Orientation to Practice - Queensland Health · Medicare funds to Queensland Health have been extended under section 19(2) of the Health Insurance Act which allows Queensland Health

Orientationto Practice

OR3400 MedicareWorkbook

Medicare Version1 (2014) A Primary Health Care Approach

OR3400 Medicare

Name

Community

Site

Position

Date Completed

Medicare Version1 (2014) A Primary Health Care Approach 2

Contents

OR3400 Medicare - Introduction 4OR3400 Pre-Session Survey 6OR3401-1 Rural and Remote Medical Benefits Scheme (RRMBS) 7OR3401-1 Learning Activity 10OR3401-2 COAG Exemption 11OR3401-2 Learning Activity 14OR3401-3 Pharmaceutical Benefits Scheme (PBS) S100 15OR3401-3 Learning Activity 17OR3402 RRMBS in practice 18Administration Officers 19Medical Officers 19Dentists, Dental Specialist or Dental Prosthetist 27Nurse Practitioners 27Practice Nurse (RN or EN) 30Midwives 32Aboriginal and / or Torres Strait Islander Health Health Workers 36Allied Health Workers 39Medical Officers After Hours 49Manual Medicare Voucher DB2-GP General Practitioner 50Batching Medicare Vouchers - Manual Vouchers 52Batching Medicare Vouchers - Electronic Vouchers 52Pathology Tests 53More Information 54Web Sites 54Help and Assistance 54OR3400 Theory to Practice 55OR3400 Quiz 59OR3401-1 Learning Activity Feedback 63OR3401-2 Learning Activity Feedback 65OR3401-3 Learning Activity Feedback 66OR3400 Theory to Practice Feedback 67OR3400 Quiz Feedback 71OR3400 - Post-Session Survey 75

Medicare Version1 (2014) A Primary Health Care Approach4

OR3400 Medicare - Introduction

Session Overview

Welcome to session OR3400 Medicare. This session examines the three Medicare schemes which have been developed to support the delivery of health services in rural and remote and primary health care settings. It includes a number of modules, which are divided by learning activities. They can be completed all at once or one at a time.

Introduction

Medicare ensures that all Australians have access to free or low-cost medical, optometric and hospital care while being free to choose private health services and in special circumstances allied health services. It provides access to free treatment as a public client in a public hospital and free or subsidised treatment by practitioners such as doctors, specialists, participating optometrists and dentists (specified services only).

Australia’s public hospital system is jointly funded by the Australian Government and state and territory governments and is administered by state and territory health departments. The Australian Government’s funding includes three major national subsidy schemes

•Medicare, •Pharmaceutical Benefits Scheme and• 30% Private Health Insurance Rebate

The contribution to the health care system is based on individual income and is made through taxes and the Medicare levy. Medicare funds are allocated to all Australian states and territories to provide health services via the National Healthcare Agreement.

Medicare funds to Queensland Health have been extended under section 19(2) of the Health Insurance Act which allows Queensland Health to bill Medicare Australia direct for the delivery of eligible medical services provided by staff employed by Queensland Health at approved rural and remote sites. There are two schemes, one is the Rural and Remote Medical Benefits Scheme (RRMBS) or at some clinics, as “Medicare Money” which is provided in Aboriginal and Torres Strait Islander communities. The other is COAG, which provides funds to small, under resourced rural and remote communities. Links to information sheets and web pages with more information can be found in Topic 2.

Queensland Health receives this extra funding is because the Federal Government acknowledges that Aboriginal and Torres Strait Islander people and those living in small rural or remote communities, do not enjoy the same health outcomes as people living in regional and metropolitan areas, and suffer from more complex and chronic health problems (AIHW, 2008).

Aboriginal and Torres Strait Islander people and those who live in rural and remote communities sometimes are unable to access the National Medicare system because GPs do not work in or operate private practices in these areas. This is where Queensland Health and Medicare can assist.


Medicare money is a way of raising revenue that goes back into the health services in the community. This can then be spent on programs, infrastructure or extra positions in the community, which benefits both the community and the health team.

Learning Objectives

On completion of this session participants will be able to: •Define the Rural and Remote, COAG and S100 Indigenous PBS medical benefits schemes•Discuss the reasons for the development of the Rural and Remote, COAG and S100 Indigenous PBS medical benefits schemes•Demonstrate an understanding on how to utilise claimable items

Modules

Topic 1 discusses the National Medicare Schemes, module 1 discusses the Rural and Remote Medical Benefits scheme (RRMBS), module 2 reviews and discusses the Medicare COAG scheme and the third module reviews the Pharmaceutical Benefits Scheme (PBS) S100 Indigenous.

Quiz

Once you have completed the modules in this topic, you are asked to complete a graded interactive quiz.

Post Session Survey

When you have completed this session, we ask you to complete another quick survey to determine if we have met your learning needs.

Certificate

The final section is the completion of a personalised certificate which provides evidence of your training. If you complete this course using the manual only, you will need to email it to [email protected]. Your certificate will be issued on receipt of the completed manual.

Included on this is the average time the session takes which can be used for professional development points.


OR3400 Pre-Session Survey

Before you commence this session we ask you to take a few moments to complete the pre-session survey for this topic. This will give us some indication what your learning needs might be.

At the end of this session we will also ask you to complete another survey to see how well we have met your needs.

Please indicate the degree to which you agree to the follow-ing, by ticking the box most relevant.

I am able to define the Rural and Remote, COAG and S100 Indigenous PBS medical benefits schemesI am confident in my ability to discuss the reasons for the development of the Rural and Remote, COAG and S100 Indigenous PBS medical benefits schemesI understand the process and am confident of my ability to process and claim Medicare items

Stro

ngly

Agr

ee

Agr

ee

Neu

tral

Dis

agre

e

Stro

ngly

Dis

agre

e


OR3401-1 Rural and Remote Medical Benefits Scheme (RRMBS)

Learning Objectives

On completion of this module participants will be able to

•Discuss why the Rural and Remote Benefits Scheme was established•Discuss the components of the Rural and Remote Medical Benefits Scheme• Identify and utilise claimable items

History of RRMBS

The Rural and Remote Medical Benefits Scheme was developed in response to recognition of much lower MBS and PBS expenditure rates for Aboriginal and Torres Strait Islander people.

Following negotiation with the States, the Commonwealth introduced a number of strategies to increase access to primary health care.

The exemption under section 19(2) of the Health Insurance Act 1973 allows the following staff to claim Medicare rebates in specified communities, where access to GPs is not available:

•Queensland Health salaried Medical Officers, Nurse Practitioners, Midwives, Allied Health and Dental Officers•Medical Officers, Nursing and Allied Health staff employed by Royal Flying Doctor Service and Aboriginal Medical Services under contract to Queensland Health

History

In Queensland, (apart from Inala), the first exemption was granted in 1997.

Initially the funding was known as the North Queensland Bulk Billing project.

It has been extended and there are 58 eligible sites listed in Queensland (however not all are accessing funds under the scheme).

The exemption is renewed every 3 years.


Aims and policy of the scheme

The aim of the RRMBS is to increase and improve access to primary health care services for rural and remote Aboriginal and Torres Strait Islander communities.

This is achieved by optimising Queensland Health’s capacity to access Medicare Funds.

All clients seen by a Medical Officer, Nursing, Midwives, Allied Health and Dental staff in an ap-proved RRMBS site can be bulk billed.

Services must be bulk billed to Medicare Australia i.e. the client cannot be billed for any service and they must not have any out of pocket expenses.

The services must work within Medicare guidelines and comply with audit requirements.

Intent of the scheme

The main intent of the scheme is to provide increased funding to the community or area for additional primary health services.

Funds generated are to be directed to the community where they were generated and must be used to enhance primary health care e.g. additional positions.

Excess funds can be spent on local health priorities after consultation with the Hospital and Health Service Chief Executive and local advisory committees/councils.

Criteria for access to RRMBS

Access to RRMBS is based on certain criteria including:

•The community is disadvantaged in terms of access to GPs, allied health and dental services due to being unable to access Medicare•Where an Aboriginal Medical Service (AMS) is providing Medicare services to a community there needs to be some negotiation with Queensland Health, the Commonwealth and the Aboriginal Medical Service for a RRMBS site approval

What items can be billed?

•GP type service items as per the Medicare Benefits Schedule•Nurse Practitioner items as per the Medicare Benefits Schedule•Nurse items provided on behalf of the GP•Allied Health Professional items provided under Chronic Disease Management•Midwife and Indigenous Health Workers services•Dental Services under Child Dental Benefits Schedule•A full list can be found in topic 2 – (RRMBS in practice)


Who ensures Medicare is billed?

