GPs want telehealth clarity

Dr Rob Hosking, Chair of the RACGP Expert Committee – Practice Technology and Management (REC–PTM), believes the rules around telehealth could have been clearer, after around 500 GPs received letters last week indicating they had been billing Medicare incorrectly for some telehealth consultations.
 
The Department of Health (DoH) had initially identified thousands of GPs in breach of the rules, but reduced the scope of its compliance activity following RACGP advocacy.
 
The majority of the breaches reportedly relate to the requirement for a patient to have seen a GP – or a GP at the same practice – face-to-face in the 12 months prior to the telehealth consultation, and the DoH has asked some GPs to undertake a self-audit and repay money that was a result of incorrect billing.
 
‘There is some uncertainty among some GPs about when the 12 months starts,’ Dr Hosking told newsGP.
 
‘The interpretation of a lot of GPs had been, “Well, this is a COVID emergency” and … the intention [of the rule] was that we just had to prove that this person had been a patient of our practice [in the 12 months prior to the telehealth item numbers being created].
 
‘But you can only keep doing telehealth using those item numbers up until it has been 12 months from the last face-to-face consultation, and then you have to have another face-to-face consultation.
 
‘It’s caught GPs out who have [now] been doing telehealth with patients for longer than the 12-month period.’

However, despite the tone of the letters, RACGP President Dr Karen Price told newsGP it is her understanding the requested self-audits are in this instance a voluntary process, aimed at promoting the rules.

‘It is important that all GPs do their best to familiarise themselves with these rules and ensure they are meeting the requirements concerning telehealth consultations,’ she said.

‘The RACGP has worked hard to ensure general practices are up to date with the changes introduced in July last year, and we will continue to do so.’
 
According to Dr Hosking, other complicating factors include exemptions related to patients who had been complying with COVID-19 restrictions.
 
‘An exception [to the rule] is if you’re in a COVID-affected area, and Melbourne was in at least three months of COVID lockdown, and then there was another five days back in January,’ he said.
 
‘Should those episodes of lockdown extend the 12 months? There doesn’t seem to be any clarity about that.
 
‘There have also been other people [in different states] who’ve been affected with outbreaks in cafes and things nearby them, and they’re confused as to whether that means you’re in a COVID affected area.’
 
Regardless of the Medicare Benefits Schedule (MBS) item descriptors’ wording, GP Dr Nathan Pinskier says the DoH could have taken a different, more immediate approach to ensuring GPs were complying with the rules.
 
‘The MBS has very sophisticated algorithms in terms of billing and claiming, and certainly they would have known from the first time a doctor lodged a claim after the 12 month face-to-face period, [and] it should have been rejected immediately,’ he told newsGP.
 
‘We wouldn’t have gotten to this point. The fact we are doing a post-audit months and months and months later, with very busy frontline GPs who are now in the middle of the COVID vaccine rollout, to me actually makes no sense whatsoever.
 
‘They could have dealt with it prospectively, not retrospectively.’
 
Dr Pinskier also believes that the compliance activity does not match up with the intention of the rules.
 
‘There was an original rule with no 12-month MBS requirement, which … resulted in a massive increase in the utilisation of the item by virtual clinics anywhere around Australia with no physical bricks and mortar,’ he said.
 
‘And as we predicted that represented a potential threat to quality and continuity of care, while also undermining the sustainability of regular, well-establish general practices.
 
‘The intent of that regulation was to restrict virtual clinics who had just sprung up from creating potential havoc and disrupting the marketplace … but for the regular doctor with a regular patient, it just seems ludicrous that it’s got to this position and some common sense needs to prevail.’
 
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