Specialists are ill-equipped to manage their Medicare compliance obligations and may end up being punished for inadvertent billing errors because they lack access to accurate advice, new research shows.
A review of specialist practitioner knowledge and practices in Medicare billing has found that most are ‘flying blind’, having received no training and they struggle to obtain authoritative advice on appropriate practices.
The qualitative review, led by Dr Margaret Faux, who has just completed a PhD thesis on Medicare claiming and compliance, outlines findings from in-depth interviews with 27 specialists and GPs on their Medicare billing in daily practice.
One key finding was that most specialists had received little or no induction or training around medical billing.
“When you are a Registrar and when you finish you then realise: ‘Oh, there is Medicare. Now what have I been taught about Medicare? Essentially nothing …’ you realise you are supposed to bill, but still have no inkling how to do it,” said one Salaried Medical Officer interviewed by the researchers.
Dr Faux, who is the CEO of a medical billing consultancy, said the interviews revealed a lack of ‘Medicare literacy’ among specialists, many of whom did not have a basic knowledge of the legal requirements around fundamental practices such as bulk billing and charging a gap fee.
And while doctors wanted to do the right thing regarding Medicare billing, the study showed there was an absence of reliable advice and support around billing, even from Medicare.
One specialist described his frustration on ringing Medicare to try get the correct billing information on MBS item 116, only to be told to look it up in the book.