DoHAC warns over ‘possibly non-compliant’ PoC HbA1c billing

3 minute read

Thousands of MBS items for HbA1c tests have been claimed by GPs over recent years, despite a lack of accredited clinics.

The Department of Health and Aged Care has raised concerns with the RACGP over potentially uncompliant Medicare billing of item numbers for HbA1c testing in general practice. 

In 2021, Medicare introduced two new item numbers, 73812 and 73826, that allow GPs and nurse practitioners, respectively, to perform glycated haemoglobin point-of care tests. 

The change followed advocacy from the RACGP, to enable enhanced and timely management for chronic disease. 

The new item numbers required practices to be accredited by an approved agency through the National General Practice Accreditation Scheme in order to claim. 

But, despite no practices having accreditation to date, according to DoHAC, over 7600 item 73812s have been claimed since 2021

Since their introduction, claims for PoC HbA1c tests performed by GPs have steadily risen, from 135 in 2021 and 2807 in 2022, to 4009 last year. 

As of February, the item has been claimed 659 times this year alone. 

Medicare claims for HbA1c tests undertaken by nurse practitioners have remained very low, with only 13 claimed in total. 

In a recent compliance meeting, DoHAC warned the RACGP of the widespread and possibly uncompliant billing. 

A DoHAC spokesperson told newsGP that without accreditation, practices were not eligible to claim for items 73812 and 73826. 

“Accreditation requirements are important because they provide a quality framework for the provision of Medicare eligible services, ensuring patient safety and the consistent delivery of value for money and quality services nationally,” they said. 

“Where the department’s compliance assessment procedures identify potential incorrect payments, it may pursue a range of responses including education, audit, and recovery of incorrectly paid Medicare benefits.” 

Regional GP and RACGP rural council censor Dr Ken Wanguhu told newsGP that HbA1c testing in general practice can be the only option outside major cities. 

“Point-of-care testing helps us make literally lifesaving decisions and it’s absolutely vital for my everyday work because it allows me to take the guesswork out of my decisions,” he said. 

“It means our patients don’t have to wait two days for a result and they don’t have to travel … and without it, patients have to travel long distances at great cost to the system and the patient. 

“Asking a patient to leave their family and go to the city for two or three days is sometimes not an option, and it’s a major undertaking for many of our patients who are not in a city where you can hop onto a bus, go to hospital, get things checked, and come back.” 

A list of accreditation services can be found on the ACSQHC website.  

Accreditation must be in line with Standards for general practices (5th edition). Once practices register with an agency, accreditation assessment must be completed within 12 months.  

The accreditation cycle lasts three years. 

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