Question: If you can do 4-5 36 a day billed to Medicare, does that include any other “36” you bill? For instance to the DVA or Workcover or even private. If you do not bill it to Medicare, does it count? (This doctor asks: “How does Medicare count the number of item 36 billed by a doctor?”)

Answer: Great question. Thank you.

It is well-known fact that Medicare flags doctors who bill disproportionally high numbers of services under item 36. There is no ‘golden formula’ for safe billing. The ultimate defence against any Medicare challenge is keeping good notes and following the rules. So, How does Medicare count the number of item 36 billed by a doctor?

  • Medicare and DVA share the same processing system. Item 36 billed via DVA is ‘visible’ to Medicare.
  • Item 36 billed via Private billings WITH the Medicare rebate is also visible to Medicare. e.g. you charged item 36 privately – $120. The patient received a Medicare rebate of $76.95.
  • Private billings WITHOUT the Medicare rebate are not visible to Medicare. For example, you charged private item 36 – $120 for cosmetic injections. This service did not attract any Medicare rebate. 
  • Workcover and TAC claims are not visible to the Medicare system. I preempt another question. Can you bill Medicare and Workcover on the same day? Yes, you can. There is more information on that here

Always check item number descriptions with MBS Online.

Categories: Q&A