• Joint responsibility for
    Medicare repayments

  • The Shared Debt Recovery Scheme commenced on 1 July 2019, as part of an increased focus to improve debt recovery from Medicare compliance activities. The scheme was introduced because Medicare billing was often delegated to non-practitioners, leading to incorrect billing practices in some instances. It is important for both doctors and practices to understand Medicare Benefits Schedule (MBS) billing requirements.

    Liability of practice owners

    Under the scheme, practice owners can be liable for Medicare debts owed by doctors who are contracted or engaged to work within the practice.

    Medicare has the power to apportion debts arising from false or misleading statements (e.g. claim for benefit) between the individual doctor and a secondary debtor, such as a practice.

    Medicare can make a shared debt determination where it is reasonably believed the:

    1. Practice could have controlled or influenced the circumstances that led to the making of the false or misleading statement
    2. Practice directly or indirectly obtained a financial benefit from the making of the false or misleading statement
    3. Circumstances of the case make it fair and reasonable for the determination to be made.


    When a doctor is first contacted about an audit, they will be asked if they would like to be considered for a shared debt determination. The doctor will be asked to produce documents in relation to the services claimed and information about relevant employment, contractual or financial arrangements. If a possible secondary debtor is identified, they will also be asked to provide information.

    A shared debt determination and your practice

    After a compliance audit, a shared debts determination will be decided by the Department of Health’s audit officer. They will decide whether a debt is owed and if it should be shared between two parties.

    The default split is 65% for the doctor (the primary debtor) and 35% for the practice (the secondary debtor). However, the parties can make submissions if they believe the proportion should be different.

    Either party can apply for a review of the decision, which will be undertaken by a review officer, working on behalf of the Chief Executive Medicare.

    How can Avant assist your practice?

    Avant Practice Medical Indemnity Insurance cover can provide your practice with medico-legal advice when responding to Medicare compliance audits as well as legal representation and defence costs in the case of a shared debt determination. We cover up to $150,000 for Medicare compliance audits subject to the full terms, conditions and exclusions of the policy.

    Find out more

    Schedule a call with one of our team at your convenience

     
  • Avant’s Practice Medical Indemnity. What it covers.^


  • Your policy includes legal costs, and in the case of a revenue or taxation audit, accounting fees, to respond to an audit of your business.

    Your practice may be audited by:

    • the Australian Taxation Office
    • Medicare

    Your policy includes legal costs of defending the practice, and compensation amounts you may become liable to pay.

    Situations that may result in a patient injury or loss claim against the practice entity include:

    • failure to follow up
    • breach of patient privacy
    • practice nurse administering the wrong vaccine
    • a patient being seen by a number of doctors and it is unclear which (if any) have been negligent.

    Our Medico-legal Advisory Service can provide personalised advice to prevent a dispute from escalating. Your policy also covers legal costs to defend a dispute.

    Common reasons why practices contact Avant for advice or defence include:

    • disputes with staff
    • disputes between staff
    • employees' use of social media
    • employment contracts.

    In response to matters brought by a state health complaint entity or criminal or coronial investigations, Avant's team of medico-legal experts will assist you and your employees with everything from drafting a formal response and preparing for a hearing, to defending the practice or it's non-medical practitioner employees.

    Reasons a practice may face an investigation or inquiry include:

    • refusal to treat a patient
    • coronial inquiry
    • allegation of discrimination
    • communication issue.

    An allegation or complaint may adversely affect revenue due to a reduction in patient numbers. Your policy includes costs for a public relations consultant.

    Many practices unintentionally breach advertising laws through the use of testimonials and social media. Your policy includes access to medico-legal advice and legal costs to defend the practice.

  • ^Cover is subject to the full terms, conditions and exclusions of the policy.

  • Resources

    Managing Medicare and practising within the guidelines is an essential aspect of delivering patient care for practices. Here are some useful resources on Medicare best practice, that will help minimise the chances of being the subject of an audit.

    It happened to me: Medicare compliance letter
    Listen to our podcast in which a doctor shares their insights after receiving a Medicare compliance letter.
    Medicare compliance insights
    Watch our video on Medicare compliance insights
    Download our factsheet on Medicare compliance
  • Practical tips to mitigate risks

    Practices should document a clear policy on the Medicare billing process in agreement with all doctors and the practice team. The policy should outline that individual doctors are responsible for ensuring the accuracy of their billings.

    Recording Medicare item numbers

    The doctor whose provider number is being used to charge Medicare, is responsible for instructing which item number is billed. Practice staff should not change the item number themselves.

    All communication regarding Medicare billings should be documented via the appointment book, email or an internal messaging facility and any changes should be recorded by the doctor.

    Documentation

    In order to bill correctly, both individual providers and practices with administrative responsibility for Medicare billings, should ensure medical records:

    • Have separate entries for each attendance by the patient for a service and the date the service was provided.
    • Include adequate clinical information to explain the type of service provided.
    • Are sufficiently comprehensible that another doctor could rely on it for ongoing care.
    • Are written at the time the service was provided or as soon as practicable afterwards.


    Interpreting item numbers

    If you notice a level of variance in the way particular item numbers are being applied, practice managers could encourage a discussion of these item numbers at practice meetings. This will help doctors stay consistent with the standards of practice amongst their peers.

    Any concerns practice management have regarding the billing of Medicare item numbers, should be discussed with the doctor (or other provider) and the discussion documented.

    If doctors need assistance interpreting MBS items and rules, practice managers could also suggest contacting the Department of Health’s advice service at: askMBS@health.gov.au

    Submitting bulk billing claims

    Prior to submitting Medicare claims, a report should be provided to each doctor listing the claims for submission. Each doctor should provide their signed and dated authority and copies be retained by the practice and individual doctors.

    If a claim is rejected, it should be returned to the relevant doctor. Practice staff can resubmit the claims once the doctor has given authority to resubmit.

    Useful links

    Avant submission to the Department of Health on the Shared Debt Recovery Scheme

    Department of Health – Shared Debt Recovery scheme – frequently asked questions

  • Important documents

    download
    Download the insurance policy booklet
    download  
    Download the summary of features
    download
    Download the application form