MBS item number changes – Residential Aged Care Facilities (RACF)

The new item number changes for March 2018 have been released and clarification from MBS provides an understanding on the correct method of billing and utilising the new 90001 and 90002 item numbers.

As of March 1 2019, when a General Practitioner or Non-GP specialist attends during normal hours for routine attendances, they will no longer use a derived fee structure. The practitioner will bill either item 90001 or 90002 in combination with the time based item number for the first patient attended.

For example, if the first patient of the day at the nursing home was a level B (less than 20 min) item number 90035 AND item 90001 would be billed – ($37.60 + $55.00 = $92.60) – this is $7.60 more than the previous payment of Item 35/1 at $85.00.

Each patient after the first attendance is then billed the relevant time based item number with no record of how many patients are seen at each visit. If a practitioner sees more than 16 patients in a single visit the 17th patient’s fees will be less than what was received on the previous Medicare rebates (source: Business For Doctors).

Summary

  • Residential Aged Care Facility item numbers for in-hours consultations have changed to include a single flag-fall regardless of the number of patients seen at one visit.
  • There are no restrictions on the number of attendances a clinician can make to a RACF in one day and the flag fall should be billed in conjunction with the first patient that is attended at each visit to the facility.
  • MBS rebates are greater than the current rebates until more than seventeen patients are seen in one visit.

For more information: MBS RACF Fact Sheet

New Dedicated Medicare Item: Heart Health Checks

From April 1 this year a new dedicated MBS item for heart health checks will support General Practitioners and patients in assessing cardiovascular risk.

The independent medical experts at the Medical Benefits Schedule Review Taskforce will also conduct a review with the potential for further development of this new Medicare item.

Further information can be found on this media release.

AskMBS Email Advice Service for Schedule Interpretation

The Department of Health (Health) provides an email advice service for providers seeking advice on interpretation of the Medicare Benefits Schedule items and rules (including those for Dental, Pathology and Diagnostic Imaging) and the Health Insurance Act and associated regulations. From 1 March 2019 the AskMBS email service has transitioned from the Department of Human Services to the Department of Health. The askMBS@humanservices.gov.au email box is no longer being monitored.

Please direct all enquiries to askmbs@health.gov.au

If you have a query relating exclusively to interpretation of the Schedule, you should email askMBS@health.gov.au

If you are seeking advice in relation to Medicare billing, claiming, payments or obtaining a provider number, please contact the Department of Human Services on the Provider Enquiry Line - 13 21 50

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