A “team approach” is required to ensure all billable services are identified and recovered from Medicare Australia.

The administration staff, RRMBS officer, health worker, nurse, doctor and client are all members of “the team” by NOT completing the claim form Queensland Health Employees are NOT ensuring full access to services for clients.

Reporting

The Commonwealth requires biannual reporting of use of the scheme on

•Positions and administrative support at sites•Revenue received•Application of funds generated


OR3401-1 Learning Activity

1. Why was Medicare RR&MBS developed?

Choice Tick

Increase and improve access to primary health care services

No out of pocket expenses for clients

To work within Medicare guidelines and comply with audit requirements

2. What were the aims of the Medicare RR&MBS scheme?

Choice Tick

Improve access

Reduce costs for clients

Comply with audit requirements

Make more money for the government

Make clients use the public health system


OR3401-2 COAG Exemption

Learning Objectives

•On completion of this module participants will•Discuss the reasons for the development of the COAG Scheme• Identify what needs to occur to progress implementation

Background of COAG

From 1 July 2006 a range of measures were introduced to improve access to primary care services in small rural and remote towns.

These initiatives include an offer to grant an exemption to Section 19 (2) of the Health Insurance Act 1973 that enable Medicare rebates to be claimed for state-remunerated primary health care services (for non-admitted and non-referred patients) in some rural and remote communities of less than 7,000 people.

A memorandum of understanding was signed between the Commonwealth and the States in relation to the cooperative implementation of the COAGs ‘Better Access to Primary Care Services in Rural Areas’ Initiative – the 19 (2) exemption initiative.

This COAG Section 19 (2) exemption is similar to, but separate from the following Section 19(2) exemptions:

• Inala Indigenous Health Service•Rural and Remote Medical Benefits Scheme (RRMBS) - specific to rural and remote Indigenous communities.

An established RRMBS site cannot change to a COAG site.

Purpose

The initiative provides exemptions under section 19(2) of the Health Insurance Act 1973 to enable Medicare rebates to be claimed for state remunerated primary health care services (non-admitted and non-referred patients) in some Rural and Remote communities.


Criteria to apply for exemption

Communities must meet a number of criteria in order to access COAG. They include:

•Rural or remote community of less than 7,000 people•Community must have a workforce shortage (specifically a GP – 1 per 1,400 people)•Community must be agreed by the State and Commonwealth as in scope•All parties must provide written consent to the agreement with a local implementation plan•Once exemption granted it continues regardless of changes in service •Funds generated must be used to enhance primary health care in community•Must not threaten the sustainability and viability of private practice

Negotiations

Extensive negotiations are to occur with:

•State and Commonwealth•Private GP’s•QH Staff •Aboriginal Medical Services•Royal Flying Doctor Service•Medicare Locals

Local flexibility with arrangements are necessary. Consideration should be given to equity between communities and parties involved.

The intention is not to set up a duplicate bulk billing service or to threaten the viability of private practice.

All local private practitioners and medicare locals are to be included in negotiations.

Where there are concerns with viability the community may consider arrangements that include limit the billing to out of hours.

Implementation Process

Identified sites are currently on file with the Revenue Strategy & Support Unit (RSSU) in the first instance.

Once exemption is granted it will remain until such time as circumstances change e.g.: arrival of new practitioners.

All parties will need to agree to new arrangements.


Application of Funds

Funds generated must be used at the site in which they were generated to enhance primary health care and may include:

•Support for locum cover•Employing additional doctors/nurses/allied health and other supporting staff•Chronic Disease initiatives•Professional development

Revenue Raised

Revenue raised is not to be considered the most significant benefit, however some financial recognition should be given to the person/organisation doing the Medicare billing.

Mechanisms need to be in place to oversee the use of the funds.

What items can be billed

Items that can be billed under the scheme include services by Medical and Nursing Officers, Allied Health and Midwives.

Services provided to clients with chronic disease can also be billed.

Reporting

Reporting is required annually to the Commonwealth to indicate how much revenue was claimed and how the revenue was used to enhance primary health care in the community.



1. What is the purpose of the Medicare COAG initiative?

Answer


OR3401-3 Pharmaceutical Benefits Scheme (PBS) S100

Learning Objectives

On completion of this module participants will:

•Discuss the reasons for the development of the PBS S100 Indigenous Scheme•Discuss the purpose of the scheme

Initiative of PBS S100

A memorandum of Understanding was signed by the Commonwealth and Queensland Health in May 2001.

The aim was to ensure the supply of PBS medicines to remote Indigenous health services.

Patients receive these medicines without the need of a prescription and at no cost.

A co-payment is not charged even though under normal arrangements these medicines would attract a co-payment.

The Commonwealth reimburses the pharmacy for the cost of the pharmaceuticals plus a small handling fee through Medicare Australia.

Only a small number of PBS items are excluded from this program

Purpose

The purpose of the scheme is to improve access to approved medicines for Aboriginal and Torres Strait Islanders to help encourage compliance with prescribed treatments.

The invested savings into service improvements are determined collaboratively by Queensland Health, Aboriginal and Torres Strait Islander Health Partnership, local Health action groups and local communities and authorities.

Calculation of Savings

The savings were originally calculated by doubling the charge out value of the medicines ordered and supplied in the first 6 months of the arrangement.

It is now indexed annually by CPI to end of March across the eight weighted capital cities.


Reporting Requirements

In order to ensure the scheme is sustained and continued, Queensland Health is required to report annually to the Commonwealth and the Queensland Aboriginal and Islander Health Council about the application of savings arising from the scheme.

Key Issues

A current key issue with the PBS S100 scheme is to consider changing the eligibility criteria to include non-remote Indiginous communities that may also have poor access to PBS medicines.

The handling fee is also under review.



1. What is the purpose of the Medicare S100 PBS?

Choice Tick

Improve access

Encourage compliance

Provide more money to Queensland Health


OR3402 RRMBS in practice

Acknowledgement

PaRROT would like to acknowledge that:

This presentation was developed by the Cape York Hospital and Health Service and adapted for use by PaRROT.

It only covers the Rural and Remote Medical Benefits Scheme.

Rural and Remote Medical Benefits Scheme

Rural and Remote Medicare Benefit Scheme (RRMBS):

Medicare payments have been extended to Queensland Health (QH) staff, delivering medical services to approved Rural and Remote sites under section 19(2) of the Health Insurance Act 1973.

All non-referred, non-admitted primary healthcare services can be billed to Medicare.

Billing Information:

Bulk billing is the process where the doctor and health service accepts a Medicare benefit as full payment for medical services provided to a patient.

Policy

The policy supporting using of Medicare in rural and remote areas is:

To maximise revenue and to standardise procedures for RRMBS bulk billing within the designated and approved sites, always complying with Medicare Australia guidelines and following acknowledged business rules and audit requirements.

All patients seen by a Medical Officer in an approved Rural and Remote site are to be bulk billed.

Nurse Practitioners, Nursing and Allied Health services (including Indigenous Health Workers) being provided or on behalf of or under referral from the Medical Officer can also be bulk billed.


Client Flow and Billing Process

Administration Officers

Administration Officers are responsible for ensuring:

•Medicare vouchers are completed and batched correctly•After hours vouchers are captured and completed•All vouchers are forwarded correctly

Medical Officers

Application for an Initial provider number for a medical practitioner can be found at:

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/0266-app-initial-medi-care-provider-number-gp.pdf

Application for an additional location Medicare provider number for a medical practitioner can be found at:

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/1413-1203-applica-tion-for-additional-location-medicare-provider-registration-number.pdf

Online Claiming Provider Agreement (complete once) can be found at:

http://www.medicareaustralia.gov.au/provider/business/online/register/files/online-claiming-provid-er-agreement.pdf

If Medicare card needs to be issued contact 132 150 for Non Indigenous or 1800 556 955 for Aboriginal and Torres Strait Islander patients.

Patient presents at reception.

