General
What is a video consultation?
Where can these services be provided?
What are the requirements for the specialist services?
Who can bill video consultations?
Can MBS billed telehealth services be provided in hospital?
What are the technical requirements for a telehealth specialist video consultation?
Patients
Do I have a choice If my practitioner suggests a video consultation?
Where can I have a video consultation?
Can I choose who will be in the room with me when I have the video consultation?
Are there special privacy requirements for video consultations?
How do I pay my specialist?
For Residential Aged Care Facilities
What is an eligible residential aged care telehealth facility?
How do I register to be an eligible residential aged care telehealth facility?
Billing and Claiming
Are there any special billing requirements for video consultations?
As a specialist/consultant, how do I bill my patient when we are not co-located?
What is the Medicare schedule fee for a telehealth video consultation?
Can I bill telehealth services which are conducted by phone or email?
Can two MBS items be billed for a patient-end service?
As a practitioner, what do I bill if I am not present throughout the total telehealth video consultation?
Can multiple telehealth specialist video consultations be billed on the same day?
Are practitioners audited on how they spend the incentive payments?
Does the patient-end practitioner need to be co-located with the patient during the video consultation?
What are the Medicare recording and compliance requirements for these services?
Am I eligible for incentive payments?
What are the requirements for patient-end services?
Can I bill for the regular GP bulk billingl incentive items?
Can I use electronic claiming to lodge a bulk bill claim?
How do I write a prescription for the patient if I’m not co-located?
Can a specialist order tests for a remote patient?
How do I get the patient to assign the Medicare benefit to me (ie bulk bill) when the patient is in another location?
How many telehealth services have been provided?
What is a video consultation?
For the purposes of this initiative, a video consultation is where a patient and eligible specialist, consultant physician or psychiatrist undertakes a referred consultation via video conferencing (i.e. visual and audio link).
Where can these services be provided?
The specialist can be located anywhere in Australia but the patient must be in a telehealth eligible area at the time of the consultation. The specialist and the patient are required to be at least 15kms by direct road at the time of the consultation. The patient, specialist or consultant physician is not able to travel to a place to meet the 15km minimum distance requirement.
Residents of a residential aged care facility or patients of an eligible Aboriginal Medical Service can receive a video consultation anywhere in Australia.
What are the requirements for the specialist services?
The requirements for these services include:
- not an admitted patient; and
- not a patient of an emergency department; and
- located in a telehealth eligible area at the time of the attendance; and
- the patient is located at least 15km by road from the specialist or consultant physician; and
- can only be claimed if the item requirements of the face to face service are met; or
- be a care recipient of a residential aged care facility (located anywhere in Australia); or
- be a patient of an eligible Aboriginal Medical Service (located anywhere in Australia).
Who can bill video consultations?
Specialists
Video consultations can be provided by any medical practitioner who is registered or authorised to practise (as described in the Health Insurance Act 1973), that is a consultant physician, psychiatrist or specialist.
Patient-end
Note: Telehealth specialist services can be provided to patients when there is no patient end service provided.
Clinical support can be provided by a GP, other medical practitioner, a participating nurse practitioner, a participating midwife, an Aboriginal health worker or a practice nurse during the video consultation. A practice nurse means a registered or an enrolled nurse who is employed by, or whose services are otherwise retained by, a general practice or a health service to which a direction under subsection 19(2) of the Health Insurance Act applies.
Patient end services can only be claimed where a Medicare eligible specialist service is claimed, the entire service is rendered in Australia and where this is necessary for the provision of the specialist service.
Can MBS billed telehealth services be provided in hospital?
No. Medicare and DVA rebates are not payable for video consultations with an admitted hospital patient. This applies to both public and private admitted patients and those patients located in emergency departments.
What are the technical requirements for a video consultation?
The Government is not mandating or endorsing any particular technical solution for telehealth. In providing MBS billed telehealth services, clinicians should be confident that the technical solution they choose is:
- capable of providing sufficient video quality for the clinical service being provided; and
- sufficiently secure to ensure normal privacy requirements for health information are met. Individual clinicians will need to be confident that the technology used is able to satisfy the item descriptor and that software and hardware used to deliver a videoconference meets the applicable laws for security and privacy. More information is provided at the technology and technical issues page.
