While the incentive itself aims to facilitate equitable access to healthcare, its operational details can sometimes be intricate and require careful explanation.
The language used in the description of the incentive may seem daunting, but breaking it down step by step can help us understand its mechanics more comprehensively.
Eligibility Criteria: Who Benefits?
The incentive targets specific medical services covered by the Medicare schedule, excluding certain items. These services must meet several criteria to be eligible for the bulk billing incentive:
The service is unreferred, meaning it's provided without a referral from another medical practitioner.
The recipient of the service is either under the age of 16 or qualifies as a concessional beneficiary.
The recipient is not currently admitted as a patient in a hospital.
Geographical Classification and Practice Locations
The incentive's applicability extends to different geographical areas classified under the Modified Monash Model (MMM). Different items within the incentive can be claimed based on where the service is provided:
Item 10990 applies to services in MMM1 areas.
Item 10991 applies to services in MMM2 areas.
Item 75855 applies to services in MMM3 or 4 areas.
Item 75856 applies to services in MMM5 areas.
Item 75857 applies to services in MMM6 areas.
Item 75858 applies to services in MMM7 areas.
Identifying Practice Locations
Medical practitioners need to determine their practice location according to the provider number used for services. The practice location can be either the practitioner's surgery or a location where services are provided away from the surgery, like home visits or visits to aged care facilities. If a practitioner operates in both eligible and ineligible areas, the incentive can only be claimed for services provided in the eligible area.
Unsure where your practice sits in the MMM? Look it up here
Scope and Claiming Conditions
The bulk billing incentive items are intended to be used alongside items in the General Medical Services Table of the Medicare Benefits Schedule (MBS). These items cover a wide range of medical services, excluding diagnostic imaging and pathology services. This means that as long as the conditions of the relevant item are met, items 10990, 10991, 75855, 75856, 75857, or 75858 can be claimed for each service. This can include attendance items, procedural items, or services provided by a practice nurse on behalf of a medical practitioner.
Limitations and Auditing
While the incentive aims to support accessible healthcare, there are limitations. The bulk billing incentive items cannot be claimed concurrently with each other. Additionally, if a patient has exceeded the allowable number of services within a given time period, the bulk billing payment won't apply to that specific service.
To ensure accurate claiming, the Department of Health and Aged Care conducts regular post-payment audits.
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