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DoHDA will be conducting a risk assessment/analysis of the following issues:
- Providers not meeting the established clinical relationship requirement (12-month rule) for Medicare Benefits Schedule (MBS) telehealth services, with a particular focus on on-demand companies and platforms.
- Multiple payments made under the Pharmaceutical Benefits Scheme (PBS). For example, where more than one claim is made for the same supply of medicines, or where claims for two identical prescriptions are made but only one is eligible for a PBS subsidy.
- MBS multidisciplinary case conferencing items – DoHDA is continuing to work through data relating to these items.
The use of artificial intelligence (AI) to support MBS billing and clinical record keeping
Our last newsletter touched on AI as an emerging compliance risk, with this technology increasingly used to support MBS billing and record keeping. We encourage you to familiarise yourself with the RACGP’s position statement on AI in primary care. We also have resources to help GPs weigh up the potential advantages and disadvantages of using AI scribes and conversational AI in their practice.
Referring patients for geriatrician assessment and management plans (MBS items 141–147)
MBS items 141, 143, 145, and 147 provide for the comprehensive assessment and development of a management plan for patients aged 65 years and over. These services support older patients with complex health needs. They are provided by a consultant physician or specialist in the specialty of geriatric medicine, who has completed the additional requirements of the Royal Australasian College of Physicians (RACP) for recognition in the subspecialty of geriatric medicine.
Referrals for these items can only be made by a GP, medical practitioner working in general practice, or a participating nurse practitioner. To be eligible for Medicare benefits, these services must be initiated by the referring practitioner specifically for the purpose of conducting a comprehensive assessment and developing a management plan. Click here for information on what to include in a referral, receiving the report and management plan, and reviewing a management plan.
Scam awareness
In partnership with Services Australia, DoHDA is seeking to promote awareness of scams targeting health professionals to gain access to their Provider Digital Access (PRODA) accounts. These credentials are then used in a range of ways for scammers to seek financial benefits they are not entitled to, including Medicare benefits.
A new fact sheet on this topic is now available. This outlines best practice protection for health professionals, including what to look out for to avoid scams.
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