Check if all patient details are up to date – including:

Medicare CardConcession Card

DVA Card

Provide consultation, create & print electron-ic Medicare voucher;

including correct concession item

numbers

Check details & send to

Revenue Officer for processing

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/0266-app-initial-medicare-provider-number-gp.pdf

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/0266-app-initial-medicare-provider-number-gp.pdf

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/1413-1203-application-for-additional-location-medicare-provider-registration-number.pdf

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/1413-1203-application-for-additional-location-medicare-provider-registration-number.pdf

http://www.medicareaustralia.gov.au/provider/business/online/register/files/online-claiming-provider-agreement.pdf



Item Number Claimable Item

Direct Billing Incentives (85% of fee)

1099110992

6499174991

»Consult - Eligible patients aged under 16 years or concession card holder »After Hours Consult – Eligible patients aged under 16 years or concession card holder »X-Ray - Eligible patients aged under 16 years or concession card holder »Pathology - Eligible patients aged under 16 years or concession card holder


Consultations (Normal Hours) (100% of fee)

3233644

»Consultation A – Simple problem, limited examination »Consultation B – Selective historyUndertaking clinical examination »Consultation C – Detailed history (multiple conditions) »Consultation D – Exhaustive history (multiple conditions)


Consultations (After Hours) (100% of fee) - Refer to After Hours Guidelines for explanations

5975995000502050405060

»Emergency Urgent Attendance 1st Patient (not 11pm – 7am) »Emergency Urgent Attendance 1st Patient (11pm – 7am) »Emergency Attendance 2nd Patient (Consultation A) »Emergency Attendance 2nd Patient (Consultation B) »Emergency Attendance 2nd Patient (Consultation C) »Emergency Attendance 2nd Patient (Consultation D)


Prolonged Professional Attendances (100% of fee) - to the exclusion of all other patients)

160161162163164

» Imminent Danger of Death (1-2 hours) » Imminent Danger of Death (2-3 hours) » Imminent Danger of Death (3-4 hours) » Imminent Danger of Death (4-5 hours) » Imminent Danger of Death (>5 hours)


Home Visits - (100% of fee) *

4243747

»Consultation A – Simple problem, limited examination »Consultation B – Selective history »Consultation C – Detailed history (multiple conditions) »Consultation D – Exhaustive history (multiple conditions)

*The fee is the same for normal hours consultations (above) plus $25.45, divided by the number of patients seen- up to a maximum of 6 patients.

For 7 or more patients, the fee is the same for normal hours consultations (above) plus $1.95 per patient.



Obstetric / Gynaecological (85% of fee)

55703557055570955723

Pregnancy Ultrasound »<12 weeks » 12 - 16 weeks » 17 - 22 weeks »>22 weeks


Suturing / Gluing - (85% of fee)

3002630029300383004130052300323003530045300483002330064

»Body - <7cm, superficial »Body - <7cm, deep »Body - >7cm, superficial »Body - >7cm, deep »Ear, eyelid, nose or lip - Full thickness laceration of »Face/Neck - <7cm, superficial »Face/Neck - <7cm, deep »Face/Neck - >7cm, superficial »Face/Neck - >7cm, deep »Soft tissue wound, deep/contaminated (incl. debridement, suture) »Subcutaneous Foreign Body, removal of, incision and exploration



Simple Procedures and Investigations - (85% of fee)

138393704130216388003880318213368001370613312300033000613400117001827046513

46244300674150041659300643006130106

142001420630062302193214713857138423550335502302824167741656301863018530406383591827230192

115063007130195

»Arterial Puncture - A&E only »Aspiration of bladder (needle aspiration) »Aspiration of haematoma »Aspiration of thoracic cavity – for diagnosis »Aspiration of thoracic cavity – for therapeutic drainage »Bier’s block »Bladder catheter, insertion of »Blood, Administration of »Blood for pathology test, femoral puncture in infants »Burns dressing, localised (includes the consult) »Burns dressing, extensive (includes the consult) »Cardioversion »ECG »Femoral nerve block »Finger nail – removal of

Foreign Body Removal »Cornea or Sclera – embedded »Deep: muscle, tendon, tissue »Ear - other than simple syringing »Nose »Subcutaneous – including closure of wound »Superficial – including cornea/sclera

»Ganglion or small bursa, excision of »Gastric lavage » Implantation by cannula, Hormone or Living tissue » Implanon removal » Incision and drainage » Incision and drainage or perianal thrombosis » Initiation of mechanical ventilation » Intra-arterial Cannulation » IUD – Contraception » IUD – Menorrhagia »Mucous cyst or ranula of mouth removal of »Nose bleed, anterior, arrest by cautery and/or packing »Nose bleed, posterior »Palmar or Plantar Warts – less than 10 (includes cryotherapy) »Palmar or Plantar Warts – 10 or more »Paracentesis of abdomen »Paracentesis of pericardium »Popliteal or posterior tibial nerve block »Premalignant Skin Lesions, (incl. solar keratosis) treatment of by ablative technique - (10 or more lesions) »Respiratory function test with permanent tracing »Skin biopsy »Skin excision


Item Number

Simple Procedures and Investigations - (85% of fee) - Continued

302071375747915479164790413300

»Steroid injection of keloid »Therapeutic venesection »Toe Nail – Ingrowing – wedge resection »Toe Nail – Ingrowing – partial resection »Toe Nail – removal of »Umbilical or scalp vein catheterisation in neonate


Excisions - (85% of fee) - When sent for histology wait for result before claiming: » If histology returns BCC or SCC, claim items below. » If not BCC or SCC, claim for skin biopsy 30071 or skin excision 30195

3552031255

31256

31257

31258

31265

31266

31267

31268

31280

31281

31282

31283

4520045206

312003120531220312253123031235

Bartholin’s abscess - incision ofBCC or SCC - Up to 10mm - Nose, eyelid, lip, ear, digit or genitalia » Initial

BCC or SCC - Up to 10mm - Nose, eyelid, lip, ear, digit or genitalia »Residual / Same MO

BCC or SCC - Up to 10mm - Nose, eyelid, lip, ear, digit or genitalia »Residual / Different MO

BCC or SCC - Up to 10mm - Nose, eyelid, lip, ear, digit or genitalia »Recurrent / Any MO

BCC or SCC - Up to 10mm - Face, neck or lower leg » Initial

BCC or SCC - Up to 10mm - Face, neck or lower leg »Residual / Same MO

BCC or SCC - Up to 10mm - Face, neck or lower leg »Residual / Different MO

BCC or SCC - Up to 10mm - Face, neck or lower leg »Recurrent / Any MO

BCC or SCC - Up to 10mm - Other areas of body » Initial

BCC or SCC - Up to 10mm - Other areas of body »Residual / Same MO

BCC or SCC - Up to 10mm - Other areas of body »Residual / Different MO

BCC or SCC - Up to 10mm - Other areas of body »Recurrent / Any MO »Single Stage Local Flap to repair 1 defect - Small and simple »Single stage Local Flap to repair 1 defec - Eyelid, nose, lip, ear, neck, hand, thumb, finger or genitals

Tumour, Cyst, Ulcer or Scar »Removal by surgical excision & suture »Sent for histology - 1-3 lesions - Up to 10mm »Sent for histology - 4-10 lesions - Up to 10mm »Sent for histology - More than 10 lesions - Up to 10mm »Sent for histology - Nose, eyelid, ear, digit or genitalia - Up to 10mm »Sent for histology - Face or neck or lower leg - Up to 10mm



Treatment of Disclocations - (85% of fee)

470634700347018470484703647000470544704247057470154706947030

»Ankle »Clavicle »Elbow »Hip » Interphalangeal joint » Jaw »Knee »Metacarpophalangeal joint »Patella »Shoulder »Toe »Wrist


Treatment of Fractures - (85% of fee)

47594473484746247516 - 475374757647300 - 4733347411 - 47459473364733947633 - 4765747735473964757947300 - 4733347663 - 476784740547360 - 47393474714735447606476214762747543 - 47573

»Ankle joint »Carpus (excluding scaphoid) »Clavicle »Femur »Fibula, shaft of »Finger/Thumb »Humerus »Metacarpal, closed reduction »Metacarpal, intra-articular »Metatarsal »Nasal bones »Olecranon »Patella »Phalanx (Finger or Thumb) »Phalanx (Toe or Great Toe) »Radius, Head of »Radius/Ulna »Ribs (1 or more) »Scaphoid »Talus or Calcaneum »Tarso-Metatarsal »Tarsus »Tibia



Radiology - (85% of fee)

589005810058500577065772157506575125771257518575245771557700

»Abdomen »Cervical »Chest »Clavicle »Femur (internal fixation of neck or intertrochanteric fracture) »Hand, Wrist, Forearm, Elbow or Humerus »Hand/Wrist, Wrist/Forearm, Forearm/Elbow »Hip joint »Foot, Ankle, Leg, Knee or Femur »Foot/Ankle, Ankle/Leg, Leg/Knee, Knee/Femur »Pelvic Girdle »Shoulder or Scapula


