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By Ashleigh McMillan


Optometry Australia has met with representatives from the federal Department of Health about MBS items.

Optometry Australia CEO Lyn Brodie, national policy manager Skye Cappuccio and national clinical policy adviser Simon Hanna attended a meeting with Department of Health representatives on 26 June and discussed minor amendments required to the Medicare Benefits Schedule to ensure items reflect contemporary practice and provide clarity of interpretation.

They also met with an adviser to Federal Health Minister Greg Hunt, and the chief of staff for Federal Shadow Health Minister, Catherine King, and reiterated concerns about the impact of the extended freeze on Medicare rebates on optometrists and their patients.

Optometry Australia representatives will be meeting with the Department of Health in August 2017 to learn more about the department’s Medicare compliance strategy, and to encourage the department to play a greater role in supporting optometrists to continue to bill compliantly.

Optometry Australia is creating a detailed resource of frequently asked Medicare questions, with the assistance of Steve Zantos, an Optometry Australia board member and former official optometric adviser to Medicare.

Medicare audit

Optometrists are currently being audited by Medicare on billing and use of Medicare Benefits Schedule items. The audits focus on services being clinically relevant, whether the optometrist has met the terms or descriptor of the item selected and whether they can justify the treatment they are providing. Clinical recordkeeping being good quality, legible and complete is important to Medicare and as well as being important for medico legal defence. It can also be critical in helping an optometrist through a Medicare investigation.

Optometry Australia national professional services manager Luke Arundel says that the onus is on optometrists, not on their employer, to ensure they are billing MBS items correctly.

‘Make sure that you’re doing the right thing, because ultimately it is your provider number that is on the line. As the clinician, the optometrist is accountable for ensuring that they bill in accordance with MBS provisions.

‘If an optometrist isn’t clear about how an MBS item descriptor should be interpreted, or if it’s appropriate to bill in specific circumstances, that’s generally something we can help out with,’ Mr Arundel said.  We have also compiled a significant amount of resources to assist members in billing smarter and accurately, and these are available in the Professional Practice Section of the Optometry Australia website.

Mr Arundel noted that many optometrists are also underbilling due to a lack of knowledge of the MBS. ‘To be confidently applying higher rebate item numbers like 10912, 10913, 10914 and so on, we would encourage members to review resources like our MBS item use guide which expands the information in the standard MBS with other advice received from Medicare over the years’.

Some current areas being flagged for optometrists when billing Medicare

  • MBS items 10912 and 10913 cannot be billed for patients who have not been to the practice before.
  • Make sure you’re meeting the terms of the item descriptor; if there are specific tests or procedures which must be performed to claim that item (for example 10943), the descriptor in the MBS will list these.
  • There is increased surveillance on the number of comprehensive consultations being billed in a day.
Filed in category: Advocacy & government, Medicare & private billing
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