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 - – 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 & 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 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, Service Incentive Specialist service$48$39 Patient-end service (GP, Nurse, Aboriginal Health Worker)$32$26 3. Bulk Billing Incentive Each time service bulk billed$16$13

Medicare rebates – Health Worker or Nurse Telehealth MBS Item Service by attend Aboriginal Health Worker or Nurse Medicare Benefit Telehealth patient support service on behalf of a medical practitioner $ Telehealth patient support service on behalf of a medical practitioner at a Residential Aged Care Facility. $31.80 CategoryPayment type MBS payments MBS MBS -Telehealth support service on behalf of a medical practitioner $31.80 Incentive - autoTelehealth service incentive, paid quarterly$32.00 Incentive - autoTelehealth 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.

Telehealth MBS Item Time Based Service –GP consultation Medicare Benefit 2100Level A Telehealth attendance at consulting rooms $ Level B$ Level C$ Level D$ CategoryPayment type MBS payments 2126 MBSTelehealth attendance at consulting rooms < 20mins$48.05 Incentive - autoTelehealth service incentive, paid quarterly$32.00 Incentive - autoTelehealth 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 Patient-End Services MEDICAL PRACTITIONER (INCLUDING A GENERAL PRACTITIONER, SPECIALIST OR CONSULTANT PHYSICIAN) TELEHEALTH ATTENDANCES 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 ($9.10) The latter applies to regional, rural or other specified geographic locations.

Discussion and Questions Refer to information sheets