Chronic Disease Management

»Healthy Kids Check for children who have received, or are receiving, their four year old immunisation »People aged 40 to 49 years (inclusive) with a high risk of developing type 2 diabetes - as determined by the Australian Type 2 Diabetes Risk Assessment Tool »People between the age of 45 and 49 (inclusive) who are at risk of developing a chronic disease »People aged 75 years and older »Permanent residents of a Residential Aged Care Facility »People who have an intellectual disability »Humanitarian entrants who are resident in Australia with access to Medicare services, including Refugees and Special Humanitarian Program and Protection Program entrants


Health Assessments - (100% of fee)

701703705707715

»Brief Health Assessment - (less than 30 minutes) »Standard Health Assessment - (30-45 minutes) » Long Health Assessment - (45-60 minutes) »Prolonged Health Assessment - (more than 60 minutes) »Aboriginal and Torres Strait Islander Health Assessment



Multidisciplinary Care Plans - (100% of fee)

721723732729731

721

»Preparing a GP Management Plan »Preparation of a Team Care Arrangement »Review of a GP Management Plan or Review of Team Care Arrangement »Contribution to Multidisciplinary Care Plan or Team Care Arrangement »Contribution to Care Plan or Team Care Arrangement in an Aged Care Facility »Preparing a GP Management Plan


Case Conferencing - (100% of fee)

735739743747750758

»Organise and co-ordinate a case conference - (15 – 30 mins) »Organise and co-ordinate a case conference - (30 – 45 mins) »Organise and co-ordinate a case conference - (45 – 60 mins) »Participate in case conference - (15 – 30 mins) »Participate in case conference - (30 – 45 mins) »Participate in case conference - (45 – 60 mins)


Dentists, Dental Specialist or Dental Prosthetist

Application for an Initial provider number for a dentist, dental specialist or dental prosthetist can be found at:

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/3301-app-initial-medi-care-provider-number-dentist-dental-specialist-dental-prosthetist.pdf

Application for an additional location Medicare provider number for a dentist, dental specialist or dental prosthetists can be found at:

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/1413-2-1203-applica-tion-for-additional-location.pdf

Online Claiming Provider Agreement (complete once) can be found at:

http://www.medicareaustralia.gov.au/provider/business/online/register/files/online-claiming-provid-er-agreement.pdf

Nurse Practitioners

Medicare information for Nurse Practitioners & Midwives can be found at:

http://www.medicareaustralia.gov.au/provider/other-healthcare/nurse-midwives.jsp

Application for Medicare provider number can be found at:

http://www.medicareaustralia.gov.au/provider/other-healthcare/files/2960-application-for-a-medi-care-provider-for-midwife-or-nurse-practitioner.pdf

Nurse Practitioners can perform 4 time-tiered specific types of service. They can also provide Telehealth Support Services.

Participating nurse practitioners must be:

(a) Registered according to State or Territory law or, absent such law, be members of a professional association with uniform national registration requirements; and(b) Registered with Medicare Australia to provide these services.

The following tables list the claimable items for nurse practitioners.

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/3301-app-initial-medicare-provider-number-dentist-dental-specialist-dental-prosthetist.pdf

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/3301-app-initial-medicare-provider-number-dentist-dental-specialist-dental-prosthetist.pdf

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/1413-2-1203-application-for-additional-location.pdf

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/1413-2-1203-application-for-additional-location.pdf




http://www.medicareaustralia.gov.au/provider/other-healthcare/files/2960-application-for-a-medicare-provider-for-midwife-or-nurse-practitioner.pdf



Claimable Item Purpose Conditions

82200 (85% of fee)

Professional Attendance

»Professional attendance by a participating nurse practitioner for an obvious problem characterised by the straightforward nature of the task

»Requires a short patient history » Limited examination and management

82205 (85% of fee)


»Professional attendance by a participating nurse practitioner lasting less than 20 minutes

»Taking a history »Undertaking clinical examination »Arranging any necessary investigation » Implementing a management plan »Providing appropriate preventative health care » 1 or more health related issues

82210 (85% of fee)


»Professional attendance by a participating nurse practitioner lasting at least 20 minutes

»As above

82215 (85% of fee)


»Professional attendance by a participating nurse practitioner lasting at least 40 minutes

»As above

82220 (85% of fee)Telehealth Support Service

Participating in video conference lasting less than 20 minutes

»Patient is not admitted


Participating in video conference lasting at least 20 minutes






Participating in video conference lasting less than 20 minutes

» Is a care recipient receiving care in a residential care service; or is at consulting rooms situated within such a complex if the patient is a care recipient receiving care in a residential aged care service; and »The professional attendance is not provided at a self-contained unit.



»As above

82225 (85% of fee0Telehealth Support Service


»As above



Pathology Requests

65060 to 7352973828 to 73837

»An eligible nurse practitioner working within their scope of practice is eligible to request the pathology services using an approved facility

Diagnostic Services Request

55036 to 58527

»An eligible nurse practitioner working within their scope of practice is eligible to request the following diagnostic services as listed in the diagnostic imaging services table

10991 (85% of fee)

Medicare Incentive Item(Procedural)

»An incentive which includes all regional, rural and remote areas (RRMA 3 to 7 under the Rural Remote Metropolitan Areas classification system)

»Can be added to Medicare items, with the exception of item 16400 & 10950 »Client must be under 16 years of age or hold of a Commonwealth Concession Card


Practice Nurse (RN or EN)

Practice Nurses (under the Medical Superintendent’s Provider number) can claim items in Queensland Health sites with a 19(2) exemptions under the Health Insurance Act 1973.

In all cases, the medical practitioner under whose supervision is being provided retains responsibility for the health, safety and clinical outcomes of the patient.

The medical practitioner must be satisfied that the practice nurse is appropriately qualified and trained to provide the service.


10983 (100%)

Telehealth Support Service to provide clinical support to a patient who:

»Participates in a video conferencing consultation with a specialist, consultant physician or psychiatrist

»Patient is not admitted and is located both within a Telehealth eligible area or at the time of the attendance at least 15klms by road from the specialist, physician or psychiatrist

10984 (100%)

Telehealth Support Service to provide clinical support to a patient who:

»Participates in a video conferencing consultation with a specialist, consultant physician or psychiatrist

»Patient receiving care in a residential aged care service

10986 (100%)

Service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner for:

»Health Assessment for a patient who is receiving or has received their 4 year old immunisation. »Provision of service on behalf of and under the supervision of a medical practitioner

»The person is not an admitted patient of a hospital »Benefits are payable on one occasion only for each eligible patient

10987 (100%)

Follow up service by a Practice Nurse for an Indigenous person who has received a Health As-sessment

»Provision of service on behalf of and under the supervision of a medical practitioner

»The service is consistent with the needs identified through the health assessment »To a maximum of 10 services in a calendar year

10991 (85% of fee)

Medicare Incentive





10997 (100%)

Service provided to a person with a chronic disease by a Practice Nurse or an Aboriginal and Torres Strait Islander health practitioner

»Provision of service on behalf of and under the supervision of a medical practitioner

»A GP Management, Team Care Arrangement or Multidisciplinary Care Plan in place »Service is consistent with the above »Maximum of 5 services per calendar year

11702 (85% of fee)

Twelve Lead ECG

»Tracing only » Item 10991 can also be claimed with this item (refer above)

16400 (85% of fee)

Antenatal service provided by a midwife, nurse or an Aboriginal and Torres Strait Islander health practitioner

»Antenatal service that is not performed in conjunction with another antenatal attendance item (same patient, same practitioner, same day

»The service is not provided for an admitted patient of a hospital »To a maximum of 10 services per pregnancy »Do not claim 10991

73805 (85% of fee)

Urine Catalase Test

»Urinalysis by dipstick

73806 (85% of fee)

Urine Pregnancy Test

» An incentive which includes all regional, rural and remote areas (RRMA 3 to 7 under the Rural Remote Metropolitan Areas classification system)

» Item can be claimed with pathology items above (similar to item 10991).


