Connecting Health Services With the Future: Questions and Answers for Patient-end Practitioners
Questions and answers which have been prepared to assist practitioners who will provide face-to-face clinical services to patients having an online consultation, to understand the new MBS items and incentive payments introduced under the
‘Connecting Health Services With the Future: Modernising Medicare by Providing Rebates for Online Consultations’ initiative.
Why has the Australian Government introduced this initiative?
The telehealth initiative is integral to the Australian Government’s broader agenda to make it easier for patients to access medical services and in particular specialists. Patients using telehealth facilities located in eligible residential aged care facilities, or an eligible Aboriginal Medical Services or who are outside inner metropolitan areas will be able to ‘see’ specialists without the time and expense involved in travelling to major cities, and in many cases sooner than would otherwise be the case.
What is a telehealth video consultation?
For the purposes of this initiative, a video consultation is where a patient and eligible specialist, consultant physician or psychiatrist undertakes a consultation via video conferencing (i.e. visual and audio link).
Is a telehealth video consultation rebatable by Medicare?
Yes. New Medicare Benefits Schedule (MBS) items will be introduced for telehealth video consultations from 1 July 2011.
A full list of telehealth MBS items is available
here.
Can telehealth consultations be claimed through the Department of Veterans’ Affairs?
Yes.
What financial incentives are available to practitioners to encourage the uptake of telehealth video consultations?
Any health practitioner who has a Medicare provider number and is eligible to provide the telehealth services covered by the new MBS items will also be eligible for financial incentives.
There are five types of Incentives available for practitioners and Residential Aged Care Facilities (RACFs):
Telehealth On-Board Incentive;
Telehealth Service Incentive;
Telehealth Bulk Billing Incentive;
RACF On-Board Incentive; and
Telehealth Hosting Service Incentive.
What are the incentives for?
Incentive payments are to encourage changes in the way practitioners provide services and recognise that incorporating telehealth into everyday workflow represents a significant change in traditional practice that will potentially affect billing and scheduling, as well as IT systems and require additional staff training. If the item is bulk billed practitioners will receive a higher incentive rate.
Where can these services be provided?
Under the telehealth initiative the specialist/consultant can be located anywhere in Australia but the location of the patient at the time of the consultation must be outside the inner metropolitan area. This is referred to as an eligible geographical area: there are exceptions if the patient is an approved care recipient of a residential aged care facility or a patient at an eligible Aboriginal Medical Service - the items cover telehealth services provided to these patients in all geographical areas of Australia.
Maps of eligible geographical areas are available
here.
Does an eligible geographical location relate to where the patient lives or location of the patient service?
Eligibility is determined by location of the patient service (which could be at a patient’s home, a GP Practice or other venue with suitable video conferencing equipment). Eligible specialists, consultant physicians or psychiatrists can provide video consultations from anywhere in Australia to a patient located in a regional, remote or outer metropolitan area or to a patient in an eligible Aboriginal Medical Service or a resident of a Residential Aged Care facility in any location.
Who can provide telehealth consultations?
Specialist-end
Video consultations can be provided by any medical practitioner who is registered or authorised to practise (as described in the Health Insurance Act 1973), as a consultant physician, psychiatrist or specialist.
Patient-end
Clinical services can be provided at the patient end of a video consultation by any medical practitioner, participating midwife or participating nurse practitioner who has a Medicare provider number linked to an eligible patient location. In addition, a practice nurse or Aboriginal health worker can provide a patient-end service ‘for and on behalf of a medical practitioner’ to a patient located in an eligible geographical area.
How is an Aboriginal Health Worker defined under this initiative?
Aboriginal health worker means a person:
(a) who is employed by, or whose services are otherwise retained by, a medical practitioner, a general practice or a health service in relation to which a direction made under subsection 19 (2) of the Act applies; and
(b) holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualification; or
(c) who is registered, and holds a current registration issued by a State or Territory regulatory authority, as an Aboriginal health worker.
Act means the Health Insurance Act 1973.
How is a Practice Nurse defined under this initiative?
Practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or a health service to which a direction under subsection 19 (2) of the Act applies.
Act means the Health Insurance Act 1973.
Can video consultations be conducted in a patient’s home?
There are Medicare items available for patient-end support services provided in the home. A video consultation can be conducted in a patient’s home if the specialist considers it is clinically appropriate and if the patient’s home is located outside an inner metropolitan area.
There are home visit items available for medical practitioners, where a General Practitioner or nurse might do a home visit and during that visit, video link with a remote specialist.
Can I provide MBS billed telehealth services to admitted hospital patients?
No. Medicare and DVA rebates are not payable for video consultations with an admitted hospital patient. This applies to both public and private admitted patients.
