6 August Reforms to Medicare compliance– firmer but fairer? August 6, 2018 By Danielle Cranefield General Medicare Compliance 0 Law reforms introduced from 1 July 2018 have given Medicare stronger debt recovery powers. The legislation also provides for fairer approaches to compliance, by apportioning responsibility for overpayments between both doctors and their employers or contractors, including public hospitals. Minister for Health, Greg Hunt said the legislation aims to deal with the “very, very small number of outliers” who don’t comply, at the same time acknowledging “the outstanding degree of integrity” among the medical workforce when the Act was being reviewed by Parliament. Recovering overpayment debts Doctors with a debt to the Commonwealth arising from Medicare compliance activities will be encouraged to enter into a repayment plan within 90 days. Medicare also has a new power to require the production of documents and information related to the financial affairs of doctors with a debt. Compliance – a shared responsibility From 1 July 2018, the Professional Services Review Committees are empowered to make findings of inappropriate practice against persons or officers of body corporates who employ “or otherwise engage” doctors. This includes practice owners and officers of corporate practices. The consequences of a finding for a person found guilty of inappropriate practice in that way includes the repayment of the whole or part of the Medicare benefits paid for a service, notwithstanding the service was rendered by an ‘associated person’ (such as the providing doctor) and the benefit was paid to an ‘associated person’. Also, from 1 July 2019, a Shared Debt Recovery Scheme will apply to the recovery of debts arising from making a false or misleading statement, e.g. a claim for benefit. The Scheme will allow Medicare to make a determination about the proportional responsibility of the primary debtor (the providing practitioner) and a secondary debtor. The secondary debtor may be a person or body corporate such as a hospital, corporation or practice. What should you do? It is in the interests of both individual providers and those who employ or otherwise engage them to cooperate, to ensure all documents related to claims for Medicare benefits are complete and accurate. The reforms do not diminish the provider’s primary responsibility for the services they provide. Providers should continue to ensure that they are knowledgeable about item descriptors and explanatory notes for Medicare Benefits Schedule services they provide. Providers should always determine what items are billed in their name and take every care to ensure documents submitted to Medicare under their provider number are accurate and not misleading. Read more (Source: Avant) Related Independent review of health providers’ access to Medicare card numbers This review examined access by Health professionals to Medicare card numbers by using the Health Professional Online Services (HPOS) system or by calling the Department of Human Services. Medicare bulk billing rate hits historic 86.1 per cent A record amount of Australians are visiting their doctor without having to pay a cent with the latest Medicare data confirming almost nine out of every ten services were fully bulk-billed. New education guide for Medicare billing for immunisations Use this new guide as a quick reference to support you with Medicare billing for immunisations. Improved Medicare Compliance: Changes to Legislation On 1 July 2018 changes occured to the Health Insurance Act 1973, the Dental Benefits Act 2008 and the National Health Act 1953, through the Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Act 2018 (the Act). Changes to Health Professional Online Services (HPOS) – September In response to the recommendation made by the ‘Independent Review of Health Providers' Access to Medicare Card Numbers’ the following changes will be made to HPOS in September. 1 July 2018 MBS Changes The Department of Human Health adds 1 July 2018 Medicare Benefits Schedule (MBS) changes to our health professional education resources. Comments are closed.