Medicare-EPC and fees for writing reports

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I've been told GPs gets paid at least $80 for every patient they refer to podiatrists. Does anyone know how much they do get paid by Medicare?

Podiatrists can earn about $250 for a 5 visit per annum patient.
We have to write at least 2 reports per annum which takes from 15 mins. to 2 hours per patient per annum depending on how thorough the podiatrist feels the reports needs to be.(At least 30 mins per patient per year). We do not get paid for this report time.
Should we not be paid for the extra professional time to write reports?
(Speak to any accountant - raised eyebrows that we don't get paid- or solicitors or medical specialists).
Should we not be receiving ready-made formats/templates for letters/reports to be sent to Medicare? There is then a consistency for all and we all know what is required - the minimum - and recognition of our professional time. Time is premium for all of us, especially when you're running a business and so any help given to us, I feel, would be most welcome and recognition that we are not getting paid.
I'm sure the detail and scale of information put in reports by podiatrists must vary enormously.
And even if it did n't, and we all knew exactly what is required so we were consistent then it comes back to time - the more complex cases/patients would mean more lengthy reports for which we don't get paid.

I know about the courtesy of writing letters to colleagues and generating more income point of view so I would appreciate any replies I may receive do not include this line of thinking. Reports are not just about 2 lines of 'thank you for your referral'....

 

The GP's if I am not mistaken claim two item numbers. The writing of the careplan as well as the referral organising. They earn somewhere around $250 + dollars for both of them !!!
Clients then whinge at me for charging a $4 dollar gap because the doctor told them it would be free.
I even just heard a talk back radio caller - A GP - say this amount was ridiculous. I've seen it rorted too and it sucks.

 

Yep, it's about $250 to do the care plan ('easy' if they are computerized- just a 'matter of punching in a few details' I was told by one GP).

I had a well dressed woman call in yesterday who went on and on about the gap (why do I charge $8 / she was told is was 'free') the huffed off out the door without making an appointment then LIT UP A CIGARETTE.................!!! Obviously destroying her health is more important than spending $ on quality foot care.

I guess part of the problem is that some GPs bulk bill, so the assumption is that we do likewise, but Patients (and GPs) don't consider our costs and longer appointment times, never mind the time spent on letters etc....

Having said that, my GP charges about $30 gap on a 15 min appt- I'm happy to pay that, as she is a great GP who is good at diagnosing and treating, rather than go to a bulk bill clinic where some GPs have no idea what they are doing.

 

We all make choices to provide our service either up to a standard or down to a price. None of our patients are bulk billed. All our private patients pay the same fee. The gap for medicare patients is $26. If patients don't like it, they are advised to go elsewhere. Price shoppers will always go elsewhere and are generally the type of clients I would rather not see.

 

This should be included as a mandatory training statement for all practitioners entering private practice. Could not agree more.

LL

 

That's a great post, Maz. Could not agree more.
Notwithstanding the fact that we are not remunerated for our time in writing reports, a template from Medicare would be a great idea in that it would create uniformity across the allied health professions in report writing.
This is especially relevant, given the sharp increase in Medicare Compliance Audits across Medical and Allied Health. A template would create transparency as regards Medicare expectations, as to what is exactly required to be contained in a report.

 

Probably the most sensible post I have read here, period. Could not agree more.


Quote:Originally Posted by podcare We all make choices to provide our service either up to a standard or down to a price. None of our patients are bulk billed. All our private patients pay the same fee. The gap for medicare patients is $26. If patients don't like it, they are advised to go elsewhere. Price shoppers will always go elsewhere and are generally the type of clients I would rather not see.This should be included as a mandatory training statement for all practitioners entering private practice. Could not agree more.LL

 

Just going off topic a little bit, how much detail do you put in your 2nd report?? My first is comprehensive, but unless anything has changed I don't say much in the 2nd...should I be??

Cheers
Esh

 

I can too relate to this. Gps refer often with only the EPC form no meducal history etc. Often pts are told its free and have no idea of why they have come. Pts do not understand or are often unaware of the extra time podaitrists put into letters and reports which is unpaid.

Would be great if there was a medicare template as then things would be standarsised for all of us.

 

Surfboy- Fine to have a "medicare template" but do those Medicare bureaucrats know what podiatrists actually do?? I'm guessing NOT, so how are they going to know what should be on the template?

Maybe the template should be drafted by A pod C or ApodA, then submitted to the Medicare pen pushers for 'approval' for use by us.

