DoHDA to send ‘early intervention letters’ in October

More than 550 providers are set to receive ‘an early intervention letter’ encouraging them to take ‘proactive steps’ to put right any incorrect Medicare claims.
 
According to the Department of Health, Disability and Ageing (DoHDA), the ‘moiety’ campaign this month is aimed at 557 providers, including 100 GPs, who may have charged a co-payment for a bulk-billed service.
 
‘Did you know when bulk billing a patient, no additional charges can be applied for the same service?’ the letter states.
 
‘Under the Health Insurance Act 1973, bulk billing for a service means accepting the relevant Medicare benefit as full payment for that service.
 
‘This means that you cannot charge the patient an additional amount for that service such as booking fees or consumables like dressings or bandages.’
 
The correspondence requests recipients review their policies and procedures ‘to ensure alignment with bulk-billing requirements’.
 
‘If you have charged an additional fee for a bulk-billed service, or identify any incorrect claims, you can take proactive steps to correct them – including refunding out-of-pocket fees to patients or submitting a voluntary acknowledgement form,’ it advises.
 
Dr Tony Bayliss, the RACGP’s Medicare Compliance Lead GP and member of the RACGP Expert Committee – Funding and Health System Reform, says the campaign is part of an ongoing more collaborative ‘educational’ approach from DoHDA.
 
‘It’s good that they’ve started to involve us,’ he told newsGP.
 
‘It’s not even enforcement activity, this is educational activity.
 
‘It is a complicated area of Medicare billing, I think if you were to speak to most GPs they wouldn't even know what moiety is.
 
‘The vast majority of GPs try very hard to be compliant, but we’re aware that Medicare compliance in terms of billing is very complicated and the bulk of non-compliance is inadvertent because of this.
 
‘I welcome the fact that this is an education rather than an enforcement-type activity.
 
‘That means that the GPs will be able to review their billings and make adjustments in corrections as they see fit.’
 
Earlier this year, DoHDA sent more than 5000 compliance letters to GPs who may have claimed an MBS item while overseas.
 
DoHDA said its top compliance priorities for 2025 include items that are claimed when either the patient or the doctor are overseas. 
 
Dr Bayliss notes this most recent compliance campaign targets far fewer GPs than the previous one.
 
‘This represents a very small proportion of GPs and it indicates that GPs are generally able to do billing in compliance with the guidance,’ he said.
 
‘One of the things it does demonstrate is the importance of GPs reviewing their billings before [they] get batched because ultimately, we are responsible for being compliant.
 
‘The main point for me is this is a continuation of education rather than compliance, which is a philosophy that we’re very much on board with.
 
‘Even though the Department don’t always do what we want, they at least let us know what they’re doing and are open to feedback.’
 
GPs can subscribe to the college’s regulation and compliance newsletter via the RACGP website.
 
DoHDA’s fact sheet has more information. Any GP receiving a letter who has questions is advised to contact Targeted.Compliance.Education@health.gov.au.
 
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bulk-billing services compliance DoHDA intervention letters Medicare