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Do you bulk-bill on podiatry Medicare items?

Discussion in 'Australia' started by LuckyLisfranc, Dec 27, 2005.

  1. LuckyLisfranc

    LuckyLisfranc Well-Known Member

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    Dear all,

    Just wondering if I could do an informal survery on the rates of bulk-billing vs scheduled-fee (or above scheduled fee) billing for Medicare patients referred under a Chronic Disease Management Plan by their GP?

    We have a CBD practice and have never chosen to bulk-bill our Medicare patients, as we have taken a lead from GP practices in our area who do likewise. Rather we charge the scheduled fee (which is lower than our usual practice fees for a standard consultation anyway) to leave a gap of around A$6.

    The motivation being our philosophy of placing a 'value' on our services, rather than being seen as a 'free' service. Also it keeps that practice from sinking...

    I would estimate we now have about 1-2 patients a day covered under the scheme. I would love to hear about othe coalface experiences with how practices are managing Medicare patients in Australia.

    Cheers, LuckyLisfranc :)

    PS Anyone know why the Dental items are conisderably more than what podiatry patients can rebate? You would think that of all the allied health professions that we could justify a commensurate rebate due to the costs of supplying a somehat equivalent service with dentistry (ie sterilisation, disposables, practice equipment etc when compared to the note pad and paper used by a dietitian for example).
  2. mimipod

    mimipod Member

    I did not know it was possible to bulkbill them. We rung and tried. We don't do it.
  3. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    The patient can assign the rebate to you by signing an "Assignment of benefit form". You cannot then charge a gap payment, and the rebate then is paid to you. I think this is fraught with potential hassles, as if all the GP paperwork is not in place you will then have to chase the patient for payment.

    See: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/79299CE412BC11F4CA256F19003CB46A/$File/AH%20fact%20sheet%201%20Nov%202005.pdf

    I'm not sure if this is the most current version of the guidelines, but billing procedures are the same. See the heading "How do patients get a rebate for these services?" and check out point 2.

    No that i have done it this way, but I know of others that do.

  4. Tully

    Tully Active Member

    Our practice (country WA) charges the patients up front the bulk bill fee, which they then receive back from medicare...we did try bulk billing directly a few times, but I have to agree with LuckyLisfranc on the GP paperwork side of things- if it hasnt been done properly, you ll be chasing your tail for months to get the money back. BUT, in the updated (?Nov 2005) info pack there there is a number you can ring to check if the paperwork has gone through, but the patient must be present.
  5. carolethecatlover

    carolethecatlover Active Member

    Why is dental more expensive? As a dental nurse, want to be hygienist(132 applications and counting), will settle for being a pod. (first applications this year)
    a) It is a postgrad course, so dentists have to pay back a higher HECS.
    b) dentists would not be seen dead sending their kids to state schools, so you have to pay for their school fees.
    c) Dentists are superior human beings and therefore you must pay them accordingly.
    d) there are more of them, and they have a bigger lobby group.
    e) Humans like sugar more than they like walking.
  6. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Carole...spot on. I should have known better than to ask such a fundamentally stupid question.

    I hope you get yourself into podiatry, we could use an extra bit of amusing cynicism in our forums! :)

    Still, I would like the kids to get into a private school...

  7. PF 3

    PF 3 Active Member

    Tried Bulk billing at one of our practices and got burnt by the GP paper work thing.
    Now upto the pt to take the papaer work to Medicare.

    Has anyone else found Medicare knocking the pt's refund back for the stupidest things?? Recptionist hadn't put Ref GP's address on our receipt. Knocked back. How this matters i have no idea.

    Have had a few knocked back because the person at Medicare didn't read the receipt correctly. Claimed we didn't put the medicare item code on it. (We had, just not where she looked (it was next tothe pod item code)) WE highlight all the major bit of info to make it REALLY obvious now.

    Whoever devised the system really needs their head read. It's not like anyone could defraud it as they can only claim 5 visits, which they have a record of. Have had quite a few little old ladies trotting back and forth to us and medicare for no reason.

