This appeared last week:
Health department launches GP telehealth crackdown
Up to 1000 compliance letters have been sent to doctors over alleged breaches of the 'existing relationship' rule for telehealth items
14th April 2021
By Kemal Atlay
GPs have begun receiving 'please explain' letters from the Federal Department of Health over alleged inappropriate billing of the MBS telehealth items.
The compliance blitz is targeting up to 1000 doctors identified by health officials after audits of their MBS claims data.
The key issue is whether the doctors saw an "existing patient" for the telehealth consult, defined as a patient they or another GP at their practice has consulted in the previous 12 months.
Melbourne GP Dr Henry Monkus received one of the missives last week which asked him to review 192 telehealth consults he has billed since July last year.
“While there are limited circumstances where these items can be claimed by a practitioner who is not a patient’s usual health provider, the department asks you to review your claiming to ensure it meets MBS requirements,” the letter said (see below).
It went on to say Dr Monkus should review each claim and either repay any incorrect payments or “consider providing an explanation” to the department.
“The department may take compliance action, such as an audit, if there are concerns that a provider has not met the MBS requirements and has been paid benefits they were not entitled to receive.
“If this occurs, administrative penalties may be applied.”
Dr Monkus said he was still considering his response but said there was confusion over the working of the “existing relationship” rule.
He stressed that he had no issue with repaying Medicare if he had broken the rules, but wanted to take a stand against the department’s attempts to “punish” GPs during a pandemic.
“We shouldn't have to justify this.
More here:
https://www.ausdoc.com.au/news/health-department-launches-gp-telehealth-crackdown
There is also coverage here:
GPs cry foul over Medicare's 'misleading' telehealth rule
Doctors targeted in the latest health department crackdown say they are victims of bureaucratic semantics
15th April 2021
By Kemal Atlay
GPs targeted in a Federal Department of Health telehealth compliance blitz say they are victims of misleading Medicare rules.
On Thursday, the department said 400 doctors had been sent letters demanding they justify their claims amid concerns that they were billing for consults with patients who had not been in their practice in the previous 12 months.
Among them was Dr Henry Monkus who is being asked to review 192 telehealth claims.
He said it was never clear to him or other doctors that the 12-month rule applied not only to a patient’s initial telehealth consult, but to all subsequent telehealth consults.
He referred to one of his regular female patients who he had last been seen face-to-face at his Melbourne practice on 5 September 2019.
“Her first telehealth consult was 11 months later, in August last year. So for me that showed I had re-established the relationship.
"I then provided further consults with her between 17 November and 14 January."
He said he had now been asked to repay the Medicare rebates for the consults.
Yesterday, the health department told Australian Doctor the 12-month rule applied to every telehealth consult with a patient, even if the existing relationship had been re-established by the patient’s first telehealth appointment.
“Telehealth services are not delivered face-to-face therefore cannot be utilised to satisfy the existing [12 month] relationship rule,” it said in a statement.
But other doctors say they have been unaware of the interpretation being made by department officials.
They even include Dr Karen Price, president of the RACGP which originally called for the introduction of an existing patient rule to prevent pop-up telehealth clinics exploiting the items.
She said: "If you've seen a patient for 20 years and you have started telehealth during the pandemic, you would intuitively think that counts as an existing relationship.
"When I realised the way the rule actually worked, I had to go and do a home visit for some of my vulnerable patients, simply so I could continue caring for them.
"It flies in the face of common sense."
https://www.ausdoc.com.au/news/gps-cry-foul-over-medicares-misleading-telehealth-rule
And finally here:
Worst nudge letter everrr: DoH loses plot while RACGP fails members
If you take the time to read one of the letters related to a so-called telehealth rule-breaker GP this week, you’ll quickly become dumbfounded as to why the Department of Health would even consider sending such a letter, given how obviously confusing the telehealth process has been and the dumb logic of their interpretation of the 12-month rule.
The pertinent (and bizarre) detail of the letter includes the fact that the GP in question allegedly failed to realise there had to have been a face-to-face visit within 12 months of each and every telehealth consult, not just the first one. Say you last saw the patient in person on 30 January 2020. You can claim for a telehealth consult on 29 January 2021, but not for a follow-up on 10 February 2021 – you have to see the patient in person before claiming telehealth again.
The rule was introduced in July last year, at the behest of the RACGP, to protect its members from patient harvesting by pop-up telehealth clinics. The idea was simply to promote good healthcare continuity with a patient, for the sake of better service delivery and safety.
The rule as interpreted by the DoH entirely defeats the spirit in which the RACGP attempted to have it put in place.
What’s worse, it obviously wasn’t very clear to anyone that this was how the rule was to be interpreted. The Medical Republic has asked the DoH to explain where and how they attempted to elucidate this pearl of logic to all GPs, but we are yet to hear back from them.
And it’s not just a series of GPs that have been caught out. The RACGP didn’t understand what was going on at the start either.
It’s very hard to understand what the DoH hopes to achieve with this letter series. It’s so bizarre in its logic and looks so stupidly bureaucratic and ill thought out that the only two conclusions a GP could arrive at are that either the DoH is the depraved and uncontrolled totalitarian regime that some GPs who have been caught out in PSR proceedings and received past nudge letters have come to think it is, or it is massively distracted by the COVID crisis and, let’s say, not thinking clearly.
We guess that, on either interpretation, the DoH is certainly fulfilling its “fill them with fear” goal. Fear that it’s that stupid. Or fear that it really is that bullying and mean.
More here:
This looks to me like a ridged bunch of bureaucrats losing site of the big picture and not realising it is a very bad idea to annoy a large number of people who you really need to get us all vaccinated.
Typical bureaucrats I guess! It is better to sort things out rather than double down!
David.
3 comments:
First Robodebt now Dock-a-Doc, is there no shame in these cocaine cowboys and girls in Canberra?
#dockadoc very nice John. Catchy and pointed.
Shows again how very little care the Department and its little agencies care for the well-being of the population. To meet this DoH interpretation of the agreement, I as a patient need to put myself in harms well, potentially exposing myself or others to COVID-19. Was this not all part of a larger effort to contain the spread?
Telehealth proves to be expensive and time consuming for both patient and provider. Where is the CHF or AIDH on all this? Are they not there for the consumer? What hurts a GP hurts the community they work in.
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