ASMOF Position on Medicare Billings in Outpatient Clinics (OPC)
ASMOF has identified a number of issues with billing practices following the implementation of the Ministry of Health’s new guideline published on 20 April 2021 pursuant to the revised National Health Reform Agreement.
We have begun a dispute in the Industrial Relations Commission to address these concerns, and have so far secured a commitment for further consultation and a new draft proposal for costs recovery from the Ministry.
ASMOF agrees that the rules must be followed and we support the Commonwealth rule that the Outpatient Financial Election Consent Form is a mandatory requirement in order to bill for eligible OPC services to Medicare.
We do not agree that:
- Our members (inclusive of staff specialists RoPP level 1 through to level 5, as well as clinical academics) should be tasked with obtaining the patient’s consent. The terms of the rights of private practice (RoPP) arrangement as set out under clause 2 of the Staff Specialists Determination, clause 24 of the Staff Specialists (State) Award, and subsection 5.5 of the NSW Health Policy (PD_2019_005) relating to the RoPP arrangements for clinician academics, state that the employer is to provide the clinicians with the administrative support staff to assist our members with such tasks, and to help the NSW public health system to comply with the Medicare rules and the Guideline.
Our members should be bearing the full responsibility (legal, financial, and reputational) for incorrect billings that are made by the hospital (public health organisations) acting as agent of the clinicians. Pursuant to subclause 2(a)(ix) of the Determination, the term states that:
(ix) All accounts for services rendered to patients by a Staff Specialist exercising rights of private practice, irrespective of the private practice level elected, are to be issued by the Public Health Organisation acting as the agent for the Staff Specialist.
ASMOF is seeking written assurances from the relevant Public Health Organisations and the Ministry that the employer provides a written undertaking to assure all staff specialists & clinical academics (regardless of their elected RoPP level) that any errors which may have been made by the employer, acting as the agent under the terms the Determination, will be repaid to Medicare by the employer from the funds that were generated as result of the Medicare billings.
ASMOF understands that whilst a few Districts have given such an assurance to members, many have not, and that some may have declined.
ASMOF v SWSLHD and the Ministry
ASMOF recently filed an industrial disputation in the Industrial Relations Commission of NSW (IRC) against SWSLHD as well as the Secretary, Ministry of Health, to pursue the above issues for our members, and since the first hearing of the matter (listed 1 November 2021), ASMOF has made some progress with both the District and the Ministry:
The District has agreed to consult with ASMOF and the first consultation occurred on 18 November 2021; ASMOF sent a separate email to our members working at this District in this regard. ASMOF has also written to the Chief Executive setting our collective concerns and re-affirming our position to the District.
The Ministry is developing a draft proposal (model) for costs recovery and will provide the draft for ASMOF’s review and consultation. It is envisaged that the draft will be provided to ASMOF before the matter is back before the IRC.
A Report Back on this matter before the IRC is listed for tomorrow- 26 November.
We will provide further updates to members on this issue in due course. In the meantime, if you have concerns, or if you know of any colleagues who have concerns about the RoPP billings, please don’t hesitate to contact us by sending an email to [email protected].