Medicare Benefits Scheme. Under the Connecting Health Services with the Future: Modernising...

Medicare Benefits Scheme

Under the Connecting Health Services with the Future: Modernising Medicare by Providing Rebates for Online Consultations initiative (announced 2010)

Medicare rebates and financial incentives for online consultations across a range of medical specialties.

23 new MBS support items available for patient-end services.

11 new items for specialist services

The MBS Telehealth Initiative

Telehealth MBS items may be billed where a specialist consultation is conducted via video conferencing with a non-admitted patient who is:

in an eligible Aboriginal Community Controlled Health Service (ACCHS) (regardless of location)

a care recipient at a Residential Aged Care Facility (regardless of location)

located outside Major Cities - http://www.doctorconnect.gov.au – for a map 

‘Store-and-forward’ Telehealth consultations (e.g. for dermatology, ophthalmology, radiology) are not funded via MBS at this stage.  

What is covered?

Outside RA 1 areas (major cities)

Eligible areas

Eligible Staff under MBS item numbers

Doctors

Specialists, consultant physicians, consultant psychiatrists

Practice Nurses and Nurse Practitioners

Aboriginal Health Workers

Note: Under Telehealth, two clinicians may bill the MBS for the same

consultation

Eligible Staff under MBS item numbers

Doctors

Specialists, consultant physicians, consultant psychiatrists

Practice Nurses and Nurse Practitioners

Aboriginal Health Workers

Note: Under Telehealth, two clinicians may bill the MBS for the same

consultation

According to the MBS guidelines an Aboriginal Health Worker:

Holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualifications; or

Is registered, and holds a current registration issued by a State or Territory regulatory authority, as an Aboriginal Health Worker; and

Is employed by, or whose services are otherwise retained by a medical practitioner or their practice.

Aboriginal Health Worker eligibility

Aboriginal Health Worker eligibility (continued)

• 'Other appropriate qualifications' may be appropriate for individuals who consider their qualification to be equivalent or higher than the qualifications listed above, they will need to contact a registered training organisation in their state or Territory to have the qualification assessed.

• When acting on behalf of a medical practitioner during a Telehealth consultation (items 10983 & 10984) the Aboriginal Health Worker doesn’t require a provider number.

For more information about registration and accessing Medicare as a AHW go to the AHPRA website.

Medicare incentives (on top of item numbers)

1. On-Board Incentive 2012-13 2013-14

First Telehealth On-Board instalment (after first MBS claim) $1,600 $1,300

Second Telehealth On-Board instalment (after tenth MBS claim) $3,200 $2,600

Total On-Board Incentive $4,800 $3,900

2. Service Incentive 2012-13 2013-14

Specialist service $48 $39

Patient-end service (GP, Nurse, Aboriginal Health Worker) $32 $26

3. Bulk Billing Incentive 2012-13 2013-14

Each time service bulk billed $16 $13

Medicare rebates – Health Worker or NurseTelehealthMBS Item

Service by attend Aboriginal Health Worker or Nurse

MedicareBenefit

10983 Telehealth patient support service on behalf of a medical practitioner

$31.80

10984 Telehealth patient support service on behalf of a medical practitioner at a Residential Aged Care Facility.

$31.80

Category Payment type MBS payments

10983 MBS MBS -Telehealth support service on behalf of a medical practitioner

$31.80

Incentive - auto Telehealth service incentive, paid quarterly $32.00Incentive - auto Telehealth bulk billing incentive, paid quarterly $16.00

Total $79.80

Example of fees (table below) reimbursed for each 15 minute video consultation with a specialist when the Health Worker/Nurse is present with the patient in the room with the Telehealth Service and Bulk Billing incentives added.

TelehealthMBS Item

Time Based Service –GP consultation

MedicareBenefit

2100 Level A Telehealth attendance at consulting rooms

$22.052126 Level B $48.052143 Level C $93.202195 Level D $137.10

Category Payment type MBS payments

2126 MBS Telehealth attendance at consulting rooms < 20mins $48.05Incentive - auto Telehealth service incentive, paid quarterly $32.00Incentive - auto Telehealth bulk billing incentive, paid quarterly $16.00

Total $96.05

Example of fees (see table below) reimbursed for each 15 minute video consultation by a patient and GP, with a specialist

Medicare rebates – GP

The item numbers – Medicare website

Telehealth MBS Item

MBS Group Location of Service

2100212621432195

GROUP A30, SUBROUP 1 At consulting rooms in a telehealth eligible area or at an eligible Aboriginal Medical Service

2122213721472199

GROUP A30, SUBGROUP 1 Other than consulting rooms such as a home visit or other institution in a telehealth eligible area

2125213821792220

GROUP A30, SUBGROUP 2 At a residential aged care facility

Patient-End Services

MEDICAL PRACTITIONER (INCLUDING A GENERAL PRACTITIONER, SPECIALIST OR CONSULTANT PHYSICIAN) TELEHEALTH ATTENDANCES

10983 GROUP M12, SUBGROUP 1 In a telehealth eligible area or at an eligible Aboriginal Medical Service

10984 GROUP M12, SUBGROUP 2 At a residential aged care facility

PRACTICE NURSE OR ABORIGINAL HEALTH WORKER TELEHEALTH ATTENDANCE PROVIDED ON BEHALF OF A MEDICAL PRACTITIONER

The item numbers (continued)

If you are bulk billing and your patient is under 16, or is a Commonwealth concession card holder (and the person is not an admitted patient) you can also claim MBS item 1090 ($6.00) or 10991 ($9.10)

The latter applies to regional, rural or other specified geographic locations.

Discussion and Questions

Refer to information sheets