Medicare FAQs

No. Bulk billing means that there is no out of pocket cost to the patient.

To comply with Medicare legislation, you need to maintain adequate and contemporaneous records.

Adequate means:

• Clearly identify patient name
• Contain a separate entry for each attendance by the patient for a service and the date on which the service was
• Each entry needs to provide clinical information adequate to explain the type of service rendered or initiated
• Each entry needs to be sufficiently comprehensible that another practitioner, relying on the record, can effectively undertake the patient's ongoing care.

To be contemporaneous, the patient or clinical record should be completed at the time that the service was rendered or initiated or as soon as practicable afterwards.

Osteopaths have three options for claiming payment for Medicare items. 

1. Electronic claiming. To make an electronic claim, sign up to Medicare PRODA. You can sign up to PRODA via the following link: PRODA registration. You can also find out more information about PRODA, what it is, what it does and how it works at the Department of Human Services website.  
2. Manual claiming using the DB2-AH form. Medicare does not provide this form online to download. You must order the DB2-AH form template from the Human Services Stationery Department, which can be accessed online. You will be asked to specify the unit number of templates needed in the order. 
3. Bill the CDM/EPC patient privately, provide receipts to the patient and have the patient claim either online or over the phone through Medicare.

Here are some templates you may find useful:

PROFORMA- ONE PAGE Report to GP (Acceptance of CDM plan/Completion of first session)

PROFORMA- ONE PAGE Report to GP (Completion of CDM sessions)

PROFORMA- ONE PAGE letter to GP providing information regarding a client’s chronic and complex conditions that may benefit from osteopathy - please note this letter is only useful if you have established a relationship with the GP.

Temporary telehealth items introduced for CDM patients during COVID-19 have been made permanent. You can conduct telehealth consultations with your CDM patients as long as it's feasible to conduct the consultation without being face to face. In using these items, please note that it is members’ professional responsibility to ensure that the service is appropriate to the medium of communication and to the patient’s condition.

Provider numbers

If you have one provider number for the clinic you work in as a sole trader, you do not need a new provider number to offer clients telehealth consultations from your own home. If your patients are still being billed through the original clinic location of the provider number, you'll be fine.

Item codes

• 93000 for a videoconference
• 93013 for a telephone consult (ONLY when video is not available)

Notes

• You do not have to bulk bill
• You can choose whether to charge a gap (co-payment) or bulk bill
• Be mindful of your language - if you say 'bulk bill' you cannot charge a gap or admin fee
• Make sure you have read and considered the issues in our Telehealth Guidance
• Services are still subject to standard Team Care Arrangement/ GPMP referral and reporting requirements
• Services must be a minimum of 20 minutes

Read MBS Telehealth Services from 1 July 2022 and the Factsheet on continuing MBS telehealth services - allied health providers.

Read MBS Online Privacy Checklist for Telehealth Services

Change your name with AHPRA first. There is a Request for Change of Personal Details form on the AHPRA website. Evidence must be a certified copy of one of the following documents:

• Standard marriage certificate (ceremonial certificates will not be accepted)
• Deed poll 
• Change of name certificate 

To revert to a maiden name, a certified copy of the full birth certificate is required. Faxed, scanned or emailed copies of certified documents will not be accepted.

For changes in gender, you will need to provide a certified statement from a registered medical practitioner or registered psychologist, a valid Australian travel document (such as passport) that specifies your gender, or an amended birth certificate that specifies your preferred gender.

Certified by who?

AHPRA maintains a list of people who can certify your documents and also provides instructions for how they should certify. They should do the following in your presence:

• Witness your signature
• Certify that each document is a true copy of the original
• Certify that any photographs are a true likeness (where applicable)

All pages should be initialled, with the last page including a statement of certification, and include details of their eligibility to make that statement (e.g. professional details or any applicable stamp, such as a Justice of the Peace [JP]).

What next?

When the AHPRA process is finished, send a copy of the evidence of the change of name with AHPRA (i.e. your new registered personal details) and a copy of your supporting evidence to provider.registration@humanservices.gov.au.

Remember to keep good documentation and put systems in place to manage the following:

• Referrals are complete and correct
• First and last reports are compliant and filed, and are sent to the GP
• Don’t exceed the number of visits (maximum of five in a calendar year)
• Don’t carry more than one visit past the second calendar year following the year of the referral
• Make sure clinical notes are relevant and reflect the content of your reports (and they are accurate for the date of the service)
• Ensure you can show that your consultations are at least 20 minutes

The Shared Debt Recovery Scheme enables the Commonwealth to hold both a practitioner (primary debtor) and another party (secondary debtor) responsible for repayment of compliance debts arising as a result of incorrectly claiming Medicare benefits. Medicare billing is often delegated to non-practitioners (such as receptionists) or administered through centralised billing areas. In some cases, this has led to incorrect billing practices. Primary responsibility for correct claiming rests with the health practitioner providing the Medicare service. The Scheme recognises that others (like your employer or practice manager) may also have obligations.

During an audit, the Department may find a secondary debtor partially responsible for any debts owed from incorrect billing.

For further information see the Department of Health's webpage on the scheme.