Bulk billing incentives, a new PIP, new women’s health items and changes to mental health… all on the same day.
In just over a week from time of writing, Medicare will receive the single largest funding injection in its 41-year history.
But, in its infinite wisdom, the government has also selected that as the go-live date for several other health-related initiatives.
What could go wrong?
Here’s the fast facts on just a few of the changes.
Bulk billing incentives
Do GPs need to register for this: No.
What’s changing: Bulk billing incentives already exist, but only apply to a very specific cohort of patients.
Historically, this has included children under 16, people with a Pensioner Concession Card, Health Care Card holders and people with a Commonwealth Seniors Health Card.
From 1 November, it will be automatically expanded to all Australians.
The expanded bulk billing incentives apply no matter what billing model the practice operates, so long as the patient is bulk billed for that specific service.
To claim the additional payment, GPs bill both a regular unreferred services consult item and the appropriate bulk billing incentive item (one of: 10990, 10991, 10992, 75855, 75856, 75857, 75858, 75870, 75871, 75872, 75873, 75874, 75875, 75876, 75880, 75881, 75882, 75883, 75884 or 75885).
This secondary item can only be charged if the patient is bulk billed, and its value depends on the type of consult and location that the doctor is practising in.
Advocacy groups like the AMA have long maintained that the bulk billing incentives do not cover the true cost of delivering high-quality medicine.
Bulk billing PIP
Do GPs need to register for this: Yes.
What’s changing: This is an entirely new practice incentive payment and requires practices to commit to universal bulk billing of all GP non-referred attendance items.
In exchange for bulk billing, participating clinics will receive quarterly payments equal to 12.5% of their bulk billing income, which includes the additional money made from the expanded bulk billing incentive.
The payments will be split 50/50 between practices and GPs.
There are other strings attached, too; participating clinics must display certain signage and register on Healthdirect as a universal bulk biller.
GPs can still charge a gap fee for some procedural items.
Related
Women’s health package
Do GPs need to register for this:No.
What’s changing: MBS items for long-acting reversible contraceptive procedures will increase substantially, as part of a women’s health package promised back in February.
On November 1, the MBS rebate for IUD insertion will go from $93.55 to $215.95, and contraceptive implant insertion will increase from $41.50 to $100.40.
There will also be new items that provide a 40% loading payment when the entire LARC service is bulk billed.
New items that allow appropriately trained nurse practitioners to insert LARCs will also be introduced.
Other parts of this package, like new items for menopause health assessments, are already live.
Mental health
Do GPs need to register for this: MyMedicare registration is strictly voluntary.
What’s changing: People who are registered with MyMedicare will only be able to see their MyMedicare-registered GP for a Mental Health Treatment Plan.
Those who are not registered with MyMedicare can continue seeing their preferred practitioner for a Mental Health Treatment Plan; being registered with MyMedicare is not a prerequisite for accessing a plan.
Mental health plan telehealth items will also no longer be exempt from the established clinical relationship rules.
In addition, all Mental Health Treatment Plan review items and ongoing mental health consultation items will be removed from the MBS, with doctors advised to use regular time-tiered items instead.
Technically, the rebates for time-tiered items are slightly higher than the soon-to-be-defunct treatment plan review items.
Referrals for mental health treatment services dated before 1 November will remain valid.
