Introducing… the MDA National Medicare Committee

Who are we?

The Medicare Committee is made up of four staff members:

• Nerissa Ferrie – Medico-legal Adviser (Perth)
• Nicole Golding – Medico-legal Case Manager (Perth)
• Dr Kiely Kim – Medico-legal Adviser (Sydney)
• Gae Nuttall – Risk Adviser (Perth)
• Daniel Spencer - Medico-legal Adviser (Perth)
  
  

What is our purpose?

The Medicare Committee was formed to facilitate and ensure consistent, high quality and comprehensive management of Medicare-related matters.

We meet monthly to share information and expertise, and to ensure MDA National provides consistent and timely member-centric advice. We remain up to date with changes and publish relevant billing information across our various communication channels.

Current challenges

The ‘Review and Act Now’ letters and other targeted compliance exercises have been keeping everyone busy. Targeted compliance often involves a self-audit process and a repayment of any inappropriately claimed items.

We also see a number of referrals to the Practitioner Review Program (PRP) and Professional Services Review (PSR) each year. In 2019-2020, the PSR recovered over $27M through Negotiated Agreements and PSR Panel and Peer Review Committees. Familiarise yourself with these two audit processes and read up on some of the case outcomes.

Top 10 tips from the Medicare Committee

1. Make sure you are aware of the item descriptor and relevant explanatory notes at MBS online for each item you bill. Ignorance is a poor defence to inappropriate billing.
2. You are responsible for your provider number – you should be aware of what is being billed against it.
3. Most doctors who come to the attention of the DoH are statistical outliers. If you have a subspecialty which means you bill specific items more than your peers, make good notes and check MBS online to confirm you are meeting the entire descriptor for that item.
4. Big ticket items for GPs include chronic disease care plans. Are your systems and processes up to date?
5. Specialist referrals have been the subject of targeted compliance in the past – ensure you have rigorous processes in place.
6. Keep up to date with changes to the MBS.
7. Make good notes! If you need to brush up on your record keeping, complete our e-learning course: Noteworthy: The How, What, Where and Why of Medical Documentation.
8. Don’t try to manage an audit alone. If you receive any DoH communication relating to your Medicare billing, contact MDA National for advice.
9. If you need to clarify an item number, send a well-worded question to askmbs@health.gov.au and keep a copy of the written response.
10. Finally, log in to Member Online Services and watch our webinar, Protecting your Provider Number, for more helpful tips.