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Telehealth and Medicare claiming
Telehealth and Medicare claiming

Details on how you can process bulk bill claims for teleheath appointments.

Emily avatar
Written by Emily
Updated over a week ago

The information in this guide is for the Australian Medicare rebates.

In light of the COVID-19 outbreak, the Australian government has stated that telehealth services can be bulk billed. As it stands right now, the eligible dates are from March 13th, 2020 through December 31st, 2021. The situation is constantly changing, and we'll keep this page updated with new information as it comes.

Claiming telehealth sessions with Medicare

On April 1st, 2020, Cliniko founder Joel Friedlaender and Tyro Health (a digital health payment company) co-founder Pete Williams discussed the recent addition of telehealth bulk billing rebates for allied health practitioners in Australia. Pete is a wealth of knowledge on all things Medicare, and this webinar they recorded should answer everything you need to know to start doing Medicare rebates through telehealth.

How do I get set up with bulk billing for telehealth?

Because there's a whole lot of information out there (and not all of it is accurate), we've prepared a guide to help you understand what the rules are around bulk billing and telehealth.

Read on below for some answers to some of your most pressing telehealth and Medicare questions!

Does Medicare mind what system I use for telehealth consultations?

You can use any system so long as it adheres to the Australian Privacy Principles. Cliniko adheres to these principles. You can read more on our security page, as well as the telehealth page on our website.

What professions are eligible?

If you're an allied health professional who delivers Chronic Disease Management (CDM, formerly known as EPC) treatments, you are eligible. Naturopathy, acupuncture, Chinese medicine, myotherapy, and remedial massage therapists are not currently eligible, however. Counselling and psychology are eligible, but there are specific requirements. It's best to check with your professional association.

The short of it is this: if you have been able to bulk bill for "regular" appointments before COVID-19 hit and telehealth became a more common way of doing things, you can bulk bill for their telehealth counterparts. For example—let's say you're a physio, and you were treating a patient as part of a referred CDM plan from their GP. You bulk billed those appointments when you saw the patient face-to-face—you can bulk bill these same appointments now, even though you're offering them via telehealth.

Can I submit patient claims?

It depends. Certain types of patients must be bulk billed—as of 6 April 2020, from the MBS (Medicare Benefits Schedule) website, "it is a legislative requirement that the new telehealth services must be bulk billed for Commonwealth concession card holders, children under 16 years old and patients who are more vulnerable to COVID-19."

You may apply your usual billing practices to the telehealth items for patients who do not fit that criteria. However, Medicare expects you to obtain informed financial consent from any patients prior to providing the service. You must provide details regarding the service fees, including any out-of-pocket costs.

Does my patient need a referral from their GP to be eligible for the rebate?

Yes. They will need to have a referral in order to be eligible for rebates on any CDM treatments provided via telehealth. 

But what if my patient can't physically go to their GP's clinic to get this referral?

That's okay! They don't need to have physically gone into the clinic to get this. Their GP can provide them with a referral via email.

Does the referral have to mention telehealth services?

No, it doesn't. If a patient is being referred to you for a knee issue (for example), you can choose to offer them a "telehealth knee consult", even though the referral might just say "knee consult". 

Do telehealth appointments count towards the CDM session limit?

Yes. If your patient has five services available through CDM, telehealth appointments are considered towards that total count. 

If you've already been treating a patient in your clinic, you can continue the CDM treatments via telehealth—so you don't need to get a new referral or start over, just because you'll be conducting your appointments over a video call. The original referral still counts.

Will the patient get any additional sessions for telehealth appointments?

No. The standard five-session-per-calendar-year limit applies.

Is there a limit to the length of each telehealth session on a CDM plan?

The minimum duration is 20 minutes. It's possible that the rules are different with other funding programs, though—it would be best to check with your professional association.

Do I need a provider number for telehealth claims?

Yes. Just use the same provider number you were using when you were practicing in the clinic!

Is the billing fee the same for each session, like it is in face-to-face appointments?

Yes, it is. The majority of all telehealth consultations will be charged at $53.80, as they have been when you were seeing your patients in the clinic. You cannot charge more than this if the patient does not fit the criteria for patient claiming, however. These include concession card holders, children under 16 years old, and patients who are more vulnerable to COVID-19.

Do I need telehealth-specific item codes?

Yes. For video-based consultations, the item code is 93000. For phone or audio-based consultations, the item code is 93013. In Cliniko, you can create unique telehealth-specific billable items and assign these codes to them.

Do I need to get my patient's consent to claim telehealth services?

You do, but you don't need to "formalise" the process as much as you do with face-to-face appointments and claiming. If you include mention in your treatment notes that the patient agrees to being bulk billed, the MBS (Medicare Benefits Schedule) will consider that sufficient. You can read more about that here.

I'm a psychologist—can I charge a gap fee?

Maybe—but not necessarily under CDM treatments. It would be under a different scheme. It's best to consult your professional association for this information.

I don't want to bulk bill for telehealth treatments. What options do I have?

If you don't want to submit bulk bill claims for telehealth appointments, you can still charge your patients the full amount and, depending on things, they may be able to claim some back from Medicare. However, you cannot charge more than the $53.80 service fee if the patient does not fit the criteria for patient claiming. This criteria include concession card holders, children under 16 years old, and patients who are more vulnerable to COVID-19.

If a patient has private health insurance, they may also be eligible to claim a partial rebate, but it will depend on the provider.

I'm ready to get claiming! What do I need to do if I want to use Cliniko to submit telehealth claims?

To get started, you're going to need to have an account with Tyro Health (formerly Medipass). As mentioned, Tyro Health is a digital health payment company that lets you process claims without a terminal—keeping the process super simple and straightforward, allowing you to spend more time treating your patients and less time doing payment-related admin work! While we're not directly associated with Tyro Health, we work closely with them, and their services are integrated into Cliniko—meaning that you can raise an invoice and submit a claim right from your Cliniko account.

We hope you find this guide useful. As mentioned, the situation is changing regularly, so we'll keep this updated as information becomes available.

If you do wish to begin bulk billing your patients for telehealth consultations, get started by reading our overview of how telehealth works, and how you can process bulk bill claims through Cliniko.

We also recommend you take a look at Tyro Health's guide to telehealth and claiming, and if you have any specific questions, our support team (or theirs) will be able to help out! 🤗

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