How do I find a specialist who will provide video consultations?
Relevant professional colleges may be able to assist with this information.
As a patient-end practitioner, do I need to be present for the whole video consultation?
No. The patient-end practitioner does not need to be present for the entire consultation, only as long as is clinically relevant - this can be established in consultation with the specialist. The MBS fee payable for the patient-end practitioner will be determined by the total time spent assisting the patient.
Can I provide telehealth patient-end services if I am a locum practitioner?
Yes. If you are located in an eligible telehealth area and you have a provider number for that location you will be able to provide a telehealth patient-end service.
Can I bill telehealth services which are conducted by phone or email?
No. The new MBS video consultation items are not payable for telephone or email consultations. There must be a visual link between the patient and the eligible specialist, consultant physician or psychiatrist in order for the patient to claim for a telehealth rebate.
Do I need to take clinical notes of the video consultation?
Yes. Clinical record requirements (for remotely located specialists, consultant physicians or psychiatrists and for patient-end practitioners) will be the same as for face-to-face consultations.
During an MBS-funded video consultation, the eligible specialist, consultant physician or psychiatrist can see their patient and, in most cases, the patient-end practitioner will support the consultation (e.g. taking pulse/BP/temperature/etc or removing dressings/examining wounds).
The eligible specialist, consultant physician or psychiatrist and patient-end practitioner should record the clinical notes of the video consultation.
What are the technical requirements for a video consultation?
In order to meet the requirements of the MBS item a visual and audio link with the patient must be present.
The Government is not prescribing any particular technical solution; however, there is some information about technical considerations available
here. Your professional College may be able to advise on requirements/recommendations they have regarding appropriate equipment for a telehealth consultation.
How does a specialist write a prescription for the patient if they are not co-located?
Patient-end practitioners can arrange to provide prescriptions ordered by specialists during a video consultation. If the drug to be prescribed can only be ordered by a specialist, or if a patient-end practitioner is not involved in the video consultation, the specialist, consultant physician or psychiatrist can mail a prescription to the patient or to the patient's pharmacist.
How do I decide when a telehealth MBS patient-end service item can be billed?
As with any MBS item, it is up to the individual practitioner to determine if the service is clinically relevant. Practitioners will need to consider whether undertaking the service and recommending a course of treatment requires the patient to be physically examined, and if so, whether this examination can appropriately be carried out by a 'support person' at the patient end. Practitioners can also seek advice from their professional colleges.
Can two MBS items be billed for a video consultation, that is, by a medical practitioner and by a practice nurse on the same occasion?
No. Only one telehealth MBS patient-end item is payable per patient video conferencing episode.
The practitioner who provides assistance to the patient during a video consultation with a specialist may seek assistance from a health professional (e.g. a practice nurse or Aboriginal health worker) but only one item is billable for the patient’s consultation with the specialist. The practitioner must be present during part or all of the consultation in order to bill an appropriate time-tiered MBS item. Any time spent by another health professional called to assist with the consultation may not be counted against the overall time taken to complete the video consultation.
Can I bill a Medicare payable service for clinically supporting my patient during a video consultation with a specialist?
Yes. New Medicare items will be available for medical practitioners, participating nurse practitioners and participating midwives, practice nurses and Aboriginal health workers to provide clinical support to a patient during a video consultation.
Can I bill a face-to-face consultation with my patient on the same day a video consultation has been provided and billed?
Yes. It is acknowledged that a patient may require a face-to-face consultation by their referring practitioner or by the eligible specialist, consultant physician or psychiatrist on the same day a telehealth service is provided. You will need to provide the time of each consultation on the patient’s account or bulk billing voucher.
Can I bulk bill my patient for a telehealth service?
Yes. All practitioners are encouraged to bulk bill their patients and this is particularly important for video consultations where the patient may receive two bills, one from their specialist and a second if clinically supported by their practitioner.
Are there any changes to the case conferencing items?
No. Case conferencing items remain unchanged. These items do not attract a telehealth incentive payment.
Do the new MBS items apply to remote monitoring?
No. There are a number of trials currently considering how telehealth monitoring and medical alert systems can support Australians mange their health needs from home. These trials will increase the evidence around these types of services.
As a practitioner, what do I bill if I am not present throughout the total video consultation?
The patient-end MBS items for medical practitioners are based on time and the appropriate item to bill would be the one that represents the total time spent with the patient during the video consultation.
Can there be multiple video consultations provided on the same day?
Yes. Medicare benefits may be paid for more than one video consultation for a patient on the same day by the same practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations. You will need to provide the times of each consultation on the patient’s account or bulk billing voucher.
Will my indemnity premiums go up if I provide video consultations?
