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PROGRAM UPDATE VERSION 6.7
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An Access Anaesthetics program update was released on August 1 to manage the issues discussed below, along with some other minor updates. See the What's New page for full details.
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JULY 2011 MEDICARE UPDATE
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Video consultation items
There are a number of new items for specialist video consultations, including a new item for anaesthetists - 17609.
The initiation of a professional attendance via video conference rendered by a specialist practising in the specialty of anaesthesia to a patient who is a) a care recipient receiving care in a residential aged care service; orb) at an aboriginal medical service or aboriginal community controlled health service in relation to which a direction made under subsection 19(2) of the act applies; orc) located outside an inner metropolitan area, not being an admitted patient being a service associated with item 17610, 17615, 17620, 17625, 17640, 17645, 17650, 17655 or 17690.
The item can be used in association with 17610 and the other anaesthetic consults. The fee is 50% of the fee for the consult. So if 17610 = $41.35, 17609 = $20.70.
Note that these items are only for outpatient consultations.
Financial incentives
There are a number of financial incentives for using the new video consultation items. The most significant of these is that a one-off 'Onboard' payment of $6000 is payable to any specialist when they claim the item for the first time. Thereafter, each claim for a video consultation will attract an incentive payment of $60, in addition to the fee paid for the item. Bulk bill claims attract an additional $20. Payments are also made at the patient end of the link.
More information
Diagnostic imaging items
Diagnostic imaging items such as 55054, 55130, 55135 (and most others) are being duplicated in the Medicare schedule. The duplicated item is the same as the original except that the fee is only half the original fee, and is applicable when the equipment used is more than a specified age. This is to encourage updating of equipment, or rather, to discourage not updating it.
Anaesthetic allergy testing
Item 21981 - in Medicare's words "the operational restriction that the anaesthetic allergy testing be performed in association with anaesthetic has been removed" (quoted from http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-20110617_July_2011_MBS).
This change is descriptive only indicating that anaesthesia is not a required part of the procedure. The item is still considered an RVG anaesthesia base item, however, which will attract a time item and modifiers as with all other 'Anaesthesia for...' items.
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HEALTH FUND FEES UPDATE
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Additional items have been added for the video consults and duplicated diagnostic imaging items.
Note that because video consultations are outpatient services, they are not covered by health fund gap cover arrangements.
There are no changes to the fees for any other items.
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MANCHESTER UNITY MERGER WITH HCF
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For some time now, Manchester Unity has been using the HCF fee schedule. The merger has now been completed, and Manchester Unity no longer exists as a health fund. We recently received the following advice from Medicare.
"Manchester Unity’s private health insurance business will merge into HCF on 30th June 2011. This follows approval from the Private Health Insurance Administrative Council (PHIAC) under section 146-5 of the Private Health Insurance Act 2007. From 1stof July 2011 MU will no longer be registered as a health fund. Therefore, MU ECLIPSE services for submitting new claims or performing Member Eligibility or Online patient verification will not be available after 5pm EST 30thJune 2011. From 1st July 2011 until 10th July 2011 HCF and MU will conduct the final stage of the two funds integration and all MU claims that are currently in transit with Medicare or with MU will be completed and remittance advice sent to providers by Friday 8thJuly 2011. MU ECLIPSE claims can be submitted via HCF ECLIPSE on or after 11th July 2011."
Consequently, from now on, you should send all claims for Manchester Unity members to HCF. This means selecting HCF on the fund page of Access Anaesthetics. Claims sent to MU (paper or online) will be rejected with the message that the fund has been deregistered.
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MEDIBANK PRIVATE NOTES
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Now that Medibank Private are accepting Eclipse claims, we can provide some feedback. The good news is that very often the claims are paid quickly - in 2-3 days. The bad news ...
Written IFC for No-Gap Claims
Originally MP would not pay the gap cover fee for claims unless the Written IFC flag was selected, even for no-gap claims. This required us to modify AA so that MP claims were always sent with the Written flag, no matter what was actually selected in the software. We did this so that clients did not have to falsely select 'Written' just to get a no-gaps claim paid. MP has now corrected this error in their system so that no-gap claims will now be paid without the Written flag. We have now modified AA to remove the automatic Written flag, and AA will now send the code you select in the IFC field. This is for your information only - there is nothing you need to do to manage this. We received an email from Medicare advising of this change, and the details are on the MP website at http://www.medibank.com.au/Health-Covers/Information-For-Health-Care-Providers/GapCover-Information/Article.aspx?Id=131
Payment by cheque
We have heard of a couple of instances where MP has paid Eclipse claims by cheque. For example ...
"Remember I told you that a couple of the drs were being paid by cheque from MP for Eclipse claims even though MP had their banking details? I’ve made several calls to try to find out why, but none of the consultants I spoke to could tell me what the problem was as they could clearly see the banking details on their system. I spoke to someone else this morning after receiving another cheque, and she told me that it is because banking details for some providers didn’t transfer across to the new system automatically when they switched to Eclipse. She couldn’t tell me why, but said the same thing has happened to quite a few providers and I should fax the drs EFT details again and they will be re-entered on the new system."
If this is a problem for you, try resending the provider's banking details to MP.
OPV does not always indicate patient is eligible
A successful patient verification (OPV) is often assumed to mean that a patient is eligible for gap-cover. In fact, it only checks that the patient is a member of the fund and that the membership number and DOB is correct. Medibank Private has a membership level which does not include gap-cover. Providers find this out when their Eclipse claim is paid with only the Medicare rebate, rather than the fund's gap cover fee. Then the provider has to chase the patient for the balance. This can be a problem, particularly if the patient has already paid a copayment, and is then asked to pay the difference between the Medicare rebate and the no-gaps fee.
Also, the processing report received from MP usually does not specify the reason that only the Medicare rebate was paid. We have pointed this out to them, but nothing has changed so far.
To avoid this, we recommend calling MP on 1300 130 460 to verify that the patient is eligible for gap-cover before sending your claims. We have also had a report of a similar issue with HCF, although this appears to be less frequent.