Do I have a choice if my practitioner suggests a video consultation?
Yes. If a video consultation is suggested, you may choose a face to face consultation instead. You should discuss the benefits and risks of any treatment including video consultations with your doctors.
Where can I have a video consultation?
Generally, patients will consult with specialists from general practices, eligible Aboriginal Medical Services and residential aged care facilities. A video consultation can be conducted in a patient’s home if the specialist considers it is clinically appropriate and if the patient’s home is located in a telehealth eligible area.
The specialist and the patient are required to be at least 15kms apart by road at the time of the consultation. The patient, specialist or consultant physician is not able to travel to a place to meet the 15km minimum distance requirement.
Can I choose who will be in the room with me when I have the video consultation?
Yes. Your referring doctor should discuss with you and the specialist whether clinical support from a doctor, nurse practitioner, participating midwife, participating practice nurse or Aboriginal health worker is required for the video consultation. If you wish to have non clinical support (i.e. from a family member); this can also be discussed with your referring practitioner and specialist.
Are there special privacy requirements for video consultations?
The same requirements that apply to a face to face consultation will apply to a telehealth video consultation. Patients should discuss any concerns with their doctors.
How do I pay my specialist?
Billing arrangements for the specialist are flexible and will be negotiated between specialists and patients, or between specialists and patient-end facilities. Options could include an invoice posted to the patient, EFTPOS or credit card payment at the patient-end facility. Patient-end practitioners will generally bill as they normally bill a face-to-face consultation.
What is an eligible residential aged care telehealth facility?
An eligible residential aged care telehealth facility is a facility where care and accommodation are provided to residents under the Aged Care Act 1997 and which meets the eligibility requirements described in the guidelines; and is registered with the Department of Human Services. A residential aged care telehealth facility will need to register with the Department of Human Services and provide reports on telehealth consultations provided in order to receive telehealth hosting service incentives.
How do I register to be an eligible residential aged care telehealth facility?
Registration details can be found at Department of Human Services website.
Are there any special billing requirements for video consultations?
Yes. Only the relevant telehealth MBS derived item and the associated consultation item are to be included and itemised on a single account/bill. This will ensure that the claim is processed correctly by the Department of Human Services.
As a specialist/consultant, how do I bill my patient when we are not co-located?
Billing arrangements are flexible and can be negotiated between specialists and patients, or between specialists and patient-end facilities. MBS telepsychiatry has been operating for several years and psychiatrists generally either bulk bill their patients or arrange credit card payments at the time of service. Patient-end practitioners can bill as they normally would a face-to-face consultation. Information regarding this issue can be obtained from the Department of Human Services website.
What is the Medicare schedule fee for a video consultation?
Fifty-five existing specialist items, previously used only for face-to-face consultations, can be used to provide services to patients via video conference. These items must be claimed with one of 11 new ‘derived’ items, especially created for telehealth in order for the service to be provided by video, rather than in person. The schedule fee for the new 'derived' items is 50% of the schedule fee paid on top of the schedule fee for the service if provided face to face.
On 1 January 2013, 6 new MBS items took effect. These items provide for a short initial video consultation where the consultation is 10 minutes or less of direct face to face time with the patient (not including the time to set up for the video consultation).
The new items are ‘stand alone’ items, that is; they do not have an associated item that they are billed with and do not need to be billed separately.
Can I bill telehealth services which are conducted by phone or email?
No. There must be a visual link between the patient and the eligible specialist, consultant physician or psychiatrist in order to bill a video consultation.
Can two MBS items be billed for a patient-end service?
No. Only one telehealth MBS patient-end service item can be billed per patient episode.
The service provider who initiates the video consultation may seek assistance from a health professional (e.g. a practice nurse or Aboriginal health worker) when it is clinically necessary to complete the service but only one item is billable for the patient episode. The initiating practitioner must be present during part or all of the consultation in order to bill an appropriate time-tiered MBS item. Any time spent by another health professional called to assist with the consultation may not be counted against the overall time taken to complete the telehealth consultation.
As a practitioner, what do I bill if I am not present throughout the total video consultation?
The patient-end MBS items for medical practitioners are based on time and the appropriate item to bill would be the one that represents the total time spent by the patient-end practitioner with the patient during the video consultation. This does not include time setting up for the video consultation.