    A good initiative made difficult by a stupid system.....

  8. One Foot In The Grave

    One Foot In The Grave Active Member

    Medicare is just trying to keep you in business.
    Getting them walking more (back & forth in their sensible court shoes I'm sure) increases their symptoms, and consequently their need for your services!
  9. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Dear all

    The frustration factor with all the red tape seems to be fraying patient and staff nerves.

    I had my poor receptionist cop an absolute ear bashing (about the 100th time since Medicare started) from a patient a couple of days ago because of confusion over the need for a new referral for the coming 12 months. There isnt even a "brochure" for patients to explain the convulted system to them, and my staff have a hard enough time trying to understand the system. Then they try and ring the GP surgery and get stonewalled by their practice staff who have even less of an idea about the process.

    Please APodC, lobby harder to removed more red tape from this process!!!! It is an enormous stress and inconvenience dealing with the paper trail. :mad:

  10. paula-j.

    paula-j. Member

    We started off charging the gap to patients but got caught up in all of the same paperwork/medicare hassles largely due to Doctors not putting their end through to medicare correctly. Now we finally have it sorted thanks to my very good receptionist who literally spent hours and hours following up every referral and my one personal visit to a doctors surgery where I sat down with the doctor and showed him all the rejections from medicare and he rang medicare while I sat in his office(most of these were resubmitted and paid). So now, after feeling sorry for those patients who had all the hassles I decided to bulk bill and it is all going very smoothly. It is also worthwhile to talk to your Division of General Practice (or equivalent) as they may help GP's to get it right and provide information. In my area (country WA) the division held an information evening for the Doctors,(and service providers) and they all came so that was very helpful. My practice is part time, and I probably see 3 CDM's per week now. Once you get it up and running with all the bumps ironed out it is quite good bulk billing it.
    Cheers Paula
  11. PF 3

    PF 3 Active Member


    Perhaps it has been changed, but i was under the impression you either Bulk bill only or make the patient pay in full and they go claim the $45.20 etc etc. I.e. you can't charge a gap when bulk billing. Don't see why you shouldn't be able too, but I'm pretty certain its that way with GP's as well.


  12. paula-j.

    paula-j. Member

    You're completely correct, you either bulk bill or charge the fee (with whatever you charge over and above the medicare sheduled fee) it's just my poor explanation. We started off charging the client with a fee over and above the scheduled fee ($6.00) ie the gap, and letting them claim back the medicare rebate but then switched to bulk billing. I have just found it so much quicker and easier and if there are paperwork problems I don't have the client coming back in and out and potentially getting angry because they can't claim their rebate, although now all the paperwork with the doctors is ironed out we don't have problems any more.
    Also there is a patient information sheet which you can give your clients which explains the scheme, it came from the Royal College of General Practitioners and I was given it through the local Division of General Practice. I use it when patients have come in saying they heard you can now claim a medicare rebate for podiatry. it explains all the in's and Out's of the CDM program.
    Cheers PJ
  13. PF 3

    PF 3 Active Member

    It seems the powers that be have improved the system. Just received a new look
    epc program referral form. It looks like the original ones on the top half, but it states in big bold letters at the bottom that the pt does not need to use this form to get their rebate. No need to photocopy any more!

    Hooray! (Just hope the told their staff at medicare that its changed!)
  14. Sean Millar