Midwives

Medicare information for Nurse Practitioners & Midwives can be found at:


Application for Medicare provider number:

http://www.medicareaustralia.gov.au/provider/other-healthcare/files/2960-application-for-a-medi-care-provider-for-midwife-or-nurse-practitioner.pdf


82100 (85% of fee0Initial antenatal professional attendance

»By a participating midwife, lasting at least 40 minutes including:

»Taking a detailed patient history »Performing a comprehensive examina-tion »Performing a risk assessment »Based on risk assessment, arranging referral or transfer care to an obstetrician »Requesting pathology and diagnostic imaging services when necessary »Discussing collaborative arrangements »Payable once only

82105 (85% of fee)Short antenatal professional attendance

»By a participating midwife, lasting up to 40 minutes

»The person is not an admitted patient of a hospital »Benefits are payable on one occasion only for each eligible patient

82110 (85% of fee)Long antenatal professional attendance

»By a participating midwife, last at least 40 minutes

»The service is consistent with the needs identified through the health assessment »To a maximum of 10 services in a calendar year

82115 (85% of fee)Professional attendance

»By a participating midwife, lasting at least 90 minutes, for assessment and preparation of a maternity care plan for a pregnancy beyond 20 weeks

»Patient is not an admitted patient of a hospital »Care plan to include outcomes, agreed expectations of care, labour and delivery, including health problems and medications »Care plan to include any referrals and diagnostic imaging services »Payable once only








82120 (75% of fee)Management of confinement

»Up to 12 hours, including delivery if undertaken

» If the patient is an admitted patient of a hospital »The attendance is by the midwife who provided the care »Payable once only


» In excess of 12 hours, including delivery where performed. Management of confinement including delivery (if undertaken) when care is transferred from one midwife to another

» If the patient is an admitted patient of a hospital »Confinement is longer than 12 hours »The second midwife is a member of the practice that has provided the patient’s antenatal care »Payable once only

82130 (85% of fee)Short postnatal professional attendance

»By a midwife, lasting up to 40 minutes, within 6 weeks of delivery

82135 (85% of fee)Long postnatal professional attendance

»By a midwife, lasting at least 40 minutes, within 6 weeks of delivery

82140 (85% of fee)Six week post natal attendance

»Professional attendance by a participating midwife not less than 6 weeks but not more than 7 weeks after delivery

»Comprehensive examination of patient and baby to ensure normal postnatal recover »Referral


»Up to 12 hours, including delivery if undertaken

» If the patient is an admitted patient of a hospital »The attendance is by the midwife who provided the care »Payable once only


» In excess of 12 hours, including delivery where performed. Management of confinement including delivery (if undertaken) when care is transferred from one midwife to another

» If the patient is an admitted patient of a hospital »Confinement is longer than 12 hours »The second midwife is a member of the practice that has provided the patient’s antenatal care »Payable once only



82130 (85% of fee)Short postnatal professional attendance

»By a midwife, lasting up to 40 minutes, within 6 weeks of delivery

82135 (85% of fee)Long postnatal professional attendance

»By a midwife, lasting at least 40 minutes, within 6 weeks of delivery

82140 (85% of fee)Six week post natal attendance

»Professional attendance by a participating midwife not less than 6 weeks but not more than 7 weeks after delivery

»Comprehensive examination of patient and baby to ensure normal postnatal recover »Referral


»Professional attendance lasting less than 20 minutes to provide clinical support

»Video consultation with specialist obstetrics, paediatrics »Not an admitted patient


»Professional attendance lasting at least 20 minutes to provide clinical support

»As above

82152 (85% of fee)Telehealth Support Serviced

»Professional attendance lasting at least 40 minutes to provide clinical support

»As above

Pathology Requests

65060 to 7352973828 to 73837

»An eligible nurse practitioner working within their scope of practice is eligible to request the pathology services using an approved facility

Diagnostic Services Request55700

»Pregnancy-related or pregnancy complication ultrasound scan, where the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation & where one or more conditions such as hypertension or diabetes mellitus

»An eligible midwife working within their scope of practice is eligible to request the following diagnostic services as listed in the diagnostic imaging services table




»Pregnancy-related or pregnancy complication, foetal development and anatomy, ultrasound scan of, by any or all approaches, if the dating of the pregnancy (as confirmed by ultra sound) is 12 to 16 weeks of gestation and where one or more conditions are present such as hypertension or diabetes mellitus.



»Pregnancy-related or pregnancy complication, foetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, if the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation

»An eligible midwife working within their scope of practice is eligible to request the following diagnostic services as listed in the diagnostic maging services table


»Pregnancy-related or pregnancy complication, foetal development and anatomy, ultrasound scan of, by any or all approaches, if the pregnancy (as confirmed by ultrasound) is dated by a foetal crown rump length of 45 to 84mm and nuchal translucency measurement is performed to assess the risk of foetal abnormality



»Pregnancy-related or pregnancy complication, foetal development and anatomy, ultrasound scan of, by any or all approaches, if the dating of the pregnancy (as confirmed by ultra sound) is 22 weeks of gestation and certain where one or more conditions are present such as known or suspected foetal abnormality or mal-presentation


10991 (85% of fee)

Medicare Incentive Item(Procedural)





Aboriginal and / or Torres Strait Islander Health Health Workers

Application for an Initial provider number for a allied health professional can be found at:

http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/provider-number.jsp

Aboriginal and / or Torres Strait Islander Health Health Workers:

•Must have a Certificate Level 3 in Aboriginal and Torres Strait Islander Health or equivalent or higher qualification to apply for a provider number for sites under 19(2) exemptions.•Can claim for follow up services provided as part of a Health Assessment, GP Management Plan, Team Care Arrangement or Case Conferences. (Must be a referred service).


10950 (85% of fee)Aboriginal and Torres Strait Island health service

»A service provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner under both a GP Management Plan (GPMP) and Team Care Arrangements (TCA)

»GP must have completed GPMP or TCA or review in past 2 years and service has been recommended »GP must refer using approved form »At least 20 minutes »Report to be provided »Maximum of 5 services

10983 (100% of fee) Telehealth Support Service to provide clinical support to a patient who is

»Participating in a video conferencing consultation with a specialist, consultant physician or psychiatrist »HW must hold a Certificate 3 in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualifications

»Patient is not admitted and is located within a Telehealth eligible area or at the time of the attendance at least 15kms by road form the specialist, physician or psychiatrist

10984 (100% of fee) Telehealth Support Service to provide support to a patient who is:

»Participating in a video conferencing consultation with a specialist, consultant physician or psychiatrist, hold a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualifications

»Patient receiving care in a residential aged care service




10986 (100% of fee) Service provided by a Practice Nurse or Aboriginal and Torres Strait Islander health practitioner being the provision of a health assessment for a patient who is receiving or has received their four year old immunisation

»Provision of a health assessment for a patient who is receiving or has received their four year old immunisation. »An Aboriginal and Torres Strait Islander health practitioner means a person who has been registered as an Aboriginal and Torres Strait Islander health practitioner by the Aboriginal and Torres Strait Islander Health Practice Board of Australia and meets the Board’s registration standards

»Benefits payable on one occasion only for each eligible patient

10987 (100% of fee) Follow up service provided by a Practice Nurse or Aboriginal and Torres Strait Islander health practitioner for an indigenous person who has received a health assessment

»Provision of service on behalf of and under supervision of a medical practitioner. »An Aboriginal and Torres Strait Islander health practitioner means a person who has been registered as an Aboriginal and Torres Strait Islander health practitioner by the Aboriginal and Torres Strait Islander Health Practice Board of Australia and meets the Board’s registration standards

»Service is consistent with needs identified through the health assessment »Maximum of 10 services per calendar year

10997 (100% of fee) Service provided to a person with a chronic disease by a Practice Nurse or an Aboriginal and Torres Strait Islander health practitioner

»Provision of service on behalf of and under the supervision of a medical practitioner »An Aboriginal and Torres Strait Islander health practitioner means a person who has been registered as an Aboriginal and Torres Strait Islander health practitioner by the Aboriginal and Torres Strait Islander Health Practice Board of Australia and meets the Board’s registration standards

»A GP Management, Team Care Arrangement or Multidisciplinary Care Plan in place »Service is consistent with the above »Maximum of 5 services per calendar year



16400 (85% of fee) Antenatal service provided by a Midwife, Nurse or an Aboriginal and Torres Strait Islander health practitioner

»Antenatal service that is not performed in conjunction with another antenatal attendance item (same patient, same practitioner, same day) »An Aboriginal and Torres Strait Islander health practitioner means a person who has been registered as an Aboriginal and Torres Strait Islander health practitioner by the Aboriginal and Torres Strait Islander Health Practice Board of Australia and meets the Board’s registration standards »The Aboriginal and Torres Strait Islander health practitioner must be employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under subsection 19(2) of the Health Insurance Act 1973

»The service is not provided for an admitted patient of a hospital »To a maximum of 10 services per pregnancy »Do not claim 10991


Allied Health Workers

Qualifications are necessary to apply for provider numbers.

