The following is an overview of some of the upcoming MBS, Practice Incentive Payment (PIP) and PBS changes. For more detailed information refer to:

• GPpartners summary of changes
•  Information about MBS items changing on 1 May 2010, Department of Health & Ageing 
• Medicare Benefits Schedule or ph 132 150
• Medicare Australia PIP information or PIP Enquiry Line ph 1800 222 032
• Medicare Australia GPII information or GPII enquiry line ph 1800 246 101

MBS items - as of 1 May 2010

Attendance items & descriptors

Fee increases for general attendance items for groups A1 (GP attendance items), A7 (GP Acupuncture attendance items), and A18 (Practice Incentive Payments) and for group A22 non-urgent after hours services. Item descriptors for Level B, C and D consultations revised to clarify that ‘a health professional may address one or more health related issues in a single consultation and to give support to health professionals providing preventive health care.‘

Health Checks and Health Assessments

Ten health assessment/check items are reduced to 4 time-based items. Fees are based on the total time taken. Total time now includes the time taken by the doctor and practice nurse to undertake a health assessment.

701 – Brief health assessment (30 mins) - $55
703 – Standard health assessment (30-45 mins) - $127.80
705 – Long health assessment (45-60 mins) - $176.30
707 – Prolonged health assessment (<60 mins) - $249.10
715 – Aboriginal & Islander health assessments (see below)

Replaces: 45 Year Old Health Check, Type 2 diabetes risk evaluation, Older persons health assessment, Comprehensive Medical Assessment, Health assessment for a person with an intellectual disability, Healthy Kids Check, Health assessment for a person under the humanitarian program.

Aboriginal & Torres Strait Islander Health Assessments

The 4 adult and child Aboriginal & Islander Health Assessments will become 1 with a new item number – 715. Specifications about length of time the assessment should take, complexity and where the assessment is done have been removed. The total time now includes the time taken by the doctor and practice nurse to undertake a health assessment.

Services provided for an assessment by a practice nurse or registered Aboriginal health worker on behalf of a medical practitioner has a new item number – 10986.

Chronic disease management

Items 725 and 727 — review of a GP Management Plan or of a Team Care Arrangements/Multidisciplinary Plan will cease and are replaced by one new item – 732 – to review either. Item 732 can be claimed twice on the same day, providing reviews are conducted as per MBS descriptors/explanatory notes. 

Mulidisciplinary Case Conference items have been reduced from 18 to 6. The new items are time-based and aligned to whether the GP is coordinating or participating in the case conference.

General Practice Immunisation Incentive (GPII) - as of 1 August 2010

Unaccredited practices will miss out on GPII payments unless compliant with new requirements. ‘In order to meet the entry requirements, practices must:

• have current public liability insurance
• make sure that all GPs working from the practice have current professional indemnity cover
• have appropriate processes in place that maintain the potency of vaccines.‘

Requirements apply to practices already participating and new practices applying. Practices already approved for the Practice Incentives Program will be automatically considered to meet the new requirements.

Practices participating in GPII but not PIP must confirm they meet the new entry requirements by 30 April 2010, in order to be eligible for August 2010 outcomes payment.

PIP - as of 1 May 2010

New Indigenous Health Incentive

Practices accredited or registered for accreditation can apply. Includes:

• One-off sign on payment – $1,000 for practices that agree to undertake specified activities.
  These include seeking consent from Indigenous patients with chronic disease (or at risk) to register them with Medicare Australia; establishing patient follow up processes (e.g. recall/reminders); undertaking cultural awareness training (within 12 months); annotating PBS scripts for the new Indigenous PBS co-payment measure (see page 11).
  Patient registration payment – $250 per patient 15+ years registered with the practice for chronic disease management in a calendar year.
  
  
• Outcomes payments – two-tiered payments tied to specific targets.
  Tier 1 - $100 for each registered patient for whom a target level of care is provided in a calendar year. This entails undertaking GP Management Plans/review, Team Care Arrangements/review.
  Tier 2 - $150 per registered patient for whom the majority of care is provided by the practice in a calendar year. (Min any five MBS services; can include those provided in Tier 1).
  

Annual PIP Confirmation Statements

Medicare Australia will provide statements to all Practice Incentive Program (PIP) practices outlining eligibility for the PIP and each incentive registered for. The practice’s authorised contact person is required to check, complete and sign the Confirmation Statement and return it to Medicare Australia. If any information on the statement is incorrect, the authorised contact person must contact Medicare Australia as soon as possible.

To ensure Medicare Australia does not withhold quarterly payments, any change of details must be made to Medicare Australia by 31 July 2010.

GP Aged Care Access Incentive (GP ACAI)

Item 712 (Comprehensive Medical Assessment of a permanent resident of an aged care facility) will cease as part of the MBS Schedule review (see page 11), therefore this item will no longer be able to be used for GP ACAI purposes. Existing items applicable to residential aged care will be used instead for Qualifying Service Levels for the GP ACAI. The new time-based health assessment items cannot be used.