MBS Telehealth Patient Eligibility Requirements

MBS Telehealth Patient Eligibility Requirements

11 March, 2021

The Australian Department of Health’s Benefits Integrity and Digital Health Division has been monitoring the claiming of COVID-19 telehealth items, and the Division has noted that instances of non-compliance are increasing in frequency over time, especially failures to meet the requirement for the provider to be the patient’s usual medical practitioner.

To be defined as the patient’s usual medical practitioner, the medical practitioner or other health practitioner located at the practice must meet the “existing relationship” requirement as set out on the Department’s website (available here).

Since the Department has identified what appears to be a significant degree of non-compliance, it intends to introduce a “tiered compliance treatment strategy” that will commence in March and April with letters to practitioners to raise awareness and may “widen its compliance approach” and enact “escalated compliance interventions” depending on the outcome of its activities and the continued monitoring of claims. This may include audits of providers which require documents to be provided substantiating appropriate claiming of services.

Practice Managers are encouraged to review the factsheets including the COVID-19 Telehealth Items Guide available here and re-assess their processes to confirm ongoing compliance in their practices.