Keeping track of Medicare

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Hi everyone,

Keeping track of my obligations in regard to Medicare patients is getting too much. Although I have minimal knowledge of excel, I have sort of drafted a spreadsheet that might help me. I don't know how to so the calculations but assume they can be done.

As far as I'm aware, the rules are:
1) Referrals expire 12 months from the referral date.
2) The number of visits allocated to podiatry relates to the abovementioned 12 month period.
3) Above all else, a maximum of 5 allied health visits per calendar year must be strictly adhered to. You need to call Medicare for this to be confirmed as another discipline may have used an extra visit than they were allocated. This is easily done as when you call Medicare, they only have the 'per calendar year' information, not who is allocated what or who has used what.
4) Reports must be sent to the GP at the first and last visits.

Can you see any shortcomings to this spreadsheet or my understanding of the rules.

Much appreciated.

Rebecca

 

Yep, all ok except point 1- the referrals actually last for 2 years from the original date (just to add more confusion)- so they can use their visits in a 2 yr period if they wish (obviously not many do-99% of them front up for another referral after the 1st year!).

This makes paperwork and tracking hard, as a few pts might come for 1 of 2 visits, then come again 12+months later with another referral, when they still have an outstanding visit on the previous referral that was not used....aaaaargh! And try explaining THAT to them!!

 

Regarding point 3 u don't have to do this but if u bulk bill and 5 visits have been claimed already in a calendar year Medicare won't pay u. More likely a patient pays u but goes to Medicare who won't pay them. Is the scheme bureaucratic and tedious? sure but it has improved to access to care for many.

 

Hi and thanks jos & antipodean!

Hmmm, this contradicts advice from my state association.

Who is the authority on all questions Medicare for this program? Is it someone in our Association, the Board or someone at Medicare (its certainly not anyone who picks up the phone on 132 150)?

Rebecca

 

Referrals do last for 2 years, I have seen many patients who come in for a diabetes assessment and then a year later or more later I recall them for another (assuming they have been allocated multiple visits of course). The confusion comes with the fact that the plan can only be renewed annually by the date of expiry of the plan OR at the start of the next calendar year. I have GP's referring to me who use both methods (although you can still only use 5 visits per calendar year assuming all are alloted to you)

Can't see how you get all that in a spread sheet.
I have been bulk billing all my plans since their inception so know every in and out through experience of having claims knocked back if they are wrong however have not had any problems for the last few years with them.

 

Hi Paula and thanks for the clarification!

Rebecca

 

It's also worth noting the GP should send you the whole plan, not just the referral form. They should specify how many visits they have allocated to you. We never ring Medicare, on occassion they forget to write it into the plan and we ring the Doctors surgery and they let us know.

Paula

 

Do you use patient file cards or do you have a practice management system and record patient files electronically?

We use patient file cards and we record all the info on the card.

eg Referral arrives for 5 visits, dated 1/3/12 for Dr Smith Prov Num: 123123AA

This information is written on the px card in red and highlighted in yellow next to the date of their first visit.
On their next visit, we write the date, then in red Tx 2 (of 5), then the notes.
Next visit, date, Tx 3 (of 5) etc.

As we get close to the end of the calendar year, we then add how many treatments for the year.
eg 1/11/12. Tx 4 (of 5) 4th for year.

Using both yellow highlight and red biro makes the info stand out clearly. Easy to see when first and last letters are needed.

We bulk bill and all the info is on the card. When we organize the cards for the next day, we create a list of the relevant info needed for our Hicaps machine. eg Px name, Dr prov num, ref date so data entry is easy. This also gives us a check sheet at the end of the day to ensure all EPCs have been submitted.

 

What about the number of visits on the referral?

If the referral is written in the middle of the year and carries over to the next year, you've got the number of visits for the year AND the number of visits left on the referral to keep track of- this is waht causes the most confusion amongst my patients!

Medicare tells them that it's only the visits in the calendar year that counts, but I am bound to adhere to the GP's referral and report to the GP after the first and last visit!!!

 

Hi all works well if updated each visit and all of the above is adhered too. With medicare claims, if you bulk bill rejected claims are found within 3 days if you check of your statement s regularly. When not paid by medicare, the patient is rung in our surgery to return and pay privatetly . Mostly they have used a visit to dietican or similiar and forgotten. Medicare won't tell you who they have seen but will tell the patient , we suggest this to the patient ( to ring medicare) when arguement with receptionists starts. hope that makes sense.

One more note often the patient comes without the team care arrangement( tca) plan and just the referral, it is necessary to get the TCA, at least the fisrt time, as if auditted it is one of the pieces of paper that you need to reproduce along with first letter , final letter etc.
Good luck being organised is essential

 

Hi Trev,

But how does your receptionist deal with this when the patient calls and makes an appointment. Say your patient calls up and makes an appointment for one weeks time. If all the info is in your manual patient files, your receptionist has no idea of the currency of the referral, how many visits used / left. Its not until the day before the appointment that he/she pulls all the files out and reads them only to find the referral has expired. Then he/she has to ring the patient and reschedule them once they have seen their GP.

I too have a manual patient files / appointment book but am seriously thinking of going computerised (practice management software). Having said that, I'm only assuming that this will make the job easier.

Rebecca

 

Exactly dyfoot, that's why I tried to get a spreadsheet happening. I've got 180 of these patients and I'm losing the will to live.

How bound are we? Paula says not so much. When Medicare come to audit me one day, how bound do they say I am, I guess that's what matters most.

 

Gosh, this is the type of thing I want to totally avoid!

Thanks dsfeet, I didn't know that.

Rebecca

 

Not sure how true this is as when I was audited they wanted to see only the referral, the 1st and last letters that were written in the CALENDAR year not the referral year. So basically they wanted a referral that had that year dated on it. Not to say that this is not correct but the auditor that saw me had a list of things he wanted to check.

