Latest MBS compliance campaign targets just 110

Nudge letters will be sent out to a relatively small proportion of GPs with high billing activity across four areas.

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The Department of Health and Aged Care’s latest compliance campaign will target those GPs with abnormally high daily services, chronic disease management and timed professional attendance claims.

Doctors who have repeatedly performed multiple services for the same patient on the same day will also be targeted.

DoHAC confirmed with The Medical Republic that 110 letters would be sent out over the next three months, with between 10 and 20 doctors receiving one each week.

The doctors were identified on the basis of a “considered review of their claiming of Medicare services by a departmental medical advisor”.

It’s a shift in focus from last February’s practice nurse item 10997 nudge letter compliance campaign, which went out to around 600 GPs, in that it is intended to feel less punitive and more educational.

The letters, which were sighted by TMR, acknowledge that MBS and PBS usage can depend on differences in location, patient population, GP special interests and additional training.

RACGP president Dr Nicole Higgins said the college had worked alongside the department to fine-tune its approach.

“We worked really hard with them to make sure that we minimised any harm to GPs and that Medicare compliance understood the impact that the campaigns have on individual practitioners,” she told TMR.

“What happened after the 10997 campaign is that people changed how they practised and stopped working as much, which reduced access to patients.”

Dr Higgins said her only concern was for doctors targeted for repeatedly performing multiple services for the same patient on the same day.

“Many GPs have undertaken activities outside of the college to look at their billing and how to do it ethically and maximise the item numbers,” she said.

“But the risk is if they’re not doing it correctly, they may get caught up in this.”

Each letter will be tailored to the individual practitioner and will include a snapshot of data to demonstrate how they vary from their peers along with reasoning as to why they were singled out.

DoHAC’s own website acknowledges that responding to a nudge letter is voluntary, but adds that “it is in your best interest to do so”.

“When monitoring future claiming and deciding whether to undertake an audit or other intervention, we will consider any information you provided to explain your claiming, corrections you made to claims [and] changes in your claiming patterns following our letter,” it said.

If DoHAC does decide to audit and identifies inappropriate billing patterns, the case is typically transferred to the Practitioner Review Program and then, if necessary, referred to the Professional Services Review.

While there has been a rise in no-fault findings by the PSR director over the last 12 months, cases that progress to the PSR’s committee stage very rarely end in favour for the doctor.