Medicare Audit Support

Introduction

Undergoing a Medicare audit is daunting even when a Medical Practitioners is not aware of any guidelines they have breached. There has been limited medical education on the legalities of legal billing and controversy around the interpretation of the Medicare Benefits Schedule.

Business for Doctors was the first established business to offer ethical and legal MBS teachings and provide doctors with a framework of best clinical and medical practice within this framework.

With better understanding of the MBS, Business for Doctors Education may result in Doctors been flagged for a Medicare Audit. As part of the medical education we provide details on the audit process and the possible outcomes.

Aim: 

  • To provide peer to peer support while colleagues undergo medical support 
  • To educate (re-educate) in ethical and legal MBS billings 
  • Identify weaknesses and strengths in clinical documentation 
  • In conjunction with the Doctors Medical Defence Organisation.
     

Education:

MBS education is available in most capital cities and regional areas throughout the year, as well as at the annual Business for Doctors conference. In addition, many workshops in business compliment the MBS teachings- marketing and advertising meeting the ACCC, TGA and APHRA legislative requirements. 

Doctors are provided updates via social media discussion that occur on a quarterly basis. Any legislative changes are also topics raised for discussion. 

Information is provided free of charge to medical practitioners in the Business for Doctors social media page from the ASKMBS team with hundreds of emails collated into an easy to read format. There are accessible online and we encourage practitioners to print and provide them for practice managers and staff to support their change in billing processes. 

Audit Support Team: 

Business for Doctors has engaged a team of health professionals who are active in the MBS and clinical practice who can provide support and education to BFD members. 

Core Medicare Education – workshops 

Dr April Armstrong 

Dr Lily Vrtik 

Dr George Forgan-Smith 

Dr Nick Tellis 

Mr Nico Materac

Practice Managers and Clinical Nurses 

Ms April  Ratajczak (RN)

Mrs Lisa Klingner – to practice manager

Medicare Audit support – Legal 

Dr Melanie Tan

Ms Sarah Bartholmeucz

Medicare Audit support Medical 

Team Leader 

Dr April Armstrong (GPO) 

General Practice 

Dr Ralph Chapman 

Additional Peers

Dr Dianne Milnes  – Paediatrics

Dr Imogen Patterson – Urology

Dr Yun Hung  – Neurology

Dr Alan TSE – anaesthetics

Xavier Yu – Radiologist

The Audit Support Process: 

Business for Doctors audit support offers Doctors the opportunity to engage with the services in addition to those available via the MDO. We ask all doctors to contact their MDO initially. 

Process:

Step 1

In order to be certain we have confidential requests for assistance please use the online request for assistance form. This will include you speciality and preferred audit support person who will be allocated depending on availability. 

Step 2

Your audit support person will email you and arrange a telephone contact to discuss the case. 

Step 3

Supporting documentation 

We ask you to provide written documentation from Medicare or a written detailed document on any telephone conversations in regards to the audit if you have not yet received any written notification 

Step 4

a) Self-Audit – we provide you with the information you require for a self-audit and ask you to document findings of this audit 

b) BFD audit review – we can provide an audit of records with the assistance of the practice manager and provide you a report outlining concerns (should there be any) 

Step 5

a) Self-audit details are provided to BFD and we will provide you with a recommendation which you should discuss with your MDO 

b) The audit report provided should be discussed with your MDO 

Step 6 – Interview 

a) We will provide a support person by telephone to document the conversation and provide a written report back to the clinician 

b) You will provide us with a script or recording of the interview and we will provide you with written interpretation of the interview. 

Step 7:  – Outcomes 

a) you will advise us the outcome of the Medicare audit 

Step 8  – Education 

a) We will provide online learning material and access to an MBS workshop and one on-site visit to a practice of your choice in the 12 months following the audit. (Duration of visit 2 hours) 

Fees: 

Initial fee $4000

Inclusions: 10 hours of audit support @$200 per hour 

Online learning material –  $500

MBS workshop –  $500

Site Visit 2 hours –  $1000

Additional Fees 

1. Legal Team $400 per hour 

2. Medical Support team $250 per hour 

3. Non-clinical support $150 per hour

Medicare Audit – Support Request:

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