The Department of Health and Ageing has received advice that indemnity premiums will not be affected by performing video consultation. Insurers have indicated that they will monitor the level of consultations provided as is normal for any new aspect of medical practice.
Are there a minimum or maximum number of video consultations for an incentive payment?
No. The Telehealth Service Incentive is volume based and accrued for each occasion that a Medicare benefit is paid for a telehealth item. Payments will be paid quarterly to the practitioner billing the service into the same account/pay group link as other Medicare benefits are paid.
If no EFT details are recorded for the provider at the location where the service is provided, this will need to be supplied to the Dept of Human Services in order to receive the payment.
When will I receive these incentive payments?
A Telehealth On-Board Incentive will be paid to an Eligible Practitioner upon the first occasion that a Medicare benefit is paid for a Telehealth MBS Item billed against a practitioner’s provider number.
A Telehealth Service Incentive will accrue to a practitioner each time a Medicare benefit is paid for Telehealth MBS Item billed against a practitioner’s provider number and a single payment will be made once per payment quarter.
How many Telehealth On-Board Incentives can I receive if I have multiple provider numbers?
Practitioners with multiple provider numbers are considered a single practitioner and may only receive one Telehealth On-Board Incentive.
How will I receive incentive payments?
Payments will be deposited directly into your bank account via Electronic Funds Transfer (EFT). EFT details must have been supplied to the Dept of Human Services.
Can I bill for the additional bulk bill incentive items?
Practitioners providing a non referred service may also bill item numbers 10990 or 10991 where they meet the requirements of those items.
Do the incentive payments include GST?
The Department of Health and Ageing has received advice that incentive payments are not subject to the Goods and Services Tax (GST).
Will there be training available on how to undertake a video consultation?
Yes. Information about training for video consultations will soon be available from some medical colleges and associations, and professional organisation websites.
Are practitioners audited on how they spend the incentive payments?
No. There will not be audits or reporting requirements on how incentive payments are spent. Incentive payments are intended to encourage a change in behaviour; specifically to change practice workflow and structure to incorporate online video consultations. The way an individual or business spends an incentive payment is up to them. You may, however, be audited on your eligibility to receive an incentive payment and if you have received an incentive payment inappropriately, you will be required to repay it.
Are there any special billing requirements for video consultations?
Yes. All video consultations provided by an eligible specialist, consultant physician or psychiatrists should be separately billed. That is, only the relevant telehealth MBS derived item and the associated consultation item are to be itemised on a single account/bill. This will ensure that the claim is not rejected by the Dept of Human Services.
When will a Medicare or DVA rebate be payable for a video consultation?
The MBS items will be available from 1 July 2011. Item descriptors can be found
here.
How will the Practice Nurse items be affected by the Practice Nurse Incentive Program?
The Practice Nurse items will be reviewed following the introduction of the Practice Nurse Incentive Program which commences on 1 January 2012.
Can a patient receive multiple video consultations on the same day?
Yes. Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations. You will need to provide the times of each consultation on the patient’s account or bulk bill voucher.
How will the specialist bill the patient for the service?
Billing arrangements are flexible and can be negotiated between specialists and patients, or between specialists and patient-end facilities. MBS telepsychiatry has been operating for several years and psychiatrists generally either bulk bill their patients or arrange credit card payments at the time of service.
Patient-end practitioners can bill as they normally would a face-to-face consultation.
Can I use electronic claiming to lodge a bulk bill claim?
You can use electronic claiming if you have those services available. Once you have consent from the patient to assign the benefit to you, you should lodge the bulk bill claim directly to Medicare on behalf of the patient. A copy of the signed assignment of benefit form must be forwarded to the patient for their records.
More information can be found on the the Dept of Human Services website.
www.medicareaustralia.gov.au
Can I use freely available products such as Skype?
The Government is not mandating or endorsing any particular technical solution for telehealth. In providing MBS billed telehealth services, clinicians should be confident that the technical solution they choose is:
- capable of providing sufficient video quality for the clinical service being provided; and
- sufficiently secure to ensure normal privacy requirements for health information are met. Individual clinicians will need to be confident that the technology used is able to satisfy the item descriptor and that software and hardware used to deliver a videoconference meets the applicable laws for security and privacy.
Does the patient-end practitioner need to be co-located with the patient during the video consultation?
Yes. The telehealth items require that the patient and their support practitioner be together at the same location.
What are the Medicare recording requirements for these services?
Participating telehealth practitioners are required to keep contemporaneous notes of the consultation and this includes documenting that the service was performed by video conference, including the time and the people who participated. Only clinical details recorded at the time of the attendance count towards the time of the consultation. It does not include information added at a later time, such as reports of investigations.