Push to lift knowledge of MBS billing rules

3 minute read

Doctors may soon need to prove their knowledge of MBS billing practices before receiving an MBS provider number


All doctors would need to prove their knowledge of Medicare billing practices before receiving a provider number, under draft recommendations before the MBS Review Taskforce.  

In its first report, the MBS Principles and Rules Committee states that many clinicians have limited understanding of Medicare billing rules and “may adopt questionable practices on the advice of colleagues”. 

Adopting mandatory training and testing using online resources provided by the Department of Human Resources is the first recommendation listed in the report. 

“The proposal, if implemented, would involve a modest additional impost on providers,” the committee says.  

“However, there would be potential benefits in terms of more efficient practice administration, and a reduced risk of incurring penalties (for example, the repayment of improperly paid benefits) from breaching compliance with MBS billing requirements.”

The committee recommends that professional colleges should include ongoing education in MBS rules and processes as part of their continuing professional development programs.

 The panel took aim at the issue of GP referrals to specialists, noting there seemed to be an “excess” of initial specialist and consultant physician attendances being claimed.  

“In part, this may be due to confusion over whether initiation of a new referral is linked to the ability to claim an initial attendance,” it said. 

The committee recommended options, including clearer rules and definitions of a “single course of treatment” and time-tiered attendances for specialists and consultant physicians, as currently apply to GP attendances.

It said the initial/subsequent attendance structure could be replaced with a new, single specialist attendance item, supplemented by an extended specialist attendance item when the attendance lasts for longer than, say, 40 minutes, with the new item designed to be cost neutral.

To crack down on overbilling and improve transparency, the report called for restricting clinicians to a maximum of claiming three MBS items for a procedure.

“It is now commonplace, for example,  for many surgical procedures to be billed using different multiple item numbers for the same surgery,” the report said.

“This practice is not transparent, potentially unfair and appears to be a misuse of the intention behind the multiple operation rule.”

Despite misgivings from some providers and consumers, it agreed to keep the three-month rule on specialist-to-specialist referrals, saying referrals should reflect the primacy of GPs as gatekeepers to the health system.

It said the three-month time limit promoted patient-GP contact.

“This was seen to be especially important when the patient’s condition changes or they develop new conditions, and these can be better and more efficiently managed by the GP.”

As foreshadowed, the committee calls for ending the so-called G&S anomaly, where GPs and specialists earn different fees for performing the same service, and paying GPs at a matching rate.

There are currently 64 such items in the MBS—that is, 32 services which have a different item number depending on whether they are provided by a GP or a specialist, left over from a much higher number of items introduced in the 1970s.

Data shows only a small number of GPs are providing such services, and many in a hospital setting,  the report says.

Doctors and consumers are invited to offer their views on the recommendations in a consultation process open till 7 October .

Read the report here.


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