Application for an Initial provider number for a allied health professional can be found at:


Allied health workers can only claim for services provided as part of a GP Management Plan or Team Care Arrangement and Case Conferences. (Must be a referred service).


Audiologist10952 (85% of fee)

»A service provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner under both a GP Management Plan (GPMP) and Team Care Arrangements (TCA)

»Minimum 20 minutes duration »GP must have completed GPMP or TCA or review in past 2 years and service has been recommended »GP must refer using approved form »Report to be provided »Maximum of 5 services

81310 (85% of fee) »A service to Indigenous Australians who have had a health assessment

»GP must have completed a health assessment »GP must refer using approved form »Report to be provided »Maximum of 5 services

Chiropractor10964 (85% of fee)

»A service provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner under both a GPMP and TCA

»Minimum 20 minutes »GPMP or TCA or review in past 2 years and service has been recommended »GP must refer using approved form »Report to be provided »Maximum of 5 services


»GP must have completed a health assessment »GP must refer using approved form »Report to be provided »Maximum of 5 services

Diabetic Educator10951 (85% of fee)


»Minimum 20 minutes duration »GP must have completed GPMP or TCA or review in past 2 years and service has been recommended »GP must refer using approved form »Report to be provided »Maximum of 5 services per calendar year




Diabetic Educator81100 (85% of fee)

»A Diabetes education service for assessment to a patient with type 2 diabetes for assessing suitability for group services

»GP must have completed GPMP or review »GP must refer using approval form »Taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs, and preparing the person for the group services » 45 minutes duration »Report to be provided »Once only per calendar year

81105 85% of fee) »A Diabetes education service provided as a group service for the management of type 2 diabetes

»The person has been assessed as suitable and is part of a group of between 2 – 12 »At least 60 minutes duration »Report to be provided »Maximum of 8 group services per calendar year

81305 85% of fee) »A service to Indigenous Australians who have had a health assessment

»GP must have completed a health assessment »GP must refer using approved form »Report to be provided »Maximum of 5 services per calendar year

Dietician10954 (85% of fee)



81120 (85% of fee) »A Diabetes education service for assessment to a patient with type 2 diabetes for assessing suitability for group services

»GP must have completed GPMP or review »GP must refer using approval form »Taking a comprehensive patient history, identifying an appropriate group services program based on the patient’s needs, and preparing the person for the group services » 45 minutes duration »Report to be provided »Once only per calendar year


Dietician (continued)81125 (85% of fee)

»A Diabetes education service provided as a group service for the management of type 2 diabetes




Exercise Physiologist10953 (85% of fee)

»A service provided to a person who has a chronic condition and com-plex care needs being managed by a medical practitioner under both a GPMP and TCA


81110 (85% of fee) »A exercise physiologist service for assessment to a patient with type 2 diabetes for assessing suitability for group services

»GP must have completed GPMP or review »GP must refer using approval form »Taking a comprehensive patient histo-ry, identifying an appropriate group ser-vices program based on the patient’s needs, and preparing the person for the group services » 45 minutes duration »Report to be provided »Once only per calendar year

81115 (85% of fee) »A exercise physiologist service provided as a group service for the management of type 2 diabetes






Mental Health Nurse81100 (85% of fee)

»A non-directive pregnancy support counselling service provided to women who are concerned about a current pregnancy or a pregnancy in the last 12 months

» 30 minutes duration »Maximum of 3 non-directive services per patient

Mental Health Worker10956 (85% of fee)

»A service provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner under both a GPMP or TCA

»Minimum 20 minutes duration »GP must have completed GPMP or TCA or review in past 2 years and service has been recommended »GP must refer using approved form » Report to be provided » Maximum of 5 services per calendar year




Allied Health Workers (continued)


Occupational Therapist10958 (85% of fee)



80125 (85% of fee) »Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder

»More than 20 minutes but no more than 50 minutes »Patient referred as part of GP Mental Health Treatment Plan »Or referred from Medical Practitioner who is managing under a referred psychiatrist assessment and management plan »Up to 10 planned sessions in a calendar year

80130 (85% of fee) »Professional attendance at a place other than consulting rooms

»Same as above


»More than 50 minutes »Patient referred as part of GP Mental Health Treatment Plan »Or referred from Medical Practitioner who is managing under a referred psychiatrist assessment and management plan »Up to 10 planned sessions in a calendar year

80140 (85% of fee) »Professional attendance at a place other than consulting rooms

»Same as above


»GROUP THERAPY with a group of 6 to 10 patients,EACH PATIENT Up to 10 planned sessions in a calendar year

81330 (85% of fee) »Service provided to a person who is of Aboriginal or Torres Strait Islander descent




82010 (85% of fee) »A service provided to a child, aged under 13 years with Pervasive developmental disorder (PDD)

»The child must be referred by a consultant paediatrician or psychiatrist for assessment, contribution to a treatment plan or early intervention treatment » 50 minutes duration »Maximum 4 services per patient

80125 (85% of fee) »A service provided to a child, aged under 15 years with Pervasive developmental disorder (PDD)

»Referring consultant paediatrician or psychiatrist must have claimed PDD treatment plan while aged under 13 » 30 minutes duration »Maximum 20 services per patient

Osteopath10966 (85% of fee)


»Minimum 20 minutes duration »GP must have completed GPMP or TCA or review in past 2 years and ser-vice has been recommended »GP must refer using approved form »Report to be provided »Maximum of 5 services per calendar year





Psychologist10968 (85% of fee)


»GP must have completed GPMP or TCA or review in past 2 years and service has been recommended »GP must refer using approved form »Report to be provided »Minimum 20 minutes duration »Maximum of 5 services per calendar year

80125 (85% of fee) »Service provided for the purpose of providing psychological assessment and therapy for a mental disorder

»Client must have a GP Mental Health Care Plan and referred psychiatrist assessment management plan »No specific referral form (note or letter) » 30 TO 50 MINUTES DURATION » IN CONSULTING ROOM »Maximum total of 16 individual services


»Client must have a GP Mental Health Care Plan and referred psychiatrist assessment management plan »No specific referral form (note or letter) » 30 TO 50 MINUTES DURATION »OTHER THAN CONSULTING ROOMS »Maximum total of 16 individual services


»Client must have a GP Mental Health Care Plan and referred psychiatrist assessment management plan »No specific referral form (note or letter) »MINIMUM 50 MINUTES DURATION » IN CONSULTING ROOMS »Maximum total of 16 individual services


»Client must have a GP Mental Health Care Plan and referred psychiatrist assessment management plan »No specific referral form (note or letter) »MINIMUM 50 MINUTES DURATION »OTHER THAN CONSULTING ROOMS »Maximum total of 16 individual services

80020 (85% of fee) »Group Service provided for the purpose of providing therapy for a mental disorder

»Therapies are time limited, being deliverable in up to ten planned sessions in a calendar year » 6 to 10 patients (each patient) »At least 60 minutes duration



Psychologist (continued)80100 (85% of fee)

»Service for the purpose of providing focussed psychological strategies services for an assessed mental disorder

»Client must have a GP Mental Health Care Plan and referred psychiatrist assessment management plan »No specific referral form (note or letter) » IN CONSULTING ROOMS »MINIMUM 20-50 MINUTES DURATION »Maximum total of 16 individual services


»Client must have a GP Mental Health Care Plan and referred psychiatrist assessment management plan »No specific referral form (note or letter) »OTHER THAN CONSULTING ROOMS »MINIMUM 20-50 MINUTES DURATION »Maximum total of 16 individual services

80110 (85% of fee) »Group Service for the purpose of providing focussed psychological strategies services for an assessed mental disorder

»Client must have a GP Mental Health Care Plan and referred psychiatrist assessment management plan »No specific referral form (note or letter) » IN CONSULTING ROOMS »MINIMUM 50 PLUS MINUTES DURATION »Maximum total of 16 individual services

80115 (85% of fee) »Provision of a non-directive pregnancy support counselling service to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months

»Client must have a GP Mental Health Care Plan and referred psychiatrist assessment management plan »No specific referral form (note or letter) »OTHER THAN CONSULTING ROOMS »MINIMUM 50 PLUS MINUTES DURATION »Maximum total of 16 individual services


»Therapies are time limited, being deliverable in up to ten planned sessions in a calendar year » 6 to 10 patients (each patient) »At least 60 minutes duration

