Understanding the Medicare 30/20 Rule for Telehealth Services
The Medicare 30/20 rule was introduced on 1 October 2022. This rule applies to general practitioners (GPs), other medical practitioners (OMPs), and consultant physicians offering telehealth services in Australia. Misunderstandings about the rule have led to compliance issues, so practitioners must understand how it works and the consequences of exceeding the threshold.
What Is the 30/20 Rule?
The 30/20 rule states that practitioners who provide 30 or more relevant telephone consultations on 20 or more days within 12 months will be referred to the Professional Services Review (PSR) for evaluation. The rule is part of Medicare’s efforts to safeguard the quality of telehealth care and to discourage practices that could compromise patient outcomes.
Key Points:
- The threshold is 29 services per day.
- If a practitioner provides 30 or more telephone consultations on 20 or more days in a calendar year, they will trigger a review.
- The rule applies specifically to telephone consultations, not in-person consultations.
Common Misunderstandings About the Rule
A major source of confusion among some GPs and OMPs is the threshold interpretation. Many believed the rule allowed up to 30 daily services without triggering a breach. However, Medicare has clarified that providing 29 consultations daily meets the threshold. Exceeding this threshold on 20 or more days over the year will result in a referral for compliance review.
For example:
- A GP conducting 30 consultations on a single day is immediately above the threshold for that day.
- If this occurs on 20 separate days within 12 months, the practitioner will be referred to the PSR.
Implications of Non-Compliance
Practitioners who breach the 30/20 rule face potential scrutiny from the PSR. Depending on the findings, this can lead to audits, penalties, or disciplinary actions. The review process investigates excessive billing and assesses whether the services meet clinical and ethical standards.
How to Stay Compliant
To avoid breaching the 30/20 rule, practitioners can take proactive steps:
- Monitor Daily Consultations: Keep track of the telephone consultations provided daily to avoid exceeding 29.
Exceptions: MBS items for services provided on behalf of a medical practitioner (items 93202 and 93203). This is CDM follow-up Telehealth equivalent of 10997.
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