have been cases where, for example, a parent or guardian may bring in a child who is ill and after seeing that child the parent or guardian says: "the other kids seem OK but could you check them while we’re here?" This can be a minefield for the doctor as it may be difficult to refuse such a request. However, if there is no clinical reason for the other children to present to the doctor, a Medicare rebateable fee cannot be charged.'
While this example is from a medical practice, optometrists may face similar situations, for example, a couple or family group who attend the practice together with only one appointment for an eye examination.
In this case, an eye examination under Medicare should be carried out on the other family members only where there is a clinically relevant reason to do so.
What is a clinically relevant service?
A clinically relevant service, as defined in the Medicare Benefits Schedule, 1 November 2007, is 'one which is generally accepted by the profession in question as necessary for the appropriate treatment of the patient'.
Services that are not clinically relevant must not be included in the charge for a Medicare item. Any fees for such services must be listed separately on the account and not billed to Medicare.
For more information call Medicare Australia on 132 150* and ask to speak with an optometric adviser.
* Call charges apply
Last updated: 18 March, 2010