News
Go-to Medicare guide aims to arm GPs with confidence
A new RACGP-backed resource provides clarity on Medicare’s principles and mechanisms to support navigation of, and compliance with, the complex system.
The new plain English guide aims to address challenges GPs may face when navigating the complex Medicare system.
The complexities of navigating Medicare are expected to be eased with the release of a new, simple handbook on the moving parts of the system.
The Department of Health and Aged Care (DoHAC) Medicare Integrity Taskforce has released the Understanding Medicare: Provider Handbook – a plain English guide detailing its basics and ‘core principles’ to support healthcare professionals navigating the system.
The resource is an outcome of the Philip Review published in April 2023, which called for a significant overhaul of a system ‘not currently fit for purpose’, and is also designed to steer Medicare compliance.
The new resource provides clear guidance on essential Medicare topics including benefits, claiming, hospitals, and Medicare Safety Nets, as well as detailing MBS rules and requirements, and advice on where to get further information and support.
The handbook introduces the fundamental concepts of Medicare and is designed to ‘build a foundational knowledge’ from the beginning of a health professional’s journey with the system and MBS items.
It can also be used for all healthcare providers to check their responsibilities when claiming with Medicare, as well as support administrative staff to help them gain a better understanding of the system.
Its chapters include:
- what is Medicare?
- when is a Medicare benefit payable?
- incorrect payments
- administrative requirements
- how providers submit claims.
RACGP President Dr Michael Wright welcomed the newly available resource.
‘For a long time, the RACGP has been asking for greater support and educational resources for GPs so we understand Medicare, and can use it with confidence,’ he told
newsGP.
‘We know the MBS can be confusing with so many item numbers, and sometimes unclear advice.
‘This is something we’ve been asking for – clarity around Medicare’s rules so that GPs know what the most appropriate item is and feel confident.’
As part of a ‘consultative, co-design approach’, stakeholder feedback from peak organisations, state health authorities and primary health networks was collated to develop the handbook.
The RACGP was among the peak organisations to review and provide feedback, agreeing it would be a useful resource for providers new to the system. The college also:
- noted the DoHAC addressed its feedback regarding clarifying some case studies and adding new ones, for example, relating to the Medicare Safety Net
- suggested it would be reasonable to require those applying for a Medicare provider number to declare they understand the content by ticking a box, but does not support mandating the reading of the document as providers consume information about Medicare in different ways. The DoHAC is yet to make a decision on this.
As part of its ongoing efforts to provide wraparound support for international medical graduates (IMGs), the RACGP deems the new Medicare handbook to be especially helpful for newer doctors and IMGs, or for those with English as a second language.
Immediate past RACGP President Dr Nicole Higgins
recently highlighted that the medical system ‘is confusing for Australian doctors, let alone for a new doctor coming into the country’.
Dr Michael Bonning, a member of the RACGP Expert Committee – Funding and Health System Reform, told
newsGP the handbook ‘serves as an important starting point in the education of those new to the MBS’.
‘Medicare and the MBS is very complex and that is true even of GPs and doctors who have worked in the system for their entire career,’ he said.
‘Any reference and resource that can make navigating the system is very overdue and must be practical and continue to be informed by doctors’ experiences.
‘The experience of new doctors and IMGs with the MBS is one often of complete uncertainty and generally results in billing practices that mirror supervisors or colleagues without any real understanding of the complexity or the MBS rules.’
And while the handbook states it may contain ‘some unfamiliar language’ for those who are new to the system, Medicare-specific terms are defined throughout, and a glossary is provided.
Dr Wright says it will be a ‘great resource’ for anyone not familiar with Medicare’s rules.
‘It will be particularly helpful for new doctors of all types, doctors new to Australia, but will be a handy reference for anyone using Medicare,’ he said.
‘I will certainly be making sure I am familiar with its contents.’
The release of the handbook comes following
a recent newsGP poll revealing three in four doctors are not confident navigating the Medicare billing system.
Elsewhere,
previous research found many GPs are ill-equipped to navigate the compliance rules embedded in the system.
The
Understanding Medicare: Provider Handbook is available on the
DoHAC website, and the RACGP has added it to its
Medicare compliance resource page under ‘Medicare basics’.
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