81000 (85% of fee) »Provision of a non-directive preg-nancy support counselling service to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months

»Maximum of three non-directive pregnancy support counselling services per patient, per pregnancy »No specific referral (note or letter) » Lasting at least 30 minutes



Psychologist (continued)81355 (85% of fee)

»Service provided to a person who is of Aboriginal or Torres Strait Islander descent

»GP must have completed a health assessment »Approved referral form »At least 20 minutes duration »Maximum of 5 services in a calendar year

82000 (85% of fee) »Psychology health service provided to a child, aged under 13 years (PDD)

»Must have been referred by consultant paediatrician or psychiatrist for assessment, contribution to a treatment plan or early intervention »At least 50 minutes duration

82015 (85% of fee) »Psychology health service provided to a child, aged under 15 years, for treatment of a pervasive developmental disorder (PDD)

»Diagnosis of PDD or an eligible disability »Received a PDD or disability treatment plan (while aged under 13 years) »At least 30 minutes duration

Physiotherapy10960 (85% of fee)


»GP must have completed GPMP or TCA or review in past 2 years and service has been recommended »Approved referral form »Report to be provided »Minimum 20 minutes duration



Podiatrist10962 (85% of fee)

»A service provided to a person who has a chronic condition and com-plex care needs being managed by a medical practitioner under both a GPMP or TCA






Speech Therapist 10970 (85% of fee)





82005 (85% of fee) »Service provided to a child, aged under 13 years

»Referred by an eligible practitioner for the purpose of contributing to the child’s pervasive developmental disorder (PDD) or disability treatment plan »Minimum 50 minutes

82020 (85% of fee) »Service provided to a child, aged under 15 years, for treatment of a pervasive developmental disorder (PDD)

»Diagnosis of PDD or an eligible disability »Received a PDD or disability treatment plan (while aged under 13 years) »At least 30 minutes duration


Medical Officers After Hours

This table provides information on the item numbers for after hours services.

It is important to ensure the time and date and the after hours item numbers are included on the voucher.The voucher must also be signed by the patient.

Item number Description

597 Emergency Urgent Attendance 1st Patient (not 2300 – 0700) - after a 2 hour break – use 597 - 1st patient number again

599 Emergency Urgent Attendance 1st Patient (2300 - 0700) - after a 2 hour break – use 599 - 1st patient number again

5000 Emergency Attendance 2nd Patient (Consultation A)

5020 Emergency Attendance 2nd Patient (Consultation B)

5040 Emergency Attendance 2nd Patient (Consultation C)

5060 Emergency Attendance 2nd Patient (Consultation D)


Manual Medicare Voucher DB2-GP General Practitioner

This image shows the sections that need to be completed on the voucher for a general presentation.

Name, Date of Birth & Address

Patient must sign – if unable guardian/parent must sign on behalf of the patient

Medicare Number and expiry date checked

Practitioners name & provider number

Item Number &/or item numbers including incentives

Patient Reference number & date


This image shows the sections that need to be completed on the voucher for a referral.

Name, Date of Birth & Address

Patient must sign – if unable guardian/ parent must sign on behalf of the patient

Medicare Number and expiry date checked

Name & address of referring practitioner and Name and provider number of consulting practitioner

Item Number

Patient Reference number & date

DB2-OT voucher

Period of referral, referral date and requesting practitioner provider number


Batching Medicare Vouchers - Manual Vouchers

The Administration Officer checks the expiry date of card and must fill in the details on the Manual.

Medicare voucher including:

•Medicare details •Date of birth •Patient reference number •Date of service•Name and Provider Number of the Doctor providing the service.

Ensure the voucher is signed by the patient.

These details should also be updated in HBCIS/Ferret (or other electronic systems).

Collate the vouchers in batches of doctor name and process as per electronic claiming procedure.

Batching Medicare Vouchers - Electronic Vouchers

The Medical Officer should complete the item numbers to be billed; print the voucher and ask the patient to sign it.

A copy of the voucher should be offered to the patient. The vouchers should be placed in a tray in the consult rooms for collection by the Administration staff.

Collate the vouchers in batches of doctor name and process as per electronic claiming procedure.


Pathology Tests

Claimable Item – 85% of fee for all of the following Purpose

73801 Semen examination for presence of spermatozoa

73802Leucocyte count, erythrocyte sedimentation rate, examination of blood film (including differential leucocyte count, haemoglobin, haematocrit or erythrocyte count – 1 test

73803 2 Tests described in item 73802

73804 3 or more tests described in item 73802

73805 Microscopy for wet film other than urine, whether stained or not, or catalase test

73806 Pregnancy test by 1 or more immunochemical methods

73807 Microscopy for wet film other than urine, including any relevant stain

73808 Microscopy of Gram-stained film, including (if performed) a service described in item 73805 or 73807

73809 Chemical tests for occult blood in faeces by reagent stick, strip, tablet or similar method

73810 Microscopy for fungi in skin, hair or nails – 1 or more sites

73811 Mantoux test

74991 (Incentive Item) Claim for each pathology test


More Information

Telephone Numbers:

Indigenous Access hotline: 1800 556 955

Medicare Australia: 132 150

Medicare Providers: 1300 302 122

Web Sites

Department of Human Services - http://www.humanservices.gov.au/

Medicare Benefits Schedule - http://www.mbsonline.gov.au/ Australian Health Practitioner Regulation Agency (Search GP registration) - http://www.ahpra.gov.au/

Help and Assistance

Medicare Australia can provide more information.

www.medicareaustralia.gov.auwww.mbsonline.gov.au

http://www.humanservices.gov.au/%20

http://www.mbsonline.gov.au/%20

http://www.ahpra.gov.au/

http://www.medicareaustralia.gov.au

http://www.mbsonline.gov.au


OR3400 Theory to Practice

1. A 45 year old Torres Strait Islander woman has presented for a check-up - you decide to do an adult health check with her. Which Medicare item would it come under?

Tick Organisation

Aboriginal and Torres Strait Islander Health Check (15-54 years) (Item 715)

Brief Health Assessment (Item 701)

Standard Health Assessment (Item 703)

Prolonged Health Assessment (Item 707)

2. An elderly patient is to participate in a video-conference with a specialist in a regional/city hospital. A practice nurse attends the video-conference with the patient. What item can be claimed?

Tick Choice

Provision of monitoring and support of a person with a chronic disease by a practice nurse (Item 10997)

Telehealth Support Service by a Practice Nurse (Item 10983)

3. An elderly female patient with Diabetes presents for a routine check-up performed by the Practice Nurse. What item can be claimed?

Tick Choice

Service provided to a person with chronic disease (Item 10997)

Taking of a cervical smear and a preventive check (item 10994)


4. A pregnant woman with no previous medical history of high risk pregnancies has been to the GP and he has advised that her ante natal checks can be done at the hospital by a midwife. How many times can the woman see the midwife?

Choice Tick

9

10

18

6

5. An elderly man experiencing chest pains arrives at a facility. The Practice Nurse performs an ECG. What item can be claimed?

Choice Tick

Twelve lead electrocardiography - tracing only (Item 11702)

Twelve lead electrocardiography - tracing & report (Item 11700)


6. A 25 year old pregnant woman presents for her first antenatal check by a midwife.

Which Medicare item can be claimed?

Choice Tick

Short antenatal professional attendance (Item 82105)

Long antenatal professional attendance (Item 82110)

Professional attendance (Item 82115)

Initial antenatal professional attendance (Item 82100)

7. A 10 year old that, as part of their health check, is identified as having problems hearing. You refer her to the visiting audiologist who has a provider number. What Medicare item number would this be?

Choice Tick

Allied Health - Aboriginal Health Worker (Item 10950)

Allied Health – Audiologist (Item 81310)

Allied Health Service provided to a child aged under 13 years (Item 82005)


8. A 49 year old Indigenous man presents with recently diagnosed diabetes, and renal disease, and requires the development of a management plan, a visit to the diabetes educator and dietician. Which Medicare items could be claimed?

Choice Tick

Contribution to a Multidisciplinary Care Plan ( Item Number 729)

Allied Health - Diabetes Educator (Item Number 10951)

Allied Health - Dietician (Item Number 10954)

Prolonged health assessment (Item Number 707).