 

Funny you should mention that Jos - keep an eye out for a lot more medicare related things from APodC to its members very soon. The wheels are in motion!

 

Did a template for Medicare eventuate? Would anyone be prepared to share their templates they use when responding to GP's for the first & last visit?

 

Hi Mark,

When I left the APodC Board late 2011 this was very high on the agenda and several of us were working on a committee dealing with this. Obviously it may have slipped down the priority list which is a real shame because it is much needed!

 

Hi Paul
Re. Reports and templates for EPC purposes

I hope they realise the need for a template but it must be one that is simple and easy to complete.
Time is of the essence and not to be bogged down with endless sections that are expected to be completed. Reports that just take a couple of minutes to complete should be sufficient. (writing addresses,stuffing envelopes and sticking stamps takes time - I prefer to post).
Also, doctors are also busy and they don't have time to get bogged down in excessive unnecessary details.
Should be kept to just anything significant, therefore more likely to be heeded by the GP.
Paperwork can take over,adds stress and it is wasted time that should be spent treating and earning a crust. We don't get paid to write 20 to 30 minute plus reports.
If we see 10 patients per day that is probably potentially 1-2 hours or more of extra time at the end of each working day.

 

Hi Maz,
You know the doppler test that you do as part of your EPC diabetes assessment.
Well, if the doctor was to do it he/she would receive $54.00 just for the doppler test alone.
Item code 11610 (two per year)
To claim this benefit they need keep a hard copy of the waveforms.
(source Vital medical catalogue 2011 page 60)

I wonder where the podiatry council is on this one? :hammer:

This was one of several questions that we emailed APODA Vic last year.
Still waiting for a response to all of the questions.
Perhaps this could be one of the reasons why APODA membership numbers are dropping?

 

I know that GP practices use a template to fill out the referral summary of everywhere the patient will go. They would waste a lot of time otherwise as this is often several pages long. I agree that APODC would need to address a template for us in regards to cutting down on our paperwork. Imagine this-efficiency in a Podiatric practice- Ahhh....

 

I think this has fallen completely off the Radar. On a separate note - after a lengthy discussion with Medicare yesterday who still tell me that they cannot guarantee payment for a service if charged through the HICAPS terminal. Great Medicare - maybe I should audit you?

 

This whole EPC thing seems to be a nightmare

The GPs seem to do what they like and no-one seems to be able to stand up to them.
I rang Medicare recently to see what they require GPs to provide Allied Health Professionals as their part of the EPC requirements. They are supposed to provide a copy of the patient's care plan as well as a copy of the EPC allocation paperwork, and have me sign a team care arrangement agreeing to be part of the patient's care plan. I find that this is adhered to some of the time and that some GPs/Practices are serial no-paperwork-providing-offenders which I explained to Medicare.

Their advice to me was to either refuse to see the patients until the paperwork is provided (ie send them back to the GP and tell their GP that I refused to see them for their FREE podiatry...) or put in a complaint about those GPs/Practices so that Medicare could investigate them (apparently this can be done anonomously). My argument to them was that this is all well and good in cities but not the easiest thing to do in regional, rural or remote areas. Putting complaints in about GPs (who seem to be above God on the food chain) and seeing them in the supermarket wouldn't be easy, even if they didn't know it was me.

Medicare not policing GPs compliance is just typical - what's the point in having rules if everyone apart from GPs has to play by them?

Writing reports to complete my part of the TCA that probably aren't read and that I don't get paid for drives me nuts!

Hopefully the APodC gets back onto this!

 

You think the GPs get away with murder for Medicare - should see how their CPD works for AHPRA! As a Podiatrist you would really feel hard done by after seeing the inner workings of that!

 

Maybe the APodC should employ David Thorne (of www.27bslash6.com notoriety) to fix Medicare and the GPs - he'd probably enjoy it!

 

Been using HICAPS terminal for sometime. My Medicare claims come through next day mostly not 3 weeks via post. Only trouble with claims I have is when patient went to another GP and asked for another EPC. the 2 GP practices have no knowledge of each other so once 1st 5 visits are used the next one is LITERALLY FREE TO the patient and to ME.

 

Pes Perfectus,

My ampathy with non compliant GPs. Most of mine come with all the requirements you have quoted. Sometimes I do end up just working off the referral sheet with how many visits to me if I can figure out from patient why GP sent them to me.

 

We have multiple examples of Medicare not honouring approved HICAPS Medicare transactions to our clinic due to the patient having services at multiple EPC approved clinics (i.e. physio, podiatry, dietician etc...)

