New approach to Medicare paperwork burden

Medicare paperwork can be really fraught. We feel that of course compliance matters and Medicare audits are to be taken seriously, but that there is also a balancing act between the needs of the client, clinician and the GP, all of which are time and cost sensitive and all with varying levels of understanding of the MBS system. In fact, in a recent internal audit we found that 31% of GP referrals received would be classed as “invalid” in the event of a Medicare audit.

We see our role as trying to be efficient and effective, to guard you from poor outcomes in the event of a Medicare audit, and also to look after your relationship with your GPs and of course to help your client access the rebates they are entitled to.  So, as an example, what should you do when you get handed an Enhanced Primary Care plan “referral”, with no patient address and no mention of the authorised sessions count accompanying a 2 page MHCP plan, with DASS results? What do you do when GP’s don’t respond to repeated written communication and verbal requests to fix their paperwork over a number of weeks? This nightmare scenario is a real situation but is not uncommon.

Suggested approach (PowerDiary)

Here is our suggested best practice solution for dealing with such scenarios and how we approach our paperwork management to achieve a sensible balance that still protects you in the event of a Medicare audit.

1: Get it in writing

We suggest using the PowerDiary templates to fax the GP looking for any omissions (using bold) to be clarified but also try to educate them on what our 7 requirements as psychologists are. Here’s some suggested wording:

Dear {ReferrerFirstName},

Re: {ClientFullName}, DOB: {ClientDOB}
{ClientMedicareNumber} {ClientMedicareIRN}
{ClientAddress}, {ClientSuburb}

Thank you for your referral under a Mental Health Care Plan, dated {ReferralStartDate}.
Medicare requires Psychologists to ensure that the referral is valid and specifically that it specifies 7 elements including the number of sessions authorised. Please see this tip sheet or scan the QR code below for more information. 

We can proceed with the appointment on {NextAppointmentStartDateTime} with {ClientFirstName} but no further without clarification. When you get the chance, can you please advise us regarding the following bolded elements:

  • the date of referral
  • the patient’s name, date of birth and address
  • the referring practitioner’s name and either their Medicare provider number or their practice address 
  • a request for services under one of the initiatives eg Better Access, Team Care, Eating Disorders Plan etc
  • the patients symptoms or diagnosis
  • the specific number of sessions to be provided
  • the practitioner’s signature.

You are welcome to either annotate the referral or update this fax. Please return them via fax or email.
Overleaf, you may find it helpful to see an example template for a completely valid yet simple referral that meets all of our requirements.

Kind Regards,

 

We will then wait up to 72 business hours for a response…

2: Keep it manageable

Remembering to follow up every GP that ignores your correspondence i non-trivial. We suggest that you take advantage of PowerDiary Tasks.  Turn on the automatic task option in the setup, then use session packs for tracking Medicare referrals and monitor the Tasks icon in the top right next to the SMS notifications. Lastly, while we try to resolve paperwork issues before the first appointment, often clients will not send paperwork early but still expect a rebate on the first day. So long as some form of vaguely reasonable but not entirely valid referral paperwork is received then then we can work with the APS guidance that a single session can be rebated while waiting for clarification. The client will get the message through the receipt “cover email” as well as on the receipt itself that there is a problem but it’s being managed. Normally PowerDiary receipts will say something like “session 2 of 6” or similar. But because the scenario above is ambiguous session count, we will do all our usual steps but create a “session pack” with a single session. This makes the task of following up the gap in the paperwork over days or weeks viable from our perspective. We will process the rebates for just this first session and on the email to your client we suggest this a our default wording:

On the receipt you will find that it mentions “session 1 of 1”. Unfortunately Medicare does not allow us to issue receipts for more than one session if the doctors referral doesn’t include 7 specific elements and yours was missing the number of authorised sessions. We have contacted Dr {ReferrerLastName} and asked them to provide this information ASAP. Rest assured, there is nothing you need to do. we will continue to follow up with them. Once we hear from Dr {ReferrerLastName} we will update our records with the specific number of sessions under this referral. 

3: Hope for a response but be resilient when you don’t hear back

If the GP sends through their amendments then we will simply update the referral and session pack and cross check the annual limits as we do. But if the GP simply does not respond, you will be able to see the 3 day old single session session pack in the PowerDiary task list and action two things:

We use a template letter that we fax to the GP from PowerDiary at the time that we are closing out the task. Our default wording from you to the GP that we suggest is:

Thank you for your referral under a Mental Health Care Plan, dated {ReferralStartDate}.

I believe that my reception contacted you on <date> to try to clarify some missing information that is a requirement for us to accept your referral as valid. Specifically the number of sessions that you are referring for under this care plan was not stated. We don’t want to add to your burden so we will commence treatment of {ClientFirstName} on the assumption that a full course of six sessions is appropriate and we will report back on progress following these sessions. Should this assumption be contrary to your wishes please advise me as soon as possible.

We then amend the session packs to a full 4,6 or 10 sessions as relevant with reference to all the usual cross checks for various calendar and scheme limits.

 

References:

https://psychology.org.au/for-members/publications/inpsych/2021/February-March-Issue-1/Keeping-up-to-date-with-Medicare-requirements

https://www.health.gov.au/sites/default/files/documents/2021/06/guideline-for-substantiating-that-a-valid-allied-mental-health-service-has-been-provided-for-allied-health-professionals.pdf

http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=80110#assocNotes

http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.6.16&qt=noteID&criteria=GN%2E6%2E16

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