    Sean Millar Active Member

    EPC. Leaves bad Taste in the mouth

    The success on the entire system depends on the philosophy of the GPs around your practice :confused: . When the EPC first became into being I seen it as a good opportunity improve patient care. Whilst Working in Community Health, we had a 6 month waiting list. Many of our diabetic clients really need regular care but with our system under strain, it was impossible. So I spent 6 months solid promoting EPCs to clients, giving them the literature circulated by the HIC. Spoke to the Division of GPs, the said it would be great if I could help by commencing and signing part of the EPC before the patients seen there GPs. All clients we referred to the GPs had need and were eligible. Well it was not long until had a phone call from the Medical Advisor to the HIC, in no uncertain terms told me I could not promote EPCs, and could not refer clients to GPs to discuss EPCs :eek: . Explanation was that the patient attended the GP and put pressure on them to fill out a care plan. This made the GPs uncomfortable :( . Since left community health to concerntrate on Private Practice. The GPs around my area (different location to public health) are also very unresponsive to EPCs. We have busy full time (5 full days) we see about one care plan every 3 weeks is equates to 5 patients on care plans, all were clients of my practice prior to being on EPCs. Decided to visit one of the busy independant GP practices to see if we could build a better relationship with EPCs. The Principle GP said he was not interested and to top things off he charged me a consultation for his time. EPCs are dependant on proactive GPs. :(
  15. paula-j.

    paula-j. Member

    How rude!! charging you a consultation for his time. That's a disgrace.
    Interesting that the Division thought it would be a good idea to commence the ball rolling with the EPC's. Our Division told us in no uncertain terms the GP was 'The driver' of the plan, which is fine by me, and luckily enough our GP's (thus far) have been fairly receptive the whole thing.
  16. LuckyLisfranc

    LuckyLisfranc Well-Known Member


    You should REPORT this GP to HIC for Medicare fraud. You have every right to make a time to visit him and discuss public health policy initiatives that help patients in his/her community.

    I feel VERY strongly about this. This is completely unacceptable.

  17. admin

    admin Administrator Staff Member

    I have it on very good authority that the next APodC bulletin being posted to members in the next few days has a section on the recent changes to the EPC and medicare.....check your mail.

    ...yes report them
  18. Heather J Bassett

    Heather J Bassett Well-Known Member

    Under cutting fees

    We have been invoved in the epcp for maybe 18 months? We have a couple of GP clinics happily involved. We have had others ring us up to tell us how much work is involved--and that theyre not happy to have to do that. We have others who ring us to ask what the process is. ( I have looked up the gp assoc in our area which has it all mapped out well, so I'm not sure why they have to ask us) One gp failing to do the appropriate paper work meant the client was unable to be reimbursed. The client was told bu the gp to treat it as a bad bet, get over it, you have lost your money!! Professional Hey!!
    On a second note I would be interested to know how many pods charge below the medicare rebate fee.. In our area we have pods charging up to $20 under that fee. What other profession regularly charges less than the medicare fee?We are such a small profession we should be banding together not under cutting each other?? We are not the enemy, perhaps other professions delving into our expertise are the enemy?? I get extremely frustrated with my colleagues who think so little of their worth. Is this a problem just in my area??
  19. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    This does not surprise me. There are still many podiatrists, that perhaps define themselves as "chiropodists" (excuse the politically incorrect nomenclature Cameron), and would prefer to not exercise much of the old grey matter when it comes to treating feet. ;)

    I would hate to be their accountant or financial planner though...

  20. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    ...so i am just between patients, after finishing a Medicare eligible patient with T2DM and onychogryphosis.

    It does annoy me that the entire success or failure of this program rests solely in the laps of General Practitioners. There are some that are ardent supporters of the program, and others that are too lazy or set in their ways to do the paperwork and get a nice fat cheque from HIC for their efforts.

    The only way this program will be of use to the community in the long term is if;
    1. There is a removal of the restriction of 5 visits (in total) across a massive range of health professionals
    2. That a GP can refer a Medicare patient to me as easily and in the same way that they would refer a private patient to me (or a Medicare patient to a medical specialist). This is the biggest disincentive.
    3. or patients can access us without GP referral!!!

    I am also frustrated that the rebate for podiatry is set at the same level as other health professionals that *do not* have anywhere like the same overheads as a podiatrist. Our practice costs are the same as a dentist, and we do similar levels of procedural work - lets get a parity of rebate! We dont operate with a pen and paper like a dietitian or a psychologist.

    Sorry to rant and rave, I am just getting the sh**'s with the riculous CDMP/EPC rules. APodC - if you're out there? -are you lobbying on these issues??

