Question.
How are you? I am writing to you this time regarding the amount of money billed.
The last weeks have been very good weeks because I am developing a good reputation in town and having many patients. I am also the only doctor in the practice that accepts patients on the day, so I am double booked quite a lot. Between the increased number of patients, the nursing homes and the knowledge that you shared with me, the billings of the past fortnight have increased a lot. This fortnight’s salary has been 21K pre-tax, and my manager has told me to be careful with auditories… Is the amount you bill a possible trigger for a Medicare audit? I am billing strictly what you taught me, but I don´t want to get audited… So is the amount that you also bill a trigger? In that case, how much would that be?
Answer.
I am glad that you are doing well.
Indeed, your practice manager is correct. Medicare is targeting GPs on three parameters:
1. Number of services for a particular item e.g. a GP billed more item 36 than any other GP in Australia.
2. Overal amount of billings e.g. a GP billed more than any other GP in Australia. I can see that GPs with overall billing over $700-750K per year often get audited. Your average overall billings will probably not reach that.
3. Overall number of services 80/20 rule https://generalpracticetraining.com.au/medicare-8020-rule/
4. Telehealth 30/20 https://generalpracticetraining.com.au/introduction-of-30-20-medicare-rule-for-telehealth/
5. Medicare auditors often count all the day’s services and calculate how many hours the doctor worked. e.g. 15 x 36, 30 x 23, 3 x 721 etc. If they see that a doctor worked 14 hours per day for a couple of months – they get interested.
Here is a free course/presentation on Medicare audits here: https://generalpracticetraining.com.au/improve_medicare_compliance_and_minimise_risk_of_medicare_audit/