What is bulk billed physiotherapy? Am i eligible?
- May 12, 2017 at 5:53pm
- Ben Strachan
Bulk Billed Physiotherapy
Many home visit physiotherapists at Owner Health, including the founder Ben Strachan bulk bill home visit physiotherapy consultations. To find a list of all the practitioners please call us. We bulk bill Medicare, Home Care Packages, and Workcover. In this article we discuss Medicare bulk billing.
Given the rising healthcare costs in Australia, easily one of the most common questions in clinics these days from patients is:“Do you bulk bill physiotherapy?” People are searching for quality government-funded physiotherapy, and given that they can attend a doctor without having to pay after the consultation, they hope things work similarly with physiotherapy. Although this article is written mainly for physiotherapy, the information presented is similar for other allied health professionals including: podiatrists, dieticians, chiropractors, and osteopaths.
What is Bulk Billing?
Bulk billing refers to sending a healthcare invoice to Medicare, the Australian government department responsible for public health administration. Healthcare consultation costs are paid by the government. Up until a few years ago, at the end of each month, doctors would send all the patient payment invoices together in one transaction, i.e. in bulk, to Medicare. This accounts for the expression “bulk billed”.
Can Physiotherapists Bulk Bill?
Unfortunately, physiotherapists and doctors do not have the same Medicare entitlements. If you visit a physiotherapist, they don’t have approval to send invoices to Medicare. Without approval, physiotherapists don't get paid. However, there is one exception. If a patient has attended their general practitioner, and they’ve been given a special type of referral called an Enhanced Primary Care (EPC) referral or Team Care Arrangement (TCA) that gives permission to bill (more below).
What is an EPC or TCA?
The Government of Australia, within its Medicare department, has a scheme called the Enhanced. Primary Care (EPC), sometimes called Team Care Arrangement (TCA). This plan provides eligible people with up to five (5) consultations annually. Your GP determines EPC eligibility.
Am I eligible for an EPC?
The EPC criteria are available on the Medicare website:
In short, the EPC is eligible for people with chronic injuries or illnesses. The condition must be present, or likely to be present, for more than six (6) months. The injury prognosis should be that treatment has a high probability of being beneficial to the patient.
Typical injuries that provide physiotherapy eligibility include:
• Disc prolapse.
• Post-surgery treatments.
• Complex trauma.
The exact criteria for eligibility are very strict and your doctor can get into big trouble for inappropriate referrals.
Bulk billed physiotherapy
What is the Difference between Chronic and Acute Injuries?
The EPC is available for people with a chronic injury, but not an acute injury. A full discussion of the exact difference between acute and chronic injuries is worth a full blog post of its own. For now, we provide a quick summary for this EPC plan only. The typical definition of acute and chronic injuries varies in medical literature, and differences can be vague. Most practitioners are in agreement on the following timeline: Acute: 0-2 weeks; Sub-acute: 2-6 weeks; Chronic: 6 weeks+. On the other hand, in the case of EPC referrals, the government uses six (6) months as the chronic injury benchmark. This is a wide discrepancy, especially since an extended period of time for symptoms does come into play to exclude eligibility for referral. Why is the Government of Australia so strict? Well from its point of view, it saves a lot of money and helps ensure that all programs remain affordable.
How Do I prove that My Injury is Chronic?
As mentioned earlier, doctors can get in trouble for inappropriate referrals. If they send too many, Medicare will undoubtedly send letters asking for further explanations. They often require proof that your injury is chronic for their records so that they have evidence in case of issues down the road.Typically a doctor will look to use X-ray or other medical imaging procedures, as well as previous medical notes as evidence. For example, if you have an X-ray that shows osteoarthritis, it's pretty hard to argue that your injury is not chronic. Similarly, if you have previously attended the doctor for the same symptoms more than 6 months ago, it's hard to argue against the injury being non-chronic, as it has been there for so long.
What is the Paperwork Required after Proving Eligibility?
Your doctor (GP) will be required to complete paperwork to be sent to Medicare. Often, the paperwork is completed by the practice nurse, who will ask you a series of questions and your treatment goals. This will be documented in your GP healthcare plan. The doctor will provide you with a lot of printed documents, most of which is not required by the physiotherapist. However, two (2) pages are very important:
• The EPC/TCA summary page.
• The EPC/TCA acceptance plan.
The summary page outlines the main details of the plan (i.e. date created, doctor's provider number, number of sessions approved, etc.). The acceptance plan must be signed by your physiotherapist and sent back to the GP. In past years, there have been occasions of fraud, i.e. doctors who created plans without real physiotherapists being associated with them. Medicare made the signed acceptance mandatory to better ensure that the plan has provided real benefits for the patient.
Do all Physiotherapists Bulk Bill?
Unfortunately, Medicare does not pay out much money via bulk billing (currently $52.95 per consultation at Owner Health versus $90 for normal physio fees), so many practitioners refuse. Owner Health does nevertheless offer bulk-billed physiotherapy.
Instead, some clinics ask you to make a gap payment which ranges from $10-$50.
Owner Health's philosophy includes the belief that people unfortunate enough to have a complex injury deserve this privilege, regardless of the often prohibitive costs of running a clinic. Therefore, if you need a bulk-billed appointment don't hesitate to book with us.
How long does Bulk-billed Eligibility Last?
Often a point of confusion for patients, appointments are valid for a calendar year, i.e. until December 31st. After that date, you must talk to a doctor who will have to create a new summary for you. With the updated summary, you're often eligible for up to five (5) more visits after December 31st. Confusion also arises because of timeline differences between doctors and physiotherapists within the same program. As mentioned before, the physiotherapy timeline is the calendar year. As a result, doctors cannot re-bill Medicare for a new item number until 12 months (365 days) later.
How do Physiotherapists Process Claims?
Owner Health clinics process the bulk-billed payment within the HICAPS terminal. You will need the summary documents from patients to make each individual claim, which you start by swiping the Medicare card then entering the following information:
• Patient id (Medicare card).
• GP provider number.
• Date created.
• Item number (e.g. 10960).
Even if you don't bulk bill, you can still use the terminal. The only difference is that you take the entire amount off the patient's eftpos (electronic funds transfer) card, then swipe the Medicare card. Medicare will then pay you the fee (e.g. $52.95) later.
Bulk billed physio
What is the Future of the Bulk-billing Plan?
In general, healthcare is expensive for the government and the EPC plan does cost a lot of money. Rumours keep floating around about its termination, not unlike the stoppage of a similar scheme in dentistry. Keep in mind though that the average dentist would receive $2500 per claim, not five payments of $52 for five bulk-billed physio visits.
What are Some Current Problems with the Plan?
Unfortunately, there are some nagging issues with the bulk-billing system, most of which are centred on doctors who do not enjoy time-consuming and repetitious paper work (EPC plans, etc.).
Physiotherapists, like other allied health professionals, got into medicine to help people, not type at a computer terminal. Sure, the $260-$300 paid out per claim by Medicare is good compensation. However, most doctors have waiting rooms filled with clients, don't want to spend heaps of time on paper work, and would rather help other patients. On top of that, rumours of fraud (e.g. incorrect referral of some patients) in the system persist to this day. This places added pressure on physiotherapists who occasionally have to deal with marginal cases, e.g. mild ankle sprains, and decide whether they should be eligible for bulk-billing.
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