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ManageBGL in a Tele-Health/Telemedicine Environment

ManageBGL is an enabling technology for tele-health consultations, allowing a patient's complete logbook and charts to be accessible online for simultaneous view by both patient, consulting doctor and General Practitioners. Skype is also commonly encouraged by government for use in these kinds of consultations.

In an Australian context, for a registered medical practitioner or specialist to bill for a remote consultation:

  • The patient must not be a hospital admitted patient or patient of an emergency department; and
  • The patient must be located in a telehealth eligible (remote) area at the time of the attendance (see map below); and
  • The patient must be located at least 15km by road from the specialist;

    OR
    • the patient can be a care recipient of a residential aged care facility (located anywhere in Australia); OR
    • the patient can be a patient of an eligible Aboriginal Medical Service (located anywhere in Australia).

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).

Defined remote areas are pretty much anywhere outside of Melbourne, Sydney, Canberra, Brisbane, Adelaide and Perth. See the map below.

There are also billable items for 'patient-end services' when a GP provides face-to-face clinical support to patients during their video consultation with the specialist, where it's necessary for the provision of the specialist telehealth service.

This page gives more detail on item numbers etc.

Standards Australia has several publications relating to telehealth which are available to download at the bottom of this page on the Standards Australia website.

Building a Tele-Health App?

Checkout our friends at Sapient, for online integration of Medicare, HICAPS and Veteran Affairs APIs.

Tele-health item numbers

Show Tele-health MBS item numbers

FAQ

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. 


 

Remote Area Map