The following changes take effect from 1 March 2019:
New group under Category 1
A35 - Services for Patients in Residential Aged Care Facilities
New subgroups under A35
1 - Flag Fall Amount for Residential Aged Care Facilities
2 - General Practitioner Non-Referred Attendance At A Residential Aged Care Facility
3 - Other Medical Practitioner Non-Referred Attendance At A Residential Aged Care Facility
4 - Non-Specialist Practitioner Non-Referred Attendance At A Residential Aged Care Facility
Services for Patients in Residential Aged Care Facilities
The government will increase the Medicare Benefits Schedule fees for GPs attending a residential aged care facility to help ensure that GPs have appropriate incentives to provide care in aged care facilities.
Currently, the Medicare benefit is calculated from the type of service provided and the number of patients seen at a residential aged care facility. This arrangement, known as a ‘ready reckoner’, calculates the total benefit based on a nominal amount plus a modifier. The modifier must be divided or multiplied (6 or fewer patients is divided, 7 or more patients is multiplied) by the number of patients seen by the doctor at the residential aged care facility.
From 1 March 2019, this arrangement will be changed for the most commonly claimed GP services in residential aged care facilities. The existing ready reckoner attendance items (20, 35, 43, 51, 92, 93, 95, 96, 183, 188, 202 and 212) will be replaced with 12 new attendance items in group A35. These items have the same requirements as the deleted attendance items but have a nominal fee amount the same as attendance items in consulting rooms. The new attendance items can be claimed for each patient attended during a residential aged care facility visit.
A new single callout fee recognises the important role of GPs in supporting the health and care of patients in residential aged care. The call out fee is $55 for GPs (item 90001) and $40 (item 90002) for other medical practitioners working in general practice.
This amount is intended to reflect the costs doctors incur when providing professional services in residential aged care facilities. The call out fee is only payable once per visit to a residential aged care facility.
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The Shared Debt Recovery Scheme (SDRS) will commence from 1 July 2019. The SDRS will introduce a fairer approach to billing practices and will enable the Department to hold an organisation responsible for a portion of any debts incurred as a result of incorrect Medicare claiming.
This change recognises that there has been an increase in the role of practices, corporate entities and hospitals in the billing of MBS services on behalf of individual practitioners. It also highlights that both parties have a responsibility to ensure MBS claims are made correctly, in that:
Mr Morrison announced that from 1 April, Australians at risk of heart disease will be eligible for a multi-point heart check-up, which will be estimated to prevent 76,500 heart attacks — 9100 of them fatal — and save $1.5 billion over the next five years. 1 April 2019, will bring a Medicare rebate of $72.80 for the half-hour service, in which a GP will check a patient’s blood pressure, cholesterol, lifestyle factors, smoking status and family history then estimate their risk of a heart attack in the next five years.
Prevention is key. This dedicated Medicare item for heart health checks will save and protect lives. Medicare access will enable GPs and patients to work together to manage their risk factors hopefully preventing a heart attack or development of heart disease.
The independent medical experts at the Medical Benefits Schedule Review Taskforce will also conduct a review with the potential for further development of this new Medicare item.
The Quality Improvement (QI) Practice Incentive Payment (PIP) is due to commence from 1 May 2019. The current PIP payments for Asthma, Cervical Screening, Diabetes, Aged Care Access and Quality Prescribing will cease from 30 April 2019, while the PIP Incentives for After Hours, eHealth, Indigenous Health, Procedural General Practice, Rural Loading and Teaching will remain unchanged.
The new QI PIP aims to improve:
As part of the QI PIP, practices will be required to commit to quality improvement activities and sharing de-identified general practice data. This also supports general practice accreditation, which encourages general practices to pursue continuous quality improvement and best practice standards.
General practices eligible to participate in the QI PIP can apply from 1 May 2019. QI PIP guidelines, including data governance guidelines, are yet to be provided by the Australian Department of Health. Further updates will be provided through Practice Connect when information becomes available, or you can register for the Incentives News Updates available through the Australian Government Department of Human Services.
WAPHA supports over 350 practices in WA through data sharing arrangements. If your practice is interested in establishing a data-sharing arrangement with WAPHA, further information is available from WAPHA’s website or contact your Primary Health Liaison.