 

Quote:
Originally Posted by dsfeet
One more note often the patient comes without the team care arrangement( tca) plan and just the referral, it is necessary to get the TCA, at least the fisrt time, as if auditted it is one of the pieces of paper that you need to reproduce along with first letter , final letter etc.
Good luck being organised is essential

I do a session at a paperbased practice when patients come without the documents we hold onto a semi completed receipt and will complete it and give it to patient when they bring the documents in. Nothing like the motivation of $51.95 to get the ball rolling

 

when i got audited we had to supply the tca , however first issue is considered ok
NOW according to the medicare website info which we check often.
My soft wear programme also alerts us if the medicare arrangement has expired, although this is checked manually in the computer notes as well/ we use front desk.
Sorry there is no way of ensuring that payment will occur and they have not used a visit elsewhere....DO NOT rely on the dr , they get it wrong more often than the patient. You can ring medicare and check before each visit ,,,who has the time certaintly not me. I have my practice in a town with a elderly population and 75% of my patient load is now medicare..why i have to be very organised...........What happens if medicare ceases who knows...had one patient today who was told by his gp to hurry in to have his feet done as medicare was going to cease in 2 weeks////////////////I haven't heard any rumours has any one else????
/wonder how patients will cope if they go back to the days proir to medicare, may be they will want their feet done 6 weekly again instead of spinning appts out to 10 weeks , god forbid they might have to pay!

 

had one patient today who was told by his gp to hurry in to have his feet done as medicare was going to cease in 2 weeks////////////////I haven't heard any rumours has any one else????


http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=75531

 

Digressing a bit here. I am amazed at the number of you that say you bulk bill patients through EPC! How on earth do you afford to run your practice ?!

 

"How bound are we? Paula says not so much. When Medicare come to audit me one day, how bound do they say I am, I guess that's what matters most. "

I don't think I said we weren't bound as such, I think it's just a case that I don't have to ring Medicare to verify anything because the Practice Manager at the Doctors surgery's we deal with are able to confirm everything with us. There are still lot's of phone calls, but now thankfully very rarely any problems.
I haven't been audited but I always receive full TCA's, all my reporting is done as per what I believe to be the requirements. I have full manual and computer records, my receptionist takes care of all the plans (all I do is the podiatric component and writing ou the report) and Surfboy you are correct, you cannot run a practice on the rebate (which is why I have now ceased bulk billing). I worked out I would be working for the princely amount of about $30.00 an hour (before tax).
A few complaints about having to pay the gap of $9.15 but I have explained it cannot be done on the rebate alone.
Also as an aside our local Division of General Practice has funding whereby any patient of aboriginal or Torres Islander descent can have the gap paid by the division.

Paula

 

I bulk bill as my normal patient patients pay either $55 or $ 52, not much difference, I realise this sounds cheap for some , but i'm actually one of the dearest in town, We do 3 patients an hour, always booked out ,have full time reception and a practice manager and i make great money. Maybe rent is a bit cheaper but that is about all, my policies are always current, sterilization to full extent we even do biological validation yearly , ohs policy updated yearly, stock and equipment at highest standard, 3 rooms fully equiped etc . And i certaintly earn more than $ 30 / hour , heaps more.
Thanks dragon for thread on apodc update, was aware of this lobbying.

 

Sorry to harp on & maybe it has been discussed elsewhere, but does a referral last 12 months from the referral date, two years from the referral date or (as I believe it is) upto the 31st December of the year after the referral was written i.e. the referral might last 2 years if written on 1st January of on year & it would then expire 31st December of the next year. I had a patient in today who I saw for their 4th of 5 visits. The referral was written back on the 9th May 2011. My receptionist had been told by Medicare the referral expired 12 months from that date. Hence today even though there was one visit left, she told the patient to go get a new referral. I thought I had clarified this with her but maybe I'm wrong? The confusion becomes that it can be harder to track when to be writing the last letter (& first letter). Again are there any other "secrets" to how you run the recording of the visits???

 

It is my conclusion from medicare that the referral runs for 2 years from date of Dr referral , however it only lasts for the 5 or number given by dr , and only 5 per calendar year . therefore you were correct, Medicare staff sometimes give wrong info, best to read the info on the website.

Letters, and any secrets..... ...record everything.
my lists go like
dr referred, date of refereall, reason for referral, No of visits
1 , 12/3 /12 gt .....letter sent
2) 5/6 /12 diabetis assess with gt
3) /8 12 gt
4) heelpain cons with gt
5) 6/10 /12 gt , checked excersises ,letter final
letter with outcomes sent ALL kept in computer notes in soft wear programe and letters scanned in too., (90 %of letters, diab assess etc are preformas with fill in the spaces and add ons )
Helps with ease of writting and time, takes time to set up initially but worth it. Front desk softwear allows for attachments and letters .
Hope that helps for ideas, tried to keep it brief so hope it was understandable.

works for me , not sure if this helps.

 

Thanks for your reply ds. My information from Medicare is slightly different - the referral lasts for two calendar years so if you receive a referral 1/6/12 it finishes 31/12/13 & not 1/6/14 Anyone able to confirm one way or the other. It's hard to believe this system has been running for 5 years (?) & I/we are still asking these basic questions.

 

Agreed ... ridiculous!

 

I could be just really slow

 

Hi Rebecca,
After each visit, I change the patients name in the computer calender

From:

Mrs Smith (5) (if has visits)

to

Mrs Smith (4) etc

so when they ring and you pull their name up, you know how many they have had. So that way when it is Mrs Smith (0) and the arc up, you can always double check with the manual file whilst on the phone and confirm you are right.

Makes life easier for me at least!