A number of new temporary MBS telehealth services have been created in response to the COVID-19 pandemic.
· Commencing 13 March 2020, new temporary MBS telehealth items have been
made available to help reduce the risk of community transmission of COVID-19 and provide protection for patients and health care providers.
· The list of telehealth services has continued to expand since 13 March. This is the latest factsheet and provides details on all current telehealth items.
· The new temporary MBS telehealth items are available to GPs, medical practitioners, nurse practitioners, participating midwives, allied health providers and dental practitioners in the practice of oral and maxillofacial surgery.
· A service may only be provided by telehealth where it is safe and clinically appropriate to do so.
· The new temporary MBS telehealth items are for out-of-hospital patients.
· From 20 July 2020, it will be a legislative requirement that GPs and Other Medical Practitioner (OMP) working in general practice can only perform a telehealth or telephone service where they have an existing relationship with the patient. There are limited exemptions to this requirement.
· It is a legislative requirement that the GP and OMP COVID-19 telehealth services, must be bulk billed for Commonwealth concession card holders, children under 16 years old and patients who are more vulnerable to COVID-19.
· Specialist and allied health service providers are no longer required to bulk bill COVID-19 telehealth items.
· Providers are expected to obtain informed financial consent from patients prior to providing the service; providing details regarding their fees, including any out-of-pocket costs.
· The bulk-billing incentive Medicare fees have temporarily doubled (until 30 September) for items relating to GP and OMP services, diagnostic imaging services (items 64990 and 64991) and pathology services (items 74990 and 74990). These items can be claimed with the telehealth items where appropriate. The fees are provided later in the factsheet. As of 20 April, two new bulk-billing incentive items have been introduced for services provided to patients who are more vulnerable to COVID-19.
What are the changes?
As part of the Australian Government’s response to COVID-19, these items have been updated to ensure continuiry of care for patients.
As of 30 March 2020 these items became general in nature and have no relation to diagnosing, treating or suspecting COVID-19.
A list of telehealth items is provided later in this fact sheet. Factsheet available on MBS Online.
Why are the changes being made?
The temporary MBS telehealth items allows people to access essential Medicare funded health services in their homes and reduce their risk of exposure to COVID-19 within the community. Updates were made on 20 July to ensure patients receive care from a GP or practice with whom they have an existing relationship.
Who is eligible?
The new temporary MBS telehealth items are available to providers of telehealth services for a wide range of consultations. All Medicare eligible Australians can now receive these services. GPs and OMPs working in general practice may only provide a telehealth service where they have an existing relationship with the patient.
Additional detail is provided in the ‘GPs and Other Medical Practitioners’ factsheet, and ‘Provider’ FAQ.
GP and OMP services provided using the MBS telehealth items must be bulk billed for Commonwealth concession card holders, children under 16 years of age, and patients who are more vulnerable to COVID-19. For specialist and allied health services, bulk billing is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service.
Vulnerable means a patient at risk of COVID-19, so a person who:
· is required to self-isolate or self-quarantine in accordance with guidance issued by the Australian Health Protection Principal Committee in relation to COVID-19; or
· is at least 70 years old; or
· if the person identifies as being of Aboriginal or Torres Strait Islander descent—is at least 50 years old; or
· is pregnant; or
· is the parent of a child aged under 12 months; or
· is being treated for a chronic health condition; or
· is immune compromised; or
· meets the current national triage protocol criteria for suspected COVID-19 infection.
A chronic health condition is medical condition that has been present (or is likely to be present) for at least six months or is terminal. The Department of Health website provides additional detail online: https://www.health.gov.au/health-topics/chronic-conditions/about-chronic-conditions. The diagnosis of immune compromised is a clinical decision made by the patient’s treating doctor. Please note this is guidance only, and does not constitute MBS claiming advice.
What telehealth options are available?
Videoconference services are the preferred approach for substituting a face-to-face consultation. However, in response to the COVID-19 pandemic, providers will also be able to offer audio-only services via telephone if video is not available. There are separate items available for the audio-only services.
No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. To assist providers with their privacy obligations, a privacy checklist for telehealth services has been made available on MBSOnline: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TelehealthPrivChecklist. Further information can be found on the Australian Cyber Security Centre website
What does this mean for providers?
The new temporary MBS telehealth items will allow providers to continue to deliver essential health care services to patients within their care.
Providers do not need to be in their regular practice to provide telehealth services. GPs and OMPs working in general practice must ensure that they have an existing clinical relationship with their telehealth patients, or be able to explain how their patients qualify for exemptions to this requirement. Additional detail is in the ‘GPs and Other Medical Practitioners’ factsheet.
The telehealth MBS items can substitute for current face-to-face consultations that available under the MBS when the service/s cannot be provided due to COVID-19 considerations. The telehealth items will have similar requirements to normal timed consultation items. Providers should use their provider number for their primary location, and must provide safe services in accordance with normal professional standards.
GP and OMP telehealth items must be bulk billed for vulnerable patients, concession card holders and children under 16 years at the time the service is being provided, meaning MBS rebates are paid to the provider. Rebates for services provided by GPs and non-vocationally registered medical practitioners will be paid at 85% of the new item fees - these fee amounts have been increased so that the Medicare rebates paid for the new GP and medical practitioner telehealth services are at the same level as the rebates paid for the equivalent face-to-face services. (Due to the urgency of the new telehealth arrangements, the Department of Health has not been able to amend the legislation that establishes 100% rebates for GP/medical practitioner services.)
For additional information on the use of telehealth items, please refer to the Provider Frequently Asked Questions document available on MBSOnline.
How will these changes affect patients?
From 20 July 2020, patients will be eligible for GP and OMP telehealth services if they have seen their GP or health practitioner (such as a practice nurse of Aboriginal and Torres Strait Islander health worker) within the same practice at least once in the preceding 12 months. This new safeguard will support longitudinal and person-centred primary health care that is associated with better health outcomes.
The temporary COVID-19 MBS telehealth items also requires GPs and OMPs to bulk-bill services to vulnerable patients, concession card holders and children under 16 years, so there will be no additional charge for these patients. Patients are required to consent to their service being bulk-billed. Eligible patients should ask their service providers about their telehealth options, where clinically appropriate.
Specialist and allied health telehealth items do not need to be bulk billed, however the provider must ensure informed financial consent is obtained prior to the provision of the service.
A consumer factsheet is available on MBSOnline which provides further information on how these changes will affect patients.
Who was consulted on the changes?
Targeted consultation with stakeholders has informed the new temporary MBS telehealth items. Due to the nature of the COVID-19 emergency, it was not reasonably possible to undertake normal, broad consultations prior to implementation.
How will the changes be monitored and reviewed?
The Department of Health will monitor the use of the new temporary MBS telehealth items. Use of the items that does not seem to be in accordance with the relevant Medicare guidelines and legislation will be actioned appropriately.
Where can I find more information?
COVID-19 National Health Plan resources for the general public, health professionals and industry are available from the Australian Government Department of Health website.
The full item descriptors and information on other changes to the MBS can be found on the MBS Online website at www.mbsonline.gov.au. You can also subscribe to future MBS updates by visiting MBS Online and clicking ‘Subscribe’.
The Department of Health provides an email advice service for providers seeking advice on interpretation of the MBS items and rules and the Health Insurance Act and associated regulations. If you have a query relating exclusively to interpretation of the Schedule, you should email askMBS@health.gov.au.
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If you are seeking advice in relation to Medicare billing, claiming, payments, or obtaining a provider number, please go to the Health Professionals page on the Services Australia website or contact Services Australia on the Provider Enquiry Line – 13 21 50.