For health professionals

Forum now available online

Forum is Medicare Australia's quarterly newsletter for health professionals and practice staff. In addition to the hard copy, Forum is now also available in a new email version so you can choose how you want to receive it.

Register for your copy of Forum online today—it is quick, easy and free!

Commonwealth Budget 2010–11

Treasurer, The Hon. Wayne Swan MP handed down the Commonwealth Budget for 2010–11 on Tuesday 11 May 2010. There are a number of measures included that will impact on the Department of Human Services Portfolio.

A summary of measures that may affect Medicare Australia's health providers are outlined below:

• Fifth Community Pharmacy Agreement
• Addressing domestic violence—continuing training for health workers in regional and rural areas
• Medicare Benefits Schedule
• Pharmaceutical Benefits Scheme (PBS)—minor new listings
• National Health and Hospitals Network – General practice and primary care – establishing Medicare Locals and improving access to after - hours primary care
• National Health and Hospitals Network—Aged care—improving access to General Practice and primary health care
• National Health and Hospitals Network—Workforce—more places on the General Practice Training Program
• National Health and Hospitals Network—more general practice training rotations for junior doctors
• National Health and Hospitals Network—Workforce—support for practice nurses
• National Health and Hospitals Network—General practice and primary care coordinated diabetes care
• Practice Incentives Program—changes to incentive payments for cervical cancer screening
• Revised arrangements for efficient funding of chemotherapy drugs
• National Health and Hospital Network - Mental health - flexible care packages for patients with severe mental illnesses

To find out about all other Human Services Portfolio Budget measures visit Human Services.gov.au or call the dedicated Budget information line 13 24 68.

Nurse practitioners and midwives

From 1 November 2010, eligible nurse practitioners and midwives can access Medicare Benefit Schedule (MBS) items and prescribe Pharmaceutical Benefits Scheme (PBS) medicines. 

• More information on nurse practitioners and midwives

Healthcare Identifiers Service

Federal, state and territory governments have developed a national Healthcare Identifiers Service which will uniquely identify healthcare providers and individuals who seek healthcare. For more information, see the Healthcare Identifiers Service information guides.

Changes to Medicare provider number arrangements

Changes to Medicare provider number arrangements are being made in line with the National Registration and Accreditation Scheme (NRAS). For more information refer to Medicare Australia's NRAS information sheet [PDF, 145Kb].

Check System Status

New PIP Indigenous Health Incentive

A new Practice Incentives Program (PIP) Indigenous Health Incentive, costing $28 million over four years, will start in May 2010.

The PIP Indigenous Health Incentive will target Aboriginal and Torres Strait Islander patients aged 15 years and over with chronic disease and is part of the Council of Australian Governments (COAG) National Partnership Agreement on Closing the Gap: Tackling Indigenous Chronic Disease.

The PIP Indigenous Health Incentive will support general practices and Indigenous health services to provide better health care for Indigenous Australians, including best practice management of chronic disease. The first payments through the Indigenous Health Incentive will be made to eligible PIP practices in May 2010.

Health Professional Online Services (HPOS)

Health Professional Online Services (HPOS) offers improved online services to help make it easier for you to do business with us.

These services include:

• Australian Childhood Immunisation Register (ACIR) reports, claiming, immunisation history and provider contact details
• Medicare services—Easyclaim processing and payment reports, provider personal details, provider number details and add a new location service
• National Bowel Cancer Screening Program (NBCSP)—submit new assessment forms and view previously submitted forms
• Patient Verification—confirm and search patient details
• a practice staff log on which allows practice staff who have a PKI individual certificate to undertake administrative tasks on behalf of health professionals
• an email subscription facility to subscribe to receive statements online for:
  • National Bowel Cancer Screening Program
  • Australian Childhood Immunisation Register
  • 90 day pay doctor cheque scheme EFT
  • Australian Defence Force Family Healthcare Program
  • Medicare bulk bill
• the ability to view a patient’s care plan history (with consent) at the time of consultation
• manage banking details
• Approved Pathology Collection Centre search
• Prescription Shopping Information Program—information, patient summary reports and FAQs
• forms for health professionals
• resources—Forum, MBS Online, PBS Online and an online eligibility tool
• Administrative Position Statements—an authorised and documented position held by Medicare Australia
• education—eLearning programs.

To access the full range of HPOS information and services, you need a PKI individual certificate.

For more information about HPOS and to register for PKI go to HPOS.

Online education services—refresh your knowledge online in just a few easy clicks

Medicare Australia’s online education services offer you increased access to nationally consistent learning and support—whether you are a new health professional, or established in your practice.

Available 24 hours a day, seven days a week, online education services provide an easy to use and convenient way to refresh your knowledge of Medicare and PBS requirements.

Online education services are updated regularly, so make sure you bookmark our website to check for updates and new content.

For more information, visit online education services as they are already on the Medicare site.

National Compliance Program 2009–2010 is now available

The National Compliance Program 2009–2010 focuses on Medicare Australia’s key stakeholder groups. It highlights areas of concern with compliance, outlines responses to these concerns and how Medicare Australia will support each group to voluntarily comply.

For more information, see National Compliance Program 2009-2010

Increased Medicare compliance audit initiative

As part of the 2008-09 Federal Budget, the government announced an increase in Medicare Australia’s Medicare Benefits Schedule (MBS) compliance activities and proposed amendments to Medicare Australia’s audit powers.

