MBS review targets specialist referrals


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

specialist attendance item, supplemented by an extended specialist attendance item where the

attendance lasts for longer than, say, 40 minutes. The fee for the ‘new’ specialist attendance

item would be designed to be cost neutral overall.

The proposal also suggests removing the current differential fee structure for the remaining 34 MBS items with different Schedule fees depending on whether the service is performed by a general practitioner or specialist.

“The origin of the G&S arrangements in the hospital ‘honorary’ system under which specialists were in effect only reimbursed for 40 per cent of their time and had to make up the shortfall through MBS revenue.

As the honorary system is no longer in place, the differential fees introduced to address it should be eliminated,” the committee said.

Other measures in the draft proposal include a requirement for doctors to complete an online assessment on MBS rules and billing requirements as part of the process for obtaining an MBS provider number.

The consultation is open until 7 October. You can read the full report here. 

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