-----Original Message----- From: Kristen Connell [mailto:[EMAIL PROTECTED] Sent: Friday, 17 February 2006 4:15 PM
Please find attached this week's GP Network News. This edition looks at checking patient eligibility for MBS items, COAG and RACGP Research Grants. http://www.ama.com.au/web.nsf/doc/WEEN-6M48F5 "AMA GP Network News Issue 06, Number 3 - 17 February 2006 Item eligibility checking More and more MBS items are being introduced that have time limitations attached, such as the patient can only access this service once a year. The new chronic disease management items are the perfect example of this new trend. There are also a growing number of health assessment items that operate in a similar manner. When the new chronic disease items were first discussed with Government, the AMA made it very clear that the strict time limitation rules made it vital doctors be able to check patient eligibility. It explained that this was necessary to prevent situations where the doctor completes the comprehensive and time consuming work related to creating a care plan only to discover the patient already had a care plan prepared by another GP. The Government agreed to make patient eligibility checking possible through a hotline (GPNN 11 June 2004). However, because of privacy issues this hotline never eventuated. According to the Government, privacy rules mean no information about a patient's item claiming history can be provided to anyone but the patient. That means that the only person who can check whether a patient is eligible for an item is the patient. The patient can check their eligibility while in the presence of the doctor or his staff. This situation is obviously inadequate as many patients do not know whether they have had a care plan previously and do not understand the MBS system fully enough to ring and check which items they have already accessed. For a doctor to ask a patient to check before providing a service would potentially impact on their relationship. The only effective way these new items can operate is for practices to be able to check patient eligibility. The AMA will be writing to the Government calling on them to revisit this decision. Until patient eligibility can be properly verified, the AMA will continue to argue against doctors being penalised for providing services in good faith." In our Pracsoft v3.4 with Online Claiming, we can do an 'OPV' check - our computer asks the Medicare computer to confirm that we have the correct Medicare number, name, address, etc. for the patient. The purpose of the OPV check is prevent the claim from being rejected because the details that we have don't match those held by Medicare. It would be good to have a similar function (perhaps called an Item Eligibility Check) for item numbers that we are proposing to bill. Our computer would ask the Medicare computer "What about if we billed item 900?" (for example). If the patient has had the item billed within the interval specified for that item (is it one year for item 900?), the Medicare computer would say, just like in the bank sketch in Little Britain: "The computer says noooo". Of course, since most EPC items are bulk billed, one *could* just actually transmit the claim for the item 900 or whatever item it is, *before* providing the service, to find out whether the claim will be rejected. The only teeny weeny possible difficulty with doing this is that it is just the tiniest bit illegal to bill for the service before providing it. Remember, you didn't hear this from me. Oliver Frank, general practitioner 255 North East Road, Hampstead Gardens South Australia 5086 Ph. 08 8261 1355 Fax 08 8266 5149 _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