Can multiple video consultations be billed on the same day?
Yes. Medicare benefits may be paid for more than one video consultation for a patient on the same day by the same practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations. You will need to provide the times of each consultation on the patient’s account or bulk billing voucher.
Are practitioners audited on how they spend the incentive payments?
No. There will not be audits or reporting requirements on how incentive payments are spent. Incentive payments are intended to encourage a change in behaviour; specifically to change practice workflow and structure to incorporate online video consultations. The way an individual or business spends an incentive payment is up to them. You may, however, be audited on your eligibility to receive an incentive payment and if you have received an incentive payment inappropriately, you will be required to repay it.
Does the patient-end practitioner need to be co-located with the patient during the video consultation?
Yes. The telehealth items require that the patient and their support practitioner be together at the same location.
What are the Medicare recording and compliance requirements for these services?
Recording
Participating telehealth practitioners are required to keep contemporaneous notes of the consultation and this includes documenting that the service was performed by video conference, including the time and the people who participated. Only clinical details recorded at the time of the attendance count towards the time of the consultation. It does not include information added at a later time, such as reports or investigations.
Compliance
Normal compliance arrangements will apply in terms of practitioners meeting the requirements within the MBS item descriptors.
Am I eligible for incentive payments?
The first instalment of the Telehealth On-Board Incentive will be paid to an Eligible Practitioner upon the first occasion that a Medicare benefit is paid for a Telehealth MBS Item billed against a practitioner’s provider number. A Telehealth Service Incentive will accrue to a practitioner each time a Medicare benefit is paid for Telehealth MBS Item billed against a practitioner’s provider number and a single payment will be made once per payment quarter.
Practitioners with multiple provider numbers are considered a single practitioner and may only receive one Telehealth On-Board Incentive.
The patient-end provider and patient are required to be in a telehealth eligible area during the video consultation with the specialist, using the correct provider number for the location.
Payments will be deposited directly into your bank account via Electronic Funds Transfer (EFT). EFT details must have been supplied to the Dept of Human Services. The Department of Health and Ageing has received advice that incentive payments are not subject to the Goods and Services Tax (GST).
What are the requirements for patient-end services?
The key requirements for patient –end services include:
- the patient-end service is necessary for the provision of the specialist service; and
- physically located with the patient in a telehealth eligible area; and
- be located at least 15kms by direct road from the specialist; and
- a Medicare eligible specialist service is claimed (eg routine post-operative care is not a separately claimable service therefore a patient – end service can’t be claimed); and
- the entire service is rendered in Australia; and
- provider number matches the location of the service; and
- the patient is not admitted to hospital (including hospital in the home) or located in an emergency department.
If any of these requirements are not met, such as if a specialist does not submit a claim to Department of Human Services for the service, then the Department of Human Services will seek recovery of the MBS rebate and incentives for the patient-end service.
Can I bill for the regular GP bulk billing incentive items?
Practitioners providing a non referred patient-end service may also bill item numbers 10990 or 10991 where they meet the requirements of those items.
Can I use electronic claiming to lodge a bulk bill claim?
You can use electronic claiming if you have those services available. Once you have consent from the patient to assign the benefit to you, you should lodge the bulk bill claim directly to Medicare on behalf of the patient. A copy of the signed assignment of benefit form must be forwarded to the patient for their records.
How do I write a prescription for the patient if I’m not co-located?
Patient-end practitioners can provide prescriptions ordered by specialists during a video consultation. If the drug to be prescribed can only be ordered by an eligible specialist, consultant physician or psychiatrist, or if a patient-end practitioner is not involved in the video consultation, the specialist, consultant physician or psychiatrist can mail a prescription to the patient or the patient's pharmacist.
Can a specialist order tests for a remote patient?
Yes. There is no difference between a video and face-to-face consultation in terms of ordering pathology and diagnostic imaging tests. In practice the arrangements for these tests could vary between email, fax, mail and/or in consultation with the supporting practitioner.
How do I get the patient to assign the Medicare benefit to me (ie bulk bill) when the patient is in another location?
Information regarding this issue can be obtained from the Department of Human Services website.
How many telehealth services have been provided?
This data is available at the Department of Human Services website.
A fact sheet has been developed to assist in extracting data and can be found at the telehealth statistics page.