Nudge letter targets nurse and chronic disease items

3 minute read

As a new round of compliance letters is sent out to GPs, the AMA is urging doctors to reach out for support if needed.

Around 600 GPs across Australia will be receiving a letter from the Department of Health in the coming days asking them to reflect on aspects of their billing practice.

The nudge letter will go to doctors who have claimed a chronic disease management item and an item 10997 – which remunerates practice nurse or Indigenous health worker services for a person with a chronic disease – for the same patient on the same day.

The compliance campaign covers the 12-month period starting March 2021 and ending February 2022.

While claiming these items on the same day is “not restricted”, the department “considers that item 10997 would not routinely be claimed at the same time as a [chronic disease management] item”.

The full descriptor of item 10998 requires that services are provided by a practice nurse or Indigenous health worker on behalf of and under the supervision of a medical practitioner, for a patient who is not admitted to a hospital and already has a GP Management Plan, Team Care Arrangement or Multidisciplinary Care Plan in place.

Patients can only access an item 10997 five times per calendar year.

“MBS item 10997 should not be claimed in relation to assistance provided to a GP to prepare or review a GP Management Plan or Team Care Arrangement,” the letter said.

AMA vice president Dr Danielle McMullen said the department seems to suspect that some doctors are routinely using item 10997 when a nurse is helping to prepare the care plan, when its intended use is for seeing a nurse between structured GP reviews.

“That’s not how they intend the item to be used,” she told The Medical Republic. “And so they’re asking doctors to reflect on that practice.”

All 596 GPs who receive a letter will be expected to review their services over the specified time period and prove that their claiming meets MBS requirements (i.e. the full item descriptor of each service is met).

If the department has any concerns about a provider potentially rorting the system intentionally, it may trigger an audit.

Dr McMullen acknowledged that receiving a nudge letter is often confronting and stressful and said the AMA had been working with the DoH to improve the wording of the letters.

“Make sure that if you’re concerned or upset by [the letter], reach out for support,” she said.

“But also recognise that this is really a focus on education and reflection and compliance is part of building a healthy system.”

The actual Medicare benefit attached to an item 10997 is $12.70.

The chronic disease items have higher rebates attached: item 721, which covers the preparation of a GP management plan, carries a benefit of $152.50 and item 729, which covers a contribution by a GP to a multidisciplinary care plan prepared by another provider, has a benefit of $74.40.

“We know that chronic disease management is complex and generally poorly remunerated, and that doctors put a lot of time into managing their patients with chronic disease outside of the [chronic disease management] items,” Dr McMullen said.

“We are working with government to better rebate patients for longer consultations, and part of the work of the Strengthening Medicare taskforce is around how to provide Medicare for people with chronic and complex disease.”

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