January 2011 - Australian Optometry article
Medicare Australia compliance activity update
In December 2010, Medicare Australia began a number of compliance activities relating to Medicare Benefits Scheme (MBS) optometrical items. These activities include audit, Practitioner Review Program intervention and distribution of targeted information letters.
The compliance activities which will continue in 2011, focus on:
- billing of unilateral and bilateral computerised perimetry items (MBS items 10940 and 10941) on the same day to the same patient
- optometrists with comparatively high proportions of computerised perimetry items (MBS items 10940 and 10941) compared to their total MBS items
- possible upcoding of MBS Item 10907 to MBS Item 10914
- optometrists who may be charging patients above the MBS schedule fee contrary to the Common Form of Undertaking for Participating Optometrists.
As part of the audit activities, self assessment schedules will be sent to optometrists for completion. Medicare Australia may also contact other parties, such as patients, to additional seek information or conduct data analysis using servicing histories to confirm that benefits were paid correctly. Where audit results identify services which do not meet the MBS item requirements, Medicare Australia may choose to recover the incorrectly paid benefits.
Should optometrists who have been contacted as part of these compliance activities have questions, these should be directed to the contact person identified in the audit or information letters.
For more information, go to Practitioner Review Program page.
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Last updated: 7 July, 2011