Wait until you get coaght out - the answer from Medicare is: "Your transaction receipt may say approved, it does not mean we will pay the transaction".

Good luck and I hope it doesnt happen to you!

 

How about the fact that if you send a report and a GP is audited and loses your sent report the burden of proof falls on you as the Podiatrist?

We are getting to the point that we wont see EPC patients because of the way the system is set up.

 

Guys,
Did you know that a practice nurse often has as much sway as the GP in a multi GP practice. Try talking to her and see if you get all the right paperwork and rules followed that you need. She is the true EPC paperwork person to contact oftentimes.

 

Almost all billing issues are avoided if you don't bulk bill.

Then any problems are between the patient and Medicare...

We've yet to ever have a problem after all these years.

LL

 

Yep, I'm with LL on that one - no bulk bill means I'm paid for services provided.
It's a pity some pods caved in to bulk billing.....

 

Jos,

I don't think it's a matter of caving in to Bulk Billing, but working effectivelly within your geographical environment and amt of competition.

We can't ALL have the prime CITY spot like LL and Yourself or we'd put you out of business with all the competition.

 

I'm not so sure about the effects of geography or competition on the decision to bulk bill or not.

In my area there would be at least 4 practices within 2km of us, and maybe 20-30 within a 5km radius. There is almost an over saturation of competition, not including public alternatives or other types of providers.

However, since day one of working in our practice we have focused on what we need to bill to run a stable business, not what our patients would prefer us to charge. I am sure that has lost us some patients who are fixated on price, but it has allowed us to grow and operate an appropriately resourced and staffed practice for 15 years.

If you lose 20% of your patients (initially) because you charge 20% more than your competition, that seems like working smarter not harder to me.

When it comes to EPC patients the issues around refund eligibility were obvious from day one. It seemed to me that the easiest way to avoid the mess would be to charge even 10cents more than the rebate, avoid the trap of bulk billing, and shift any problems away from us so that we got paid at the time of service every time.

I think the city/country/competition argument is a straw man.

LL

 

Hear, hear!

I have 5 lever arch files stuffed FULL of EPC referrals, so obviously some people are happy to attend for treatment/.assessment at my clinic and pay a gap for a comprehensive service.

But, sure, some have moaned and groaned and gone elsewhere-GOOD, I say!!

 

LL,
When you add up 20% more patients and an occasional unpaid visit- it adds up to many dollars in the bank not out. My maths says you win every time.

Besides this, there are many genuine Medicare patients that you are helping out and that is not a bad thing for a Health Professional to foster.

Business wise we all must calculate our risk on the fees schedule we sign up for and go from there.

'Better to agree to disagree' in this argument I say.

 

Hi,
I do not live in Australia, but what we have in the UK, is a Petition Board on the Govt (Houses of Parliament Website. People raise a petition on the Govt website, and everyone within the UK, can add their name if they agre to it. At the end date of the petition, the Govt then responds openly to the petition. If a certain number of "signatures" are received, then the matter is discussd in Parliament.

So, if you guys have something similiar in the Australia, you may want to use it, to raise awareness of your predicament, and know what the response would be by the Australian Govt.

Hope you guys come right with your issue.,,,,,

 

Same as LL. No bulk billing and last I saw, you weren't allowed to do a co-payment. Our patients pay up front and they can either go to medicare with their receipt or we will do their claim for them on the HICAPS machine to savings/cheque account on EFTPOS. If it doesn't go through, between the pt and medicare.

As far as audits and reports, use Argus, an electronic submission of reports to GP's. No paperwork and you have a record of them receiving the information. Too easy as most of our reports are now in template and generally take under 5 minutes at the end of the consult to personalise, upload the doppler waveforms and attach it in argus and off it's sent to the GP. Professional and easy.

 

The other alternative for Medicare EPC payments is easyclaim.
You charge the customer your fee. Then after you have been paid you then make the Medicare claim for the patient while they are still in your office. Medicare rebates the fee into the patients bank account, most likely before they get home. You have been paid and if there is a problem it is between the patient and Medicare.

You don't have to settle for the bulk bill rate. Easyclaim will still work if there is a gap between your fee and the rebate amount.
You can get away from the free podiatry care image. As we all know anything that is free has no value.
I think that the change to easyclaim to allow for allied health came about when Medicare stopped paying cash from their shopfront offices.

Medicare offers Easyclaim training, call them.
We had a Medicare cold call visit to our clinic to motivate us into using easyclaim.