Medicare/MBS
Preventive health care and the Medicare Benefits Schedule
What is preventive healthcare?
Preventive healthcare aims to prevent illness and assist in the early detection of specific diseases whilst encouraging the promotion and maintenance of good health. Preventive healthcare is essential to the future of Australia’s health and general practice has a pivotal role to play in ensuring better health outcomes for all patients.
Claiming Medicare items for preventive healthcare
On 1 May 2010, changes to Medicare Primary Care Items of the Medicare Benefits Schedule (MBS) were introduced. To ensure that GPs are better supported in delivering preventive healthcare activities, revisions were made to the general attendance items descriptors for Level B, C, and D consultations.
The items descriptors now include ‘Providing appropriate preventive healthcare’, which allows GPs to deliver preventive based clinical activities. Attendance items can be billed to Medicare providing they are for clinically relevant services and in accordance with MBS requirements. Therefore, if the services provided are in accordance with the MBS item descriptor, then the appropriate attendance can be claimed.
Full Medicare item descriptors can be found at www.mbsonline.gov.au.
Case study
Joe presents to his GP who he last visited a year ago with a lacerated hand. That visit was entirely focused on cleaning and suturing the wound. Joe is 52 years old and separated from his wife 2 years ago. They have two adult children. He has maintained regular work as a plumber. His new partner Julie has a 5 year old child and has urged him to get a check up.
Joe says he feels well and is happy in his new relationship. His GP is pleased to have the opportunity to perform a medical assessment and advise on preventative health approaches.
After taking a screening history, including asking about issues with sexual functioning, the GP enquires about smoking, nutrition, alcohol and physical exercise.1 The GP conducts a general physical exam2 including height, weight, BMI, waist circumference, BP and urinalysis. Because of the outdoor work performed by Joe, skin cancer risks are discussed and a full skin check is offered. Screening for bowel and prostate cancer3 are also discussed and Joe opts to have a prostate examination. A lipid profile and fasting BGL is arranged.
This consultation takes 30 minutes and is billed as an Item 36, as preventative healthcare is now included in the descriptors for consultation items in the MBS.
1. The SNAP guidelines developed by the RACGP are designed to address lifestyle health issues that can be raised in the context of a preventive health consultation or in connection with chronic disease management. They can be accessed at www.racgp.org.au/guidelines/snap.
2. There is strong evidence to support annual screening for obesity, hypertension and kidney disease. Bowel cancer screening by FOBT is recommended every 2 years from age 50. Fasting blood glucose should be screened every 3 years from age 40 and more often in higher risk groups. Lipids should be screened every 5 years from age 45 and more often in higher risk groups. A full list of evidence based preventative health checks is included in the RACGP ‘red book’, which can be accessed at www.racgp.org.au/redbook/index.
3. Prostate screening requires a patient centred approach and discussion of the potential benefits and harms.
Related files
Preventive health care and the Medicare Benefits Schedule (557KB)
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