GPs should be able to see their billing against national averages: RACGP President

Doug Hendrie

23/09/2019 3:06:00 PM

Dr Harry Nespolon believes such a change would help to ensure GPs are billing correctly.

Dr Harry Nespolon
RACGP President Dr Harry Nespolon believes greater billing transparency would help to ease the mental load on GPs.

The calls come as the Department of Health (DoH) ramps up its compliance activities and broadens its scrutiny of Medicare billing, using what a medico-legal expert describes as increasingly sophisticated techniques. 
RACGP President Dr Harry Nespolon told newsGP greater billing transparency would help to ease the mental load on GPs.
‘We have heard from our members that the Department of Health’s increased compliance activities are leading to unnecessary stress and worry,’ he said.
‘We all have a common goal of improving health outcomes for the community. Let us see early on if there’s a potential issue, so we can fix it.’
Dr Nespolon said it would reduce stress on GPs if they could check the DoH’s records of their billing against the average, rather than hearing about an issue for the first time with a warning letter.
‘The Government is constantly talking about trying to fix an issue before it becomes a problem. We should have the technology to provide this information regularly and, in a sense, anonymously to all medical practitioners, not just GPs, who may be billing inappropriately,’ he said.
‘This will help GPs who do not lodge their own claims to see what is being billed under their provider number.’
MDA National medico-legal adviser Nerissa Ferrie has previously noted that DoH compliance efforts have increased in volume and sophistication, moving beyond obvious statistical outliers into analysis of billing ratios.
‘Billing ratios are being raised more often, which is a sign of the increased sophistication of the DoH’s analysis tools,’ she wrote for newsGP.  
‘In some [warning] letters, an area of concern may be timed item ratios – how many Level B consultations you bill versus Level Cs. They will quote the national average and then provide your ratio.’
These national ratios are, however, not readily accessible for GPs who want to ensure they are billing correctly.
A DoH spokesperson told newsGP there is currently no method for GPs to see their billing relative to their peers.
‘While GPs have a number of mechanisms available to them to get an overview of their claiming, there isn’t currently a mechanism which enables them to compare their claiming to that of their peers,’ the spokesperson said.
The DoH previously published Provider Percentile Charts for frequently claimed Medicare Benefits Schedule (MBS) items so GPs could see the distribution of claims. But that practice was ended after a collaboration with a Monash University team found the charts were linked to an increase in subsequent billing, the spokesperson said. 
Department of Human Services general manager Hank Jongen said doctors can generate reports for billing through his department’s Health Professional Online Services portal. He said GPs can also use the portal’s ‘Find a patient’ service to ensure a patient’s Medicare or Department of Veterans’ Affairs card was accurate, as well as the MBS Items Online Checker to check eligibility for patients based on their history and a GP’s eligibility to claim item numbers.
Mr Jongen said practices can use their management software to submit claims and generate claiming reports.
‘Alternatively, they can make a request to the Department of Human Services to obtain a statement of their claiming history,’ he said.

compliance Department of Health Medicare Medicare Benefits Schedule

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Dr Dan Hobbs   24/09/2019 2:02:31 PM

It is unclear why there is this belief that “average” equates to compliant, and “outlier” is seen as potentially noncompliant, since there are plenty of “inliers” who aren’t compliant.
Only with the Department of Health and the PSR are statistics and averages the reference standard; elsewhere it is whether care falls within professionally-accepted standards. If the Department’s and PSR’s standards were aligned with the rest of medicine and its regulation then doctors practising good medicine would have nothing to fear. At the moment however, they do.

Dr Christopher Jakob Topovsek   24/09/2019 6:53:30 PM

Bell curve = always outliers = "problem" never solved = more happy bureaucrats = more Bell curves