The government is demanding repayment for items claimed in violation of an inscrutable rule.
The Department of Health is telling GPs to check they have claimed services correctly or else risk “administrative penalties” as part of its latest campaign to recoup money from the Medicare Benefits Schedule.
The RACGP in response says GPs should “familiarise themselves” with the face-to-face rule and “ensure they are meeting the requirements”, while acknowledging the rule is unclear and counterintuitive.
Up to 1000 GPs are understood to be the target of compliance letters from the DoH, which ask providers to check and repay any inappropriate billing of telehealth services.
Earlier this week, the exact rule which triggered the telehealth compliance campaign was revealed.
For every individual telehealth service, patients must have attended at least one face-to-face appointment with the same GP or practice in the previous 12 months.
This is contrary to what some GPs believed, namely that the 12-month period was only relevant when billing the initial telehealth consult for a patient.
RACGP president Dr Karen Price told TMR that while the college had lobbied for the introduction of an existing patient rule to curb the trend of phone-only providers, the rules may not have been clear or “intuitive” to all GPs.
“As I have stated, these rules – which were introduced to prevent pop-up telehealth clinics exploiting the Medicare items and disrupting continuity of care – may not have been intuitive for all GPs,” she said.
Dr Price acknowledged that many GPs had to adjust to these changes in the middle of the pandemic last year, when they were attending to many other changes in their clinic practice.
“The RACGP maintains that this process could be made easier through the use of automated Medicare rules, as per patient eligibility for other items,” she said.
“However, it is important that all GPs do their best to familiarise themselves with these rules and ensure they are meeting the requirements concerning telehealth consultations.”
Dr Price said GPs should carefully check the dates of attendance of each and every one of their long-term patients, to ensure compliance.
Since the changes were introduced in July last year, Dr Price said the RACGP worked hard to ensure general practices are up to date with the changes.
This is despite reports from GPs this week, who upon receiving a compliance letter, called the DoH telehealth rules “misleading”.
“Any GP who has received a compliance letter needs to ensure they are billing correctly for telehealth consultations in the future,” Dr Price said.
The question remains whether the enforcement of such a rule is justifiable by the DoH during a pandemic, particularly when these items were initiated to deliver safe and effective remote healthcare.
TMR asked the DoH when the GP colleges were first notified of the strict changes to patient eligibility last year, including the rule that patients had to been seen in person in the previous 12-month period for every telehealth consult.
TMR also asked whether the rule was clearly explained to GPs, and whether it was not counterintuitive and defeating the purpose of the rule to apply it to each and every consult.
The DoH told TMR that the existing relationship rule was developed last year “in close consultation with medical experts and peak bodies, including the AMA and the RACGP”.
“The existing relationship requirement is detailed in the Health Insurance Act and Medicare Benefits Schedule Advisory Note AAN.1.1.
“The Department has published additional educational material with many peak representative bodies reproducing this material for their members, for example, the RACGP COVID-19 telehealth MBS items factsheet.
“This material, including the RACGP factsheet, makes it clear that the existing relationship rule requires a face-to-face service to a patient within the last 12 months; telehealth services are not delivered face-to-face therefore cannot be utilised to satisfy the existing relationship rule.
“Exemptions from the existing relationship requirement are provided, including for patients who at the time of accessing telehealth services have had their movement restricted by a State or Territory COVID-19 public health requirement, including patients who are subject to quarantine.”