New compliance letters to target bulk billing incentive items

Doug Hendrie

22/07/2019 4:12:13 PM

A crackdown on bulk billing incentive items is part of what medicolegal experts dub an ‘increasing compliance program’.

Medicare card
Bulk billing incentives are under the spotlight.

Hundreds of GPs have been sent a ‘Review and Act Now’ letter around Medicare Benefits Schedule (MBS) claiming activity for bulk bill incentive items 10990, 10991 and 10992.
The letter asks recipients to review potential claiming errors for patients who were not concession card holders or not under the age of 16, but who had been billed one of the three items.
The review covers January to December last year.
A Department of Health spokesperson said the letters were sent to 425 healthcare providers, who were mostly GPs. 

MDA National professional services executive manager Dr Sara Bird told newsGP the letters are part of a wider compliance program being rolled out by the Department of Health (DoH).
‘It’s well worth GPs being aware of this. The department’s compliance activities are certainly increasing around Medicare. What they’re often looking at is where more than one item number is billed at the same time,’ she said.
‘It’s important that you’re aware of what the item numbers are that you’re billing, reviewing them on a regular basis, and making sure you and your practice staff are aware of what the criteria are.
‘My view is that if you’re going to bill an item number, you should make sure you’ve read the MBS descriptor. Ultimately, it’s the individual doctor who is responsible, if it’s billed under your provider number.
‘If you’re looking through the list of items claimed under your name at the end of each week and you see an item number you’re not familiar with, read what it is and make sure the criteria have been met.’ 

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Dr Evan Ackermann   22/07/2019 9:50:28 PM

Looks like the "nudge technique" has become the default instrument of regulatory enforcement.

Dr David Adam   23/07/2019 2:01:31 PM

I'm surprised the online billing systems don't reject invalid concessional items outright - I imagine the history of Medicare from the DoH and HCC being DHS is why though

Mark Miller   23/07/2019 6:45:27 PM

At the time of the Medicare OPV check (when a patient checks in) would be an ideal time for an automated compliance flag to indicate the patient is/is not eligible for the bulk billing incentive items and would theoretically greatly decrease any chance of error.

Graeme Banks   27/07/2019 7:11:20 AM

I’ m retiring at Xmas time.
Thank God I won’t have to put up with this sort of crap anymore.
Good luck to the rest of you watching general practice die.

Dr Makawitage Duminika Minushi Perera   27/07/2019 9:55:30 AM

Isn’t the incentive item number something that automatically comes up ? We don’t enter it ourselves ..

Dr Andrew Carr   27/07/2019 4:19:54 PM

Is this perhaps a way to encourage GPs to move away from bulk billing to private, in a coupled bid to encourage people to go to the pharmacy for ‘simple’ care?

Dr Horst Paul Herb   27/07/2019 11:01:17 PM

The whole system is geared towards more often defrauding us doctors than the other way round - Medicare knows which patients are entitled to the incentive item. If they were fair and just, they would run the system by allowing us to merely indicate whether a claim was bulk billed or not, and automatically pay the incentive if applicable.

As it is designed, we are missing out often ion the item - sometimes because patients are actually too ashamed to concede that they have a concessional card, sometimes because checking compliance is too much effort and costs too much, and hence we forfeit it - or take the patient's word for it and may fall foul of the regulation if we were lied to.

I guess most of us would be much happier to comply with items to the letter if Medicare was fair in its dealings... and would be able to give a legally binding and concise definition of all item numbers.

Michael Kozminsky   28/07/2019 8:17:38 PM

And the audit will reimburse for those eligible but unknown to be eligible so not paid
Eg patient lost his job & we didn’t know

Dr Sherif Francis   2/08/2019 5:52:35 PM

Time to move to Gap payment guys. $30 or $40 Gap unless proof of health care is produced by the patient. the worst case is 3 month waiting on the balance. I will start exploring this option.

Dr Stephen Gann   7/08/2019 12:08:20 PM

I received that STUPID letter!
I work in an Aboriginal Medical Practice in a very remote area.
Almost all, if not all, of my patients have concession cards.
Medicare has stuffed up (or F..... up) again!

Dr Alfredo Osmar Aiello   21/08/2019 7:55:00 AM

The government invests millions of dollars to recover money?
Why don’t they use the millions for GPS to earn a decent wage.

Dr Aseel Sherif Marioud   26/01/2020 5:51:04 PM

No appreciation to our hard work
They basically telling us to quit Gneral practise or bill private