Connecting Health Services With the Future: Questions and Answers for Medical Specialists
Questions and answers which have been prepared to assist Medical Specialists in understanding 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 video consultations from 1 July 2011. A full list of telehealth MBS items is available
here.
Can video consultations be claimed through the Department of Veterans’ Affairs?
Yes.
What financial incentives are available to practitioners to encourage the uptake of 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.
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.
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.
Who can provide video 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.
Where can I find participating practitioners?
Relevant professional colleges may be able to assist with this information.
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.
Can I bill telehealth services which are conducted by phone or email?
No. The new MBS telehealth items are not available for telephone or email consultations. There must be a visual and audio link between the patient and the eligible specialist, consultant physician or psychiatrist in order for the patient to claim for a telehealth rebate.
Can a specialist/consultant provide a video consultation to multiple patients at once?
No. The MBS items require an attendance by a medical practitioner on a single patient on a single occasion. It is possible to provide consultations to multiple patients consecutively during a single conference, but these would need to be separate consultations.
How do I write a prescription for the patient if I’m not co-located?
Patient-end practitioners can provide prescriptions ordered by specialists during a video consultation. If the drug to be prescribed can only be ordered by an eligible specialist, consultant physician or psychiatrist, 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 the patient's pharmacist.
Can I order tests be done on the patient?
Yes. In terms of ordering pathology and diagnostic imaging tests, there is no difference between a video and face-to-face consultation. In practice the arrangements for these tests could vary between email, fax, mail and/or in consultation with the supporting practitioner.
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.
As a specialist/consultant, how do I bill my patient when we are not co-located? How will the patient pay me 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.
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 consultations. Insurers have indicated they will monitor the level of consultations provided as is normal for any new aspect of medical practice.
Are there any changes to the case conferencing items?
No. Case conferencing items remain unchanged. These items do not attract a telehealth incentive payment.
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.
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 provide advice on requirements/recommendations they have regarding appropriate equipment for a video consultation.
Are there financial incentives for changing my business practices to include video consultations?
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.
Are there a minimum or maximum number of 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 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).
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.
When will a Medicare or DVA rebate be payable for a video consultation?
The MBS items will be available from 1 July 2011.
What is the Medicare schedule fee for a video consultation?
The schedule fee for a telehealth video consultation is based on two MBS items; that is, the existing specialist item and a telehealth item which derives its schedule fee as an additional 50% of the base (existing) item.
Can a patient receive multiple telehealth video consultations on the same day?
Yes. Medicare benefits may be paid for more than one telehealth 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 bill voucher.
Can two MBS items be billed for patient-end services during a video consultation; that is, by a medical practitioner and by a practice nurse?
No. Only one telehealth MBS patient-end service item can be billed per patient episode.
The service provider who initiates the video consultation may seek assistance from a health professional (e.g. a practice nurse or Aboriginal health worker) to complete the service but only one item is billable for the patient episode. The initiating 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 telehealth consultation.
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.
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.
How do I calculate the derived fee for the telehealth items?
Fifty-five existing specialist items, currently used only for face-to-face consultations, can now be used to provide services to patients via video conference. These items can be claimed with one of 11 new ‘derived’ items, especially created for telehealth. These 11 new telehealth items have derived fees which increase the base Schedule fee for the existing consultation items by 50%. This means that, when the two items are claimed together, the total Schedule fee for a telehealth specialist consultation will be 150% of the Schedule fee for the equivalent face-to-face service.
For example if a specialist is providing a follow up consultation via video consultation to a patient located outside an inner metropolitan area then MBS items 105 and 99 can be billed. The Schedule fee is calculated by adding the fee for item 105 ($41.35) and 50% of this amount for item 99 ($20.70) giving a total fee = $62.05. The Medicare rebate being 85% of the Schedule fee = $52.75.
| MBS Item | 105 | 99 | Total |
| Fee | $41.35 | $20.70 | $62.05 |
| Benefit (85%) | $35.15 | $17.60 | $52.75 |
Do the Extended Medicare Safety Net (EMSN) benefit caps apply to any telehealth MBS items?
Yes. Two of the new telehealth items have an EMSN benefit cap.
Telehealth item 13210 (Group T1 - Miscellaneous Therapeutic Procedures) has an EMSN benefit cap of $5. This aligns with the calculation of derived fees for the telehealth items, which are calculated at 50% of the fee for the associated item. Item 13209 has an EMSN cap of $10, and item 13210 has an EMSN cap of $5.
Telehealth item 16399 (Group T4 – Obstetrics) has an EMSN benefit cap of $22.95. This also aligns with the calculation of derived fees for the telehealth items. However, as the associated items have varying EMSN caps, the fee has been calculated at 50% of the weighted average of the existing EMSN caps.
More information on the EMSN can be found in the fact sheet section of
mbsonline.
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.
How do I get the patient to assign the Medicare benefit to me (ie bulk bill) when the patient is in another location?
There are a number of options available :
If patient-end support is present
- ask the supporting practitioner in attendance to complete the assignment of benefit form and seek the patient’s signature on the specialists behalf and forward it to the specialist for lodgement with Department of Human Services;
If patient-end support is not present