New ‘targeted awareness’ approach for Medicare compliance

The Department of Health (DoH) has said it is adopting a new, lighter touch approach towards Medicare compliance, which will run in addition to its more hard-line measures.
 
Called ‘targeted awareness raising’, the approach is aimed at those demonstrating the ‘lowest levels of potentially non-compliant claiming behaviour’, and has been designed to complement existing measures such as targeted campaign letters, audits and practitioner reviews.
 
‘Targeted awareness raising involves the department writing to providers who are exhibiting lower levels of possible non-compliance to bring to their attention Medicare claiming rules,’ they wrote in a statement provided to newsGP.
 
‘It is the department’s expectation that providers will use this information to make any necessary changes to ensure their future claiming is compliant.’
 
The first batch of ‘targeted awareness letters’ focus on aftercare items, newsGP understands.    
 
RACGP President Dr Karen Price described the new approach as ‘a step in the right direction’, after a highly criticised compliance campaign targeted GPs caught out by new Medicare Benefits Schedule (MBS) rules surrounding telehealth.
 
Dr Price wrote an open letter earlier this year to outline the college’s concerns and said the new approach is the result of the proactive stance taken by the RACGP towards the DoH and Professional Services Review (PSR).
 
‘They are listening to the feedback,’ Dr Price told newsGP. ‘There is certainly a desire to engage with the medical profession so that compliance targets only the people who are genuinely involved in deliberate acts.

‘If something happens that is not a lapse of professionalism but an outcome of a very complex system, then that can be managed in an educative way. We think that is a much better way to approach GPs.’
 
The DoH said it has been working with peak bodies including the RACGP on the approach, which is designed to provide GPs and other health providers with the relevant information required to lodge claims. MBS fact sheets and rules are included with the letters.
 
‘While recognising the impact of responding to COVID-19, the department has a legislative responsibility to address potential non-compliance with Medicare claiming rules and it is important that providers have access to this information early to avoid potentially non-compliant claiming continuing,’ the DoH said.
 
In contrast to the compliance letters that went out to GPs around telehealth billing last year, the DoH correspondence for the targeted awareness raising will not include a schedule of claims.
 
Dr Price said the complexity of the Medicare system often causes problems.
 
‘Just understanding the Medicare Benefits Schedule is becoming a discipline in itself,’ she said.
 
‘We are conscientious individuals delivering healthcare and are extraordinarily busy with the complexity of that, so to have audits and justifications is a very stressful situation.
 
‘Anything that can be done to lessen that for people who are not deliberately doing anything wrong is a good move.’
 
However, there are ongoing concerns that general practices with a particular specialty could be targeted unfairly.
 
‘We’re interested in making sure that ordinary practice doesn’t get caught up in this,’ Dr Price said.
 
‘You might have a practice that’s focused on refugee health or diabetes care, for instance, so your skew of Medicare items will be necessarily different.
 
‘Variation in practice shouldn’t mean that you should generate a Medicare audit.’
 
Dr Price said the new approach’s impact will be monitored carefully and any member concerns conveyed to the department. She believes that if the perception of the onerous levels of compliance required for general practice does not improve, it could compromise efforts to recruit and retain new GPs.
 
‘I hope we can continue to have the discussion about the bigger system issues around the complexity of Medicare,’ she said.
 
Webinar and Medicare survey
The RACGP is running a survey for doctors, aimed at assessing the value of current compliance resources and any other resources that could be introduced to help GPs bill Medicare.
 
An ‘Understanding Medicare compliance’ webinar is also being held for GPs in training on Wednesday 24 November at 6.30 pm (AEDT).
 
The webinar will use billing scenarios to look at problematic MBS item numbers, and provide information on note-taking requirements and compliance education resources to help GPs bill correctly.
 
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