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.
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.