6 September 2021

Let a lawyer guide you through the MBS Wild West

KnowCents Medicare Medicolegal

Doctors shouldn’t be relying on AskMBS to determine whether their Medicare billing is legal, says an Australian solicitor who’s launching the most comprehensive educational library for providers.

Margaret Faux, a solicitor specialising in Medicare and health insurance law, recently completed a PhD on medical billing and decided she wanted to share her knowledge with other healthcare professionals.

Today, her company Synapse launched an online educational platform called the Australian Institute of Medical Administration and Compliance (AIMAC).

“We’re very excited to have put together the most comprehensive courses on Medicare and medical billing law in the country,” she told TMR.

As a registered nurse herself, Ms Faux has spent years watching healthcare professionals bill Medicare incorrectly, sometimes after receiving erroneous advice from the government.

And unfortunately, following bad advice about Medicare billing, even when it comes straight from the government, leaves individuals legally vulnerable.

Ms Faux said medical practitioners could not rely on the email service AskMBS.

“The only people in Australia who are authorised to give legal advice are lawyers. The government cannot give legal advice.”

Partnering with the Leo Cussen Centre for Law in Victoria, AIMAC will try to upskill doctors in correct billing practices while also training lawyers on the ins and outs of Medicare law.

“If the Australian legal profession can be upskilled in this very complex area, they will be better placed to advise and support doctors,” Ms Faux said.

In an ideal world, Ms Faux would like to see a national curriculum created so that individuals could become certified experts in Medicare law, similar to solicitors who had an expertise in taxation or employment law.

But in the meantime, Ms Faux and her colleagues hope their education modules will provide comprehensive advice about billing to GPs and other specialists.

“These are the most legally accurate courses that can be provided at this point in time,” Ms Faux said.

Doctors engaging with AIMAC would be able to select a course based on their existing level of Medicare billing knowledge.

“In addition, I’ve created a series called ‘How to bill’ which are little 4-8 minute videos describing how to correctly bill key item numbers,” Ms Faux said.

These videos cover key items billed across a range of medical specialties, because of the variation in legal requirements across the field.

“What applies to GPs doesn’t apply the same way to a cardiologist, and what applies to a cardiologist does not apply the same way for pathology and radiology,” Ms Faux said.

There are various companies already offering guides and shortcuts to streamline billing compliance for the profession.

But Ms Faux said she would caution against taking billing advice from anyone who didn’t have qualifications to be teaching law.

“Medicare is a system of laws, and it’s paid for by taxpayers so the penalties for non-compliance are very serious, and rightly so,” she said.  

“You cannot be vague in this area and I always like to land comfortably on the right side of the law, and don’t like being in the grey zone.

“Doctors can be very confident that anything we provide by way of education will be very comfortably in the safe zone. If I feel it is an area which is interpretive and vague, I will say so.”

Look out for more advice from Margaret Faux in the first of a series of columns in Wednesday’s Money & Medicine newsletter.

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Prasad
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Prasad
14 days 3 hours ago

Would AIMAC pay the fines if Medicare still penalises a doctor who has taken their courses and billed accordingly?

Anchita Karmakar
Guest
12 days 17 hours ago
Prasad I hear your point and I can personally vouch for Margaret’s credibility and candid work to help the profession. Yes, as the laws stand, at the moment no matter what you do, it seems you are doomed to fail w PSR and in court, however, having guidance and following something like what Margaret creates would make it a lot easier for law firms to defend your case for sure. At the end of the day, its true, even if you maybe able to claim a third party action against her advice, that is a whole new litigation and concern,… Read more »
Margaret Faux
Guest
13 days 14 hours ago
Hi Prasad, like all legal education institutes, including Leo Cussen, to provide legal advice requires the entering of a solicitor/client relationship via a costs agreement. After that point then our legal indemnity insurance kicks in to protect our clients, just like your medical indemnity insurance protects your patients. You will see on AIMAC that there is a link to my law firm, mbsanswers.com.au where I also provide comprehensive legal answers to questions submitted to me by doctors, hospitals and other health professionals. I currently have over 30 incredibly complex questions in the queue. Medicare law is profoundly complex and if… Read more »
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