Care Plans and Mental Health Plans – wrong pattern.

I am not aware of any particular internal guidelines at Medicare on the pattern of services. I could only notice that GPs with certain patterns are more often audited than others.

It is common sense that if GP is interested in chronic disease management, the whole range of CDM items should be present in the billing bix. For example, it is odd if GP bills only items 721+723 but never bills review items 732+732. It is also odd if GP bills for many care plans but patients never see allied health professionals. Hence, Medicare never receives items from physio or dietitian for those patients. 

I have personally heard a question posed by a Director of Professional Services Review, Prof. Quinlivan to one of the doctors: “ Why didn’t you consider Home Medication Review for such and such patient?” The doctor in question has billed for a significant number of Care Plans but never referred one patient for a Home Medication Review. Professor was perfectly logical in her assumption that if you really provide good chronic disease services, why did not provide them properly and in a whole range? That meeting was very helpful. The Director of PSR made an impression of a person acutely aware of all aspects of GP and very reasonable.

Practice point: Chronic disease management provided using a limited range of services looks odd and, most likely incorrect. Learn about clinical algorithms for chronic disease management and provide in-depth care.


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