Thousands of GPs around Australia received letters from Medicare. Medicare asked GPs to review compliance with the rules in relation to item 10997.

Provision of monitoring and support for a person with a chronic disease by a practice nurse or Aboriginal and Torres Strait Islander health practitioner (item 10997) is a service that attracts a rebate of $12.70. This service can be billed 5 times in a calendar year for any patient with the Care Plan.

The service may be used to provide checks on clinical progress, monitor medication compliance and self-management advice, and collect information to support GP reviews of Care Plans. This service may comprise measuring weight, taking blood pressure readings and reinforcing health education. Any intervention must be related to a goal or an issue recorded in the Care Plan.

It is perfectly fine to bill item 10997 with any other MBS items. However, Medicare ‘does not expect’ item 10997 to be billed with the initial Care Plan items 721 and 723.

There are numerous scenarios when item 10997 is justified in being billed with items 721 and 723.

For example. A patient and her GP agreed to develop a Care Plan for Asthma. The goals and actions of the Care Plan included checking the inhaler technique, regular spirometry and asthma education. The Practice Nurse/Health Educator saw this patient for spirometry on the same day as the Care Plan. During the measurement of lung function, the nurse checks the inhaler technique and provides asthma education. That would justify billing item 10997.

Let us go back to the Medicare nudge letters. I have assisted several doctors. Approximately 2-5% of the services billed under item 10997 were not compliant with Medicare requirements. 90% of the non-compliant billings were due to an administrative error. The admin staff submitted item 10997, where service was not provided. GPs and Practice Nurses missed the fact of a wrong billing.

Remaining non-compliant items occurred when the services were provided but were not recorded.

GPs in question submitted the voluntary repayment forms for the items that were incorrectly billed.

There are ways to minimise incorrect billing of item 10997. The first is to train the Practice Nurses in the correct procedure for item 10997. Practices where compliance training was revisited regularly demonstrated significantly better outcomes.

The second is to develop management shortcuts in the clinical software. The shortcuts make it easier for the nurses to record the service.

For example. Nurse CDM follow-up. Discussed: weight, BP, diet. Review: 3/12.

It does not seem much, but a few seconds of the time saved encourage the nurses to make notes.