  21. Heather J Bassett

    Heather J Bassett Well-Known Member

    I would not have expected those pods who are recent graduates and especially those who lecture at the university to not use their grey matter and look at themselves as chiropodists?? Perhaps if you lecture and just have a practice on the side you don"t have any overheads, no consumables no registrations, no insurance, no rates, no super, no sterilisation,etc,etc,etc. I mean $45 for an initial consultation ( because we have extra paperwork to do) and $40 for subsequent visits sound professional don"t you think????

    Where do they cut their costs?? or are they simply running at a loss for some tax reason??

    Perhaps if the new grads see lecturers charging these sort of fees they do follow the chiropody(using your term) mentality. This is just ONE example of a clinic not far from us. These type of practioners do nothing to help the status of the profession or themselves!!!!!!

    It is no wonder we have trouble getting reimbursements from HIC ans Private Healthe Insur etc.
  22. yvonnespod

    yvonnespod Member

    We don't bulk bill and patients pay $52 then claim.I just find it strange that new young healthy employed diabetics can utilise the service to check if they can still wear nail polish yvonnespod
  23. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Perhaps this is our first taste of the many inconsistencies and waste within the Medicare system...?

    This is probably our equivalent to the old granny that presents to the GP for her monthly BP "check" (nee: 'chat'), when there is nothing else wrong with them!

    Good to see you don't bulk bill!

  24. Stuart Blyth

    Stuart Blyth Active Member

    At the risk of sticking my head out of the parapet I feel have to comment on this remark.

    Pods need to stop bulls*****g about how much they charge because it gives little indication of how much profit they actually earn.

    Many practices have cost structures that allow bulk billing. How anyone can comment on what another pod is charging without knowing that individuals cost of service delivery is beyond me.

    We charge less than the rebate amount for most of our private consults and my partner and I make a healthy margin.

    Pods need to work out their own cost of service delivery, including capitalization, then add a profit margin and then decide if they should be bulk billing or not.

    Stuart Blyth

    Ps {Quote: You should REPORT this GP to HIC for Medicare fraud.}

    Yep.... that will do wonders for our relationship with the medical community.
  25. LuckyLisfranc

    LuckyLisfranc Well-Known Member


    Fair call, there are always differences in the cost of running practices, and how one provides a service. If you and your partner can make a living from charging less than the rebate amount, I say good on you! I'm afraid my practice would go under if this were the case - we are in a CBD location with high overheads etc.

    In terms of reporting GPs (or any other service provider) for HIC fraud, this may be detrimental in the short term for a practice in terms of losing one referring GP, but fraud is fraud. The GP is breaking the *law*. If I were to submit a fraudulent claim like this to DVA or Medicare - would you (or my profession) support me??? I doubt it.

    I bet my local GPs would report me in a tachycardic heart beat if *I* billed any of my meetings with them to Medicare.

    I agree on your first point, but cannot do so with the latter.

  26. Stuart Blyth

    Stuart Blyth Active Member

    Faircall back LL !
  27. Tuckersm

    Tuckersm Well-Known Member

    A GP Reffering a person with a chronic illness under the enhanced primary care/GP care plan system to a podiatrist is not fraud. The patient may have had a very simple question that they needed answered, but it is also an opportunity for the pod to warn of the possible future risks of diabetes to the feet and how best these can be prevented, so that the patient doesn't in 5 or 10 years come back with a hole in their foot.

    Medicare is a universal healthcare system supported by a mixture of Australian Gov taxes, the Medicare levy, and in the running of public hospitals and community health services, the state gov.
  28. LuckyLisfranc

    LuckyLisfranc Well-Known Member


    Our discussions about the possibility of Medicare fraud relate back to comments earlier in this thread about a podiatrist being billed with a Medicare consult to visit a GP to discuss the new CDMP/EPC initiative.

    Referral under EPC/CDMP, by definition, is of course not fraud. This was never in question and would be a silly non-sensicle comment to make.

    Does that make more sense now?


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