Specialists who require patients to obtain unnecessary GP referrals so that they can claim “initial” consult items have been targeted under draft plans put forward by the MBS Review Taskforce.
The MBS principles and rules Committee says it wants to tackle an “excess” of claims for initial specialist and consultant physician attendances – items 104 and 110.
“It is the Committee’s view that where the patient needs continuing care by a specialist or consultant physician as part of the same ‘single course of treatment’ a new referral issued because the period of a previous referral has expired should not trigger another initial attendance (i.e. item 104 for specialists or item 110) for consultant physicians,” the draft document states.
According to the committee potential options to address the issue include:
Amending rules and definitions around the concept of a ‘single course of treatment’ to improve
clarity;
Introducing a time-tiered attendances structure for specialists and consultant physicians, as
currently applies to GP attendances;
Abolishing the initial/subsequent attendance structure and replacing it with a new single