DoH sending MBS compliance letters

11 Feb 2021

Since November 2020, about 800 doctors will have received targeted compliance letters from the Department of Health about potentially inappropriate Medicare claims.

The specialties include reproductive health specialists, surgeons, General Practitioners and Other Medical Practitioners, Cardiac and Diagnostic Imaging specialists and radiation oncologists.

The bulk of the potentially inappropriate claims relate to after-hours attendances or co-claiming of attendance items with another medical service (contrary to the MBS complete medical service rule).

The AMA continues to meet with the Department on a regular basis to ensure compliance activities are appropriately targeted and to minimise the unnecessary emotional toil and time strain put on busy clinicians, particularly during these unprecedented times.

Targeted letter campaigns are undertaken to alert providers whose claiming patterns indicate they may be at risk of non-compliance.

These letters generally compare the individual provider’s claiming to that of their peers and attach a schedule of claims for review.

Reviewing the schedule and responding to the letter is voluntary. However, it is in the provider’s interest to do so.

In monitoring future claiming and deciding whether an audit or other intervention may be required, the Department will take into account information received from the provider about why they consider their claiming is correct, any corrections to claims and/or any changes in claiming patterns following the letter.

The Department has previously advised that where a lengthy schedule is attached, providers may choose to review a sample of the claims before deciding whether a line-by-line review is needed.

The AMA reminds members to ensure they review all MBS item descriptors and claiming rules in the explanatory notes to ensure they meet the MBS claiming requirements and avoid compliance issues.

More information is available on the Australian Government Services Australia website on MBS education for health professionals.