Physicians have been warned of a Medicare crackdown on inappropriate double-billing for patients in hospital settings.
The Federal Health Department updated its Medicare Billing in Public Hospitals webpage to highlight “concerns” about duplicate payments claimed for MBS services that would be already covered by the National Health Reform Agreement between the Commonwealth and states and territories.
Key points are that Medicare benefits are not payable for services provided to a public patient in a public hospital, and a public hospital must not assume that a patient who has private insurance will automatically elect to be admitted as a private patient.
It is particularly important to establish the public or private election status of a patient where referred or requested services, imaging or testing is provided, the Health Department advice emphasises.
“Health practitioners should actively manage referrals, requests and claiming arrangements to ensure services are not paid for twice through public hospital and MBS funding,” it says.
It is also important for physicians to consider whether the service could be part of pre-care (eg tests prior to admission) or aftercare (follow-up) relating to a public episode that should be funded as a public service, the Health Department warns.
The RACP and other peak bodies have been working worked with the department to produce new guidelines to clarify the rules and help clinicians avoid double-billing. As the following case studies show, however, the devil is in the detail.