Follow up service provided to a person with a chronic disease (Item Number 10997)


OR3400 Quiz

1. The intent of the Medicare system is

Tick Choice

To ensure that all Australians have access to free or low-cost medical, optometrical and hospital care

Provide free treatment as a private patient in a private facility

Provide free or subsidised treatment by private practitioners for specified services only

Provide services only to low income Australians

To allow Australians to choose private health services

Replace the private health service system

Provide free treatment to a public patient in a public facility

All of the above

None of the above

2. Queensland Health can receive extra funding because Aboriginal and Torres Strait Islander people do not enjoy the same health outcomes as non-Indigenous Australian’s and die some 15-20 years younger and suffer from more complex and chronic health problems.

Tick Choice

True

False


3. Which of the following health service providers are able to provide services under the Rural and Remote Medical Benefits Scheme?

Tick Choice

A: Queensland Health salaried medical officers

B: Practice nurses

C: Allied health professionals

D: Health workers

E: Medical officers employed by RFDS under contract to Queensland Health

F: Medical officers employed by community controlled organisations

A, E and F only

B,C, E and F only

A, B, C and D only


4. Which of the following are permitted to provide PBS medications in bulk under the S100 scheme?.

Tick Choice

A: State pharmacies

B: Private pharmacies

C: Medical officers in eligible areas

D: Registered Nurses in eligible areas

A and B only

C and D only

All of the above

5. Funds generated from the Medicare COAG initiative must be used to enhance primary health care services in the community .

Tick Choice

True

False


6. Which of the following meet the criteria for access to the Medicare COAG initiatives?

Tick Choice

A: Which of the following meet the criteria for access to the Medicare COAG initiatives?

B: Community of 7,000 people with 6 GPs

C: Remote community with 2,000 people and 1 GP

D: Rural community with 6000 people and 2 GPs

All of the above

B, C and D only

None of the above


OR3401-1 Learning Activity Feedback

1. Why was Medicare RR&MBS developed?

Choice Tick

Increase and improve access to primary health care services

No out of pocket expenses for clients

To work within Medicare guidelines and comply with audit requirements

Feedback:

The RRMBS was developed to increase and improve access to primary health care services for rural and remote Aboriginal and Torres Strait Islander communities. All clients seen by a Medical Officer in an approved RRMBS site can be bulk billed and the client cannot be billed for any service and has no out of pocket expenses. The services funded, however, must work within Medicare guidelines and comply with audit requirements.


2. What were the aims of the Medicare RR&MBS scheme?

Choice Tick

Improve access

Reduce costs for clients

Comply with audit requirements

Make more money for the government

Make clients use the public health system

Feedback:The aim of the RRMBS is to increase and improve access to primary health care services for rural and remote Aboriginal and Torres Strait Islander communities. This is achieved by optimising Queensland Health’s capacity to access Medicare Funds. Services must be bulk billed to Medicare Australia i.e. the client cannot be billed for any service and has no out of pocket expenses.



1. What is the purpose of the Medicare COAG initiative?

Answer

The purpose of the initiative is to provide exemptions under section 19(2) of the Health Insurance Act 1973 to enable Medicare rebates to be claimed for state remunerated primary health care services (non-admitted and non-referred patients) in some Rural and Remote communities



1. What is the purpose of the Medicare S100 PBS?

Choice Tick

Improve access

Encourage compliance

Provide more money to Queensland Health

Feedback:

•The aim of the S100 PBS is to improve access to approved PBS medicines for Aboriginal and Torres Strait Islander clients•Help encourage patient compliance with prescribed treatment regimes• Invest savings made by Queensland Health into local community health service improvements


OR3400 Theory to Practice Feedback

1. A 45 year old Torres Strait Islander woman has presented for a check-up - you decide to do an adult health check with her. Which Medicare item would it come under?

Tick Organisation

Aboriginal and Torres Strait Islander Health Check (15-54 years) (Item 715)

Brief Health Assessment (Item 701)

Standard Health Assessment (Item 703)

Prolonged Health Assessment (Item 707)

2. An elderly patient is to participate in a video-conference with a specialist in a regional/city hospital. A practice nurse attends the video-conference with the patient. What item can be claimed?

Tick Choice

Provision of monitoring and support of a person with a chronic disease by a practice nurse (Item 10997)

Telehealth Support Service by a Practice Nurse (Item 10983)

3. An elderly female patient with Diabetes presents for a routine check-up performed by the Practice Nurse. What item can be claimed?

Tick Choice

Service provided to a person with chronic disease (Item 10997)

Taking of a cervical smear and a preventive check (item 10994)


4. A pregnant woman with no previous medical history of high risk pregnancies has been to the GP and he has advised that her ante natal checks can be done at the hospital by a midwife. How many times can the woman see the midwife?

Choice Tick

9

10

18

6

5. An elderly man experiencing chest pains arrives at a facility. The Practice Nurse performs an ECG. What item can be claimed?

Choice Tick

Twelve lead electrocardiography - tracing only (Item 11702)

Twelve lead electrocardiography - tracing & report (Item 11700)


6. A 25 year old pregnant woman presents for her first antenatal check by a midwife.

Which Medicare item can be claimed?

Choice Tick

Short antenatal professional attendance (Item 82105)

Long antenatal professional attendance (Item 82110)

Professional attendance (Item 82115)

Initial antenatal professional attendance (Item 82100)

7. A 10 year old that, as part of their health check, is identified as having problems hearing. You refer her to the visiting audiologist who has a provider number. What Medicare item number would this be?

Choice Tick

Allied Health - Aboriginal Health Worker (Item 10950)

Allied Health – Audiologist (Item 81310)

Allied Health Service provided to a child aged under 13 years (Item 82005)


8. A 49 year old Indigenous man presents with recently diagnosed diabetes, and renal disease, and requires the development of a management plan, a visit to the diabetes educator and dietician. Which Medicare items could be claimed?

Choice Tick

Contribution to a Multidisciplinary Care Plan ( Item Number 729)

Allied Health - Diabetes Educator (Item Number 10951)

Allied Health - Dietician (Item Number 10954)

Prolonged health assessment (Item Number 707).

Follow up service provided to a person with a chronic disease (Item Number 10997)


OR3400 Quiz Feedback

1. The intent of the Medicare system is

Tick Choice

To ensure that all Australians have access to free or low-cost medical, optometrical and hospital care

Provide free treatment as a private patient in a private facility

Provide free or subsidised treatment by private practitioners for specified services only

Provide services only to low income Australians

To allow Australians to choose private health services

Replace the private health service system

Provide free treatment to a public patient in a public facility

All of the above

None of the above

2. Queensland Health can receive extra funding because Aboriginal and Torres Strait Islander people do not enjoy the same health outcomes as non-Indigenous Australian’s and die some 15-20 years younger and suffer from more complex and chronic health problems.

Tick Choice

True

False


3. Which of the following health service providers are able to provide services under the Rural and Remote Medical Benefits Scheme?

Tick Choice

A: Queensland Health salaried medical officers

B: Practice nurses

C: Allied health professionals

D: Health workers

E: Medical officers employed by RFDS under contract to Queensland Health

F: Medical officers employed by community controlled organisations

A, E and F only

B,C, E and F only

A, B, C and D only


4. Which of the following are permitted to provide PBS medications in bulk under the S100 scheme?

Tick Choice

A: State pharmacies

B: Private pharmacies

C: Medical officers in eligible areas

D: Registered Nurses in eligible areas

A and B only

C and D only

All of the above

5. Funds generated from the Medicare COAG initiative must be used to enhance primary health care services in the community .

Tick Choice

True

False


6. Which of the following meet the criteria for access to the Medicare COAG initiatives?

Tick Choice

A: Which of the following meet the criteria for access to the Medicare COAG initiatives?

B: Community of 7,000 people with 6 GPs

C: Remote community with 2,000 people and 1 GP

D: Rural community with 6000 people and 2 GPs

All of the above

B, C and D only

None of the above


OR3400 - Post-Session Survey

Now that you have completed this session we ask you to take a few moments to complete the post-session survey for this topic. This will give us some indication about how well we have met your learning needs. Once submitted you will be eligible to receive your certificate.

Please indicate the degree to which you agree to the following, by ticking the box most relevant.

I am able to define the Rural and Remote, COAG and S100 Indigenous PBS medical benefits schemesI am confident in my ability to discuss the reasons for the development of the Rural and Remote, COAG and S100 Indigenous PBS medical benefits schemesI understand the process for utilising claimable items

What, if anything could have been added to this session?

Stro

ngly

Agr

ee

Agr

ee

Neu

tral

Dis

agre

e

Stro

ngly

Dis

agre

e


Documents

Orientation to Practice - Queensland Health · Medicare funds to Queensland Health have been extended under section 19(2) of the Health Insurance Act which allows Queensland Health