Telehealth Claims - New information from Human Services (Medicare)

Telehealth – assignment of benefits for specialist services

Recently, the Department of Human Services introduced a new option to enable patients who have a telehealth consultation with a specialist to assign their right to a Medicare benefit to the specialist via email. 

This option has been made available to meet the needs of specialists who wish to bulk bill their patients when they are not in the same location and is available for all Telehealth services provided from 1 July 2011 retrospectively.

This option is in addition to other ways of obtaining a signature, such as:

  • sending the assignment of benefit form to the patient for signature and the patient returning it to the specialist for lodgement with Human Services; or
  • asking the supporting practitioner (if 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 Human Services.

Where the patient assigns the Medicare benefit to the specialist via email, the wording ‘email agreement’ will be accepted as a valid signature on the Medicare Assignment of benefit form. 

If the Medicare Assignment of benefit form does not contain the signature of the patient and the wording ‘email agreement’ is not present, the telehealth service will not be paid.

Please note: it is not a requirement for the patient to sign the Assignment of benefit form at the time of the consult but must be signed prior to lodging the claim with Human Services.

The steps you need to take to obtain an ‘email agreement’ can be found under Bulk Billing at www.medicareaustralia.gov.au/provider/incentives/telehealth.jsp

 Use of MBS Item 99 for miscellaneous services

Human Services is experiencing instances where the Telehealth MBS Item 99 is being used to signify miscellaneous services which do not attract a Medicare benefit. This is resulting in incorrect Medicare benefits and incentives to be paid.

MBS Item 99 should only be used to accompany MBS Items 104 or 105 to signify a Telehealth service.

 

Use of asteric (*)

Do not include an asteric (*) after or before an MBS Item unless the service was performed within a hospital.

Telehealth services are not claimable for in-hospital services and if an asteric (*) is included within the MBS Item, this may cause Medicare benefits for Telehealth services and incentives not to be paid.

 

Electronic claiming channels

Medicare Online

Telehealth services can be claimed via Medicare Online. 

To enable Human Services to pay the correct Medicare benefit, both the base and derived fee Telehealth MBS items must be claimed within the same voucher, unaccompanied by any other MBS items. 

This enables the derived fee item to be attributed to the appropriate base consultation item. 

Medicare Easyclaim

Telehealth services can be claimed via Medicare Easyclaim for patient claims for both specialist and supporting practitioner services only. 

It is not possible to use Medicare Easyclaim when bulk billing Telehealth specialist services. 

This limitation applies to all services where a base and derived fee is to be claimed due to technical limitations with the calculation of the derived fee against the base item and is not restricted to a Telehealth service. 

Amount Charged Information

The amount charged for both the base and derived fee item must be present at the time of lodging a Medicare claim with Human Services. 

This is a requirement under the Health Insurance Regulations 1975 and applies to the benefit assigned section of bulk bill vouchers and private accounts.

Please note: If this information is not included, the claim may be rejected and a Medicare benefit not paid. 

Incentive Payments - Electronic Fund Transfer

All Telehealth Incentive payments will be paid directly into the bank account registered against the practitioner who is to receive the payment. This would be the same bank account that Medicare benefits are paid into. 

Practitioners must ensure their bank account details are provided to Medicare prior to billing their first Telehealth service. 

Comprehensive questions and answers can be found at –

http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/mbsonline-telehealth-landing.htm

Further information is also available on the Human Services website at www.medicareaustralia.gov.au/provider/incentives/telehealth.jsp

 

 

AttachmentSize
Telehealth helpful information update.doc40.5 KB