The once-per-lifetime check will go live in just over one month… but it won’t always be the better financial choice.
More than a decade after Medicare-funded children’s health checks were phased out, the scheme will return to the MBS – here’s what will be different.
From 1 November, GPs will be able to use the existing sets of time-tiered health assessment items (701-707 for fellowed GPs, 224-227 for other medical practitioners) to perform a one-off “Medicare Healthy Kids Check” for Medicare-eligible three-year-olds.
The item can only be claimed once per child. It will not be available to patients who are under three years of age or over four years of age.
All checks must include an assessment of the toddler’s family relationships, their behaviours, their environment, and their progress against age-appropriate developmental milestones, as well as their toileting habits and urinary continence.
Related
The physical portion of the service must include an examination of the patient’s eyesight, hearing, and oral health, alongside measurements of their height and wright.
Other mandatory steps are to provide advice to the patient’s carer about the child’s physical, social, and emotional development, and how to engage in activities that support development.
GPs must also arrange any “necessary” interventions or referrals, add a record of the health assessment to the patient’s medical record, and offer a written report to the patient’s carer.
The item is technically part of the broader Thriving Kids initiative, which seeks to identify and provide early intervention for children with developmental delays or autism.
Because the $126.1 million in funding for the Healthy Kids Check was awarded as part of the Thriving Kids initiative, its introduction is subject to the Thriving Kids legislation passing before 1 November.
But will it be worth more?
Because of the quirks of Medicare’s bias against longer appointments, GPs may not always be financially better off billing the health check MBS items.
The time-tiered MBS rebates for health checks start at $71 for consults lasting less than 30 minutes, which translates to $2.44 per minute at the very least (i.e., assuming the consult runs for 29 minutes).
Without the health check item, a 30-minute GP consult is rebated under item 36, which covers consults between 20 minutes and 40 minutes and is worth $87.10.
Again, assuming the consult runs for 29 minutes in total, the minimum per-minute rebate is $3.00.
In instances where a health check runs to 29 minutes or less, then, GPs are financially better off by billing the MBS item for a regular consult.
If the health check runs longer, though, this changes.
The rebate for an item 703, which covers health checks running longer than 30 minutes but shorter than 45 minutes, is worth $165.05.
The largest per-minute rebate (assuming a 30-minute consult) is $5.50 per minute, while the lowest per-minute rebate for this item (assuming a 44-minute consult) is $3.75 per minute.
Translating these to time-based consult (i.e., non-health check) items: a 30-minute consult under item 36 is rebated at $2.90 per minute, and a 44-minute consult under item 44 also works out to about $2.92 per minute.
Therefore, for health checks which take 30 minutes or more, GPs are financially better off billing a health check item.
There are two additional time-tiered health assessment levels: item 705, which is rebated at $227.75 and covers assessment consults between 45 and 60 minutes; and item 707, which is rebated at $321.75 and covers all health assessments longer than 60 minutes.
These are both worth more than their time-based consult rebate equivalents.
