Care Plans, Assessments, Mental Health Plans – how many is too many? There are no guidelines exist in regards to how many Chronic Disease items GP should bill. Various statistics state that 20 – 30% of Australians suffer from chronic conditions. We can also see from the attendance statistics of Read more…
Consistently billing ‘favourite’ items in significant numbers. Some GPs develop billing habits for certain services significantly more often than their colleagues in the area. Example 1: GP bills item 47915 INGROWING NAIL OF TOE, wedge resection for, with the removal of a segment of the nail, ungual fold and portion Read more…
Number of patients seen. We have already discussed this earlier. The main points are: Never see 80 or more patients on 20 days within 12 months period! Try not to see a lot of patients in general. It is financially counterproductive and medico-legally dangerous. (There are ways to earn more Read more…
Billing Medicare items for ‘Unrelated’ services. Some items have absolute restrictions on billing, e.g. 721/723/732 and 23/36/44 in any combination. However, in any combination, some items can be billed together, e.g. 23/36/44 and 2717/2715/2712/2713/2700/2701. I have encountered GPs being audited for billing those combinations consistently several times per session. Especially Read more…
23 or 36 or 44. Is there a ‘golden formula’ for ‘safe’ billing? Yes, there is a formula for ‘safe’ billing: bill what is appropriate + keep good notes + ask yourself how would you be judged by your peers later = being prepared and confident that you will pass Read more…
23 or 36 or 44. The ‘tricky’ items. The consultation items are time-related. 23 – less than 20 min, 36 – 20 to 40 min, 44 – longer than 40 min. There is a good reason why I call them ‘tricky’ because these items are not just about time spent Read more…
How to minimise risk of being audited? (cont.) How GPs end up in prison? Only a handful of doctors ended up in prison in the history of Medicare. No doctor is going to jail for failing some of the Medicare requirements, except one. That is billing Medicare without seeing the Read more…
How to minimise the risk of being audited? (cont2.) GP bills unusually high number of items 36 and 44 comparing to item 23. What is unusually high? I have noticed that if GP bills more than 4 items 36 per each item 23, there is usually some attention from Medicare. Read more…
How to minimise risk of being audited? (cont.) GP consistently provides services too close to 80 patients a day or more – highly likely to get audited. The sum of the time for the items billed in one day is beyond the reasonable working day. E.g. the sum of the Read more…
How to minimise the risk of being audited? The only way to minimise the risk of being audited is to follow the rules and guidelines and not engage in practices that deemed to be suspicious by Medicare. The worst thing that you can do is provide services to more than Read more…