As part of the initiative, an additional 2000 MBS compliance audits are now carried out each financial year. This has increased Medicare Australia’s audit coverage to nearly four (4) per cent of the provider population, compared to the previous audit coverage of less than one (1) per cent.

The government also announced that it would introduce legislation to:

• allow Medicare Australia to ask health professionals to produce documents to verify the Medicare services they have provided
• introduce a formal internal review function for health professionals to use if they are unsatisfied with an audit decision
• establish a financial penalty for health professionals who are not able to substantiate their Medicare services, above a specified threshold.

The Department of Health and Ageing (DoHA) and Medicare Australia have produced two information sheets on the initiative. Released in October 2008 and February 2009, the information sheets explain how the legislation changes operate, and address common questions from peak bodies. Specifically, the information sheets outline:

• how providers are selected for MBS compliance audits
• why the changes to the audit process are being made
• what the Government is doing to help health professionals comply.

Compliance Working Group

Medicare Australia has formed a Compliance Working Group (CWG) to work with key stakeholders to support the Government’s commitment to assist health professionals on how Medicare Australia conducts its compliance activities. The CWG comprises of members from the Australian Medical Association, Royal Australian College of General Practitioners, Australian General Practitioner Network, Australian Association of Practice Managers, and the Rural Doctors Association of Australia. The CWG:

• facilitates greater transparency and accountability in our stakeholder engagement
• provides a channel for seeking and responding to feedback following the implementation of selected compliance action strategies
• provides a channel for stakeholders to contribute to the direction of selected compliance action strategies, or elements of these.

New provider percentile charts

New Provider percentile charts show the number of services billed by peer groups for selected MBS items. You can use these charts to compare your billing data with your peers.

Changes to legislation affecting the PBS

• Legislation update [PDF, 140Kb]

Changes to legislation will give your customers greater access to affordable medicine through the PBS and the PBS Safety Net.

These changes include:

• Safety Net—equal treatment for same sex couples (as part of broader legislative changes relating to same sex couples)
• Safety Net—couples separated by illness
• PBS—government officers working outside Australia.

 PBS Safety Net—equal treatment for same sex couples

From 1 January 2009, PBS Safety Net families can include same sex de facto couples and their dependants, providing the same access to PBS Safety Net benefits for all couples, regardless of gender. The same Safety Net rules will apply for these families and they will be eligible for the same thresholds and concessions.

To be included as part of a Safety Net family, a couple must be living together on a permanent basis, unless living separately due to illness (see below).

 PBS Safety Net—couples separated by illness

From 1 January 2009, married and de facto couples living separately due to illness, infirmity or frailty (for example, for nursing care, residential or Aged Care) can access PBS Safety Net benefits jointly as a family, as if they were living together.

 PBS—government officers working outside Australia

Up until recently, it has been illegal for you to supply PBS medicine for a person who is not in Australia at the time of supply, and for PBS medicine to be sent overseas for another person.

Changes to the legislation mean you can now dispense PBS prescriptions for Commonwealth, state or territory government officers working overseas, and for their accompanying partners and dependants. The medicine can be sent out of Australia for use by these officers and their families. Safety Net benefits and entitlements apply.

Before dispensing, check:

• you are satisfied the person is eligible for PBS access—information from the officer’s government agency or department can be used for this purpose
• the Medicare card number or Veterans’ Affairs entitlement number is valid.

More information

Department of Health and Ageing Website

Call Department of Health and Ageing PBS Information Line 1800 020 613*

Email

* Call charges apply from mobile and pay phones only.

Medicare Teen Dental Plan and Medicare chronic disease dental scheme

On 1 July 2008, the Australian Government introduced the Medicare Teen Dental Plan to help with the cost of an annual preventative dental check for eligible teenagers.

• Medicare Teen Dental Plan
• Medicare Teen Dental Plan forms for dentists

The Medicare chronic disease dental scheme was introduced in November 2007. The scheme allows chronically ill people who are being managed by their GP under an Enhanced Primary Care (EPC) plan access to Medicare rebates for dental services.

• Medicare chronic disease dental scheme
• Medicare chronic disease dental scheme forms for dentists
• Referral forms for GPs – Medicare chronic disease dental scheme are available on the Department of Health and Ageing website or by faxing a request to (02) 6289 7120.

For more information

Call Medicare Australia on 132 150 or visit the Department of Health and Ageing website at www.health.gov.au/dental

Online Medicare eLearning for Dentists

An eLearning program has been developed to support dentists who are new to billing Medicare. The program is interactive and easy to use. Modules include 'What is Medicare?' and 'Billing and Claiming.' The program takes approximately 45 minutes to complete.

New laws on inducements for pathology and diagnostic imaging effective 1 March 2008

There have been changes to the legislation around inducements for pathology and diagnostic imaging referrals. These new laws are effective from 1 March 2008. They apply to any existing arrangements as well as any new arrangements put into place after 1 March 2008.

For more information visit Pathology Services on the Department of Health and Ageing website or call 132 150.

The Department of Health and Ageing has consulted with pathology, diagnostic imaging and medical organisations about the development of regulations. The regulations provide extra detail on some aspects of the legislation.

Further consultation is currently underway. If you have any comments or need more information, please contact the Department of Health and Ageing at legislativeamendments@health.gov.au.

If you are unsure how the changes will affect you, please seek legal advice.

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Last updated: 26 August, 2010