Five Easy Steps to safeguard medical practice from MBS non-compliance debt recovery

Five Easy Steps to safeguard medical practice from MBS non-compliance debt recovery   The Health Legislation Amendment (Improved Medicare Compliance and other measure) Bill 2008 came into effect July 1 2018 and provides Medicare with an avenue to pursue debts raised against practitioners for non-compliance of MBS item numbers billed. Outstanding debt to Medicare was over $50 million when the recovery changes came into effect.


Legislation Changes There are essentially five changes that will effect medical practitioners and practice owners. The key changes are, Record Keeping, notice to Produce, Debt Recovery, Administrative Penalties and the Shared Debt Recovery Scheme.


Record Keeping MBS item numbers are frequently charged that require documentation to be created, such as mental health plans, health assessments, GP management plans, Team Care Arrangements and reviews (Items 2700, 2712, 2713, 2701, 2715, 2717, 701,703,705,707,715, 721, 723,732 for VR doctors). Under the new legislation these documents must now be kept for 2 years.


Notice to Produce Medical Practitioners may be asked to substantiate MBS billings with the evidence of the documents created for the above item numbers. The new legislation provides Medicare the right to request these documents to ensure compliance.


Debt Recovery Recovery of debts raised for incorrect claiming has been an ongoing issue and the new legislative changes provide varies means for Medicare to now recover debt. These include cooperative agreements between Medicare and a Practitioner to repay the debt, deduction from money payable to the provider (MBS item numbers and incentives), powers to obtain garnishee orders.


Administrative Penalties Medicare may apply an administration penalty of up to 20% of the debt raised for non-compliant billing. This applies to debt over $2500 where practitioners have failed to provide substantiating documents within the required timeframe. These fees can be avoided or reduced by utilising the voluntary acknowledgement of debt or notifying the department that an incorrect amount has been paid prior to the specified notice to produce document ends.


Share Debt Recovery Scheme Shared Debt recovery scheme should raise alarm bells with practices owners who have employee and contractor doctors. The department has stated that these organisations will now be proportionally responsible for debts raised as a result of claiming incorrect Medicare item numbers. In cases were practices have employees such as registrars the practice will be 100% for the debt repayment, potentially crippling small businesses.


Protecting the Practice Management should be taking this opportunity to review employment contracts, policies and procedural manuals and the role of the Practice Manger in addressing possible non-compliance. Practice nurse education is key to successful compliances and documentation for care plans, health assessments and team care arrangements. Five easy steps to safeguard your practice would include

  1. MBS Education for health practitioners, practice managers and Nurses
  2. Template reviews and modifications as required for health assessments, care plans and TCAs
  3. Consideration for voluntary acknowledgement of debt for non-compliant services prior to the July 1 2019 implementation of the shared debt recovery program
  4. Review of employment contracts and service agreements to include the practitioner’s agreement for MBS education, compliance and practice audit
  5. Ongoing random audits of MBS item numbers to be certain compliance has not only been achieved but maintained.

Medical practice business is a highly competitive area that leaves little opportunity for practice owners to be complaint in any areas, but with the potential serious and significant impact of non-compliance debts it is imperative that practices act sooner rather than later to implement safe guards to ensure the long term viability of their business.

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