07 March 2023

RACGP: Compliance letters an unnecessary headache for hardworking GPs

The Royal Australian College of General Practitioners (RACGP) has written to the federal Minister for Health and Aged Care Mark Butler calling on him to withdraw compliance letters sent to almost 600 GPs nation-wide that incorrectly suggested they broke Medicare billing rules.

The open letter to Minister Butler states that:

·    compliance letters were sent to GPs who co-claimed a Medicare Benefits Schedule (MBS) item for practice nurse support (10997) with other items for chronic disease management (e.g., 721, 723, 732) on more than 300 occasions in a 12-month period (and where this constitutes at least half of their total claims for chronic disease management services)

·    the combination of item numbers are legitimately able to be billed together

·    GPs who have followed the relevant item descriptors are shocked and concerned to receive correspondence suggesting that they are breaking MBS rules. The wording of the compliance letter is problematic, with GPs unclear on whether they have done the wrong thing and have to repay funds.

RACGP President Dr Nicole Higgins said Minister Butler should intervene to wrestle control from the Department of Health and Aged Care and withdraw the clumsy and misdirected letter.

“This entire process reminds me a lot of Robodebt,” she said.

“There are circumstances where these item numbers can legitimately be claimed together and many GPs who have done so have done nothing wrong. There is also nothing in the relevant MBS item descriptors to say that they cannot be claimed on the same day.

“Instead of carefully investigating any unintentional misuse of Medicare items, the Department has taken a scatter-gun approach and written an appallingly vague letter to almost 600 GPs who just happen to have co-claimed these items at a higher rate than their peers. What the Department needs to understand is that GPs service diverse patient populations, and some work in areas with a higher burden of chronic disease than others.

“This campaign will have a ripple effect throughout the entire profession at a time when GPs are flat out and needed by their communities more than ever before. Instead of a clumsy bulk letter campaign that causes unnecessary distress, the Department should focus on educative processes to prevent incorrect claiming. The letter was written in such a way that GPs will think they have done something wrong. This leads to unneeded stress and many hours checking records and consulting with colleagues away from their core clinical duties looking after patients.”

The RACGP President said the entire debacle highlighted how difficult it was for GPs to adhere to the Department’s rules.

“GPs are tied down by red tape and an officious Department constantly looking over our shoulder,” she said.

“Our 2022 Health of the Nation report revealed that three-quarters of survey respondents said that ensuring compliance with Medicare takes time away from their core job of actually caring for patients. The toll is enormous, with 61% reporting that the complexity of Medicare is something that worries them outside of their work day. More than that, it actually impacts the type of care provided, with 47% of GPs indicating that they either avoided providing certain services or avoided claiming patient rebates despite providing services out of fear of Medicare compliance ramifications.

“To give you an idea of the complexity involved in this particular case, the letter states that practice nurse item 10997 can be claimed if the patient has an existing GP Management Plan, Team Care Arrangement or Multidisciplinary Care Plan in place. However, the AskMBS Advisory on GP services states that this item would not be expected to be routinely claimed on the same day as items 721 or 723, which concern chronic disease management. So, this indicates there are circumstances when items 721 or 723 and 10997 can be co-claimed but it could also be interpreted to mean that you can only bill both items for a patient on the same day if they visit the practice for two separate attendances.

“In addition, the letter contradicts itself by stating that item 10997 should not be claimed for assistance provided to a GP to prepare or review a GPMP or TCA but claiming these items on the same day is not restricted. While co-claiming is not restricted, the letter does not explain under what circumstances it would be appropriate to do so. So, basically GPs are left flying blind, the whole thing leaves you cross-eyed.

“We have enough on our plate and don’t need another headache. Let us get on with our job and find alternative work for those employed in misdirected bureaucracy.”

Dr Higgins said the compliance campaign came at the worst possible time.

“These letters have been sent to GPs at a time when there is a strong focus on Medicare reform and coordinated, multidisciplinary care,” she said.

“This campaign will cause GPs to avoid providing coordinated, chronic disease care through the Medicare Benefits Schedule. It will also lead to many of them second-guessing themselves and add to the mental strain many GPs are experiencing, which makes the task of attracting and retaining GPs that much harder.

“I am fully aware that it is not customary for the Department to rescind letters; however, desperate times call for desperate measures and I call on the Minister to intervene immediately. I hope that the Department learns from this experience and ceases mindless compliance campaigns like this one. A GP’s time is better spent taking care of their patients – surely the Department has something better to do.”

The RACGP calls on the Department to:

·    remove the requirement for GPs to retrospectively review their claiming due to the ambiguity that currently exists around billing rules

·    issue straightforward guidance (e.g., fact sheets) on which chronic disease management items can be co-claimed with practice nurse item 10997. Vague language (e.g., ‘may be’, ‘sometimes’, ‘not restricted’) in explanatory materials should be avoided

·    provide case scenarios of when it would be appropriate to co-claim these items and only undertake compliance action if, after a reasonable period following the development of educational materials, concerns around claiming persist

·    make it clear in future targeted compliance letters that this activity is voluntary and an opportunity for providers to self-reflect on their billing. Using language such as “you must repay” is unhelpful and leads to fear and anxiety

·    investigate options for automatically rejecting incorrect claims when they are submitted, rather than allowing these to be processed and leading GPs to believe they have billed correctly.

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John Ronan

Senior Media Advisor