If your private practice has been struggling to adapt to the new normal after COVID-19, you’re not alone and it seems like every day there are new regulations and a new standard that needs to be met. Every governmental department has differing regulations and requirements, and even private health insurance providers vary widely in how they reimburse Telehealth appointments.
But while you’re trying to see clients and work with new technologies, it’s important that you don’t fall behind on the financial side of your business. With this in mind, we’ve created a reference guide to help make billing and receiving reimbursement for Telehealth services easier.
1. Medicare & Telehealth Reimbursements
Medicare’s response to COVID-19 has been to introduce Telehealth items that mirror existing in-person items. These item numbers are available until the end of September 2020, but they are subject to review so you need to keep checking for updates. A full updated view of COVID-19 Telehealth MBS items is available here.
Medicare COVID-19 Telehealth Items
| Service | Item Number | Rebate | Existing Items | Expiry |
|---|---|---|---|---|
| Telehealth attendance by an eligible allied health practitioner for chronic disease management | 93000 | $53.80 | 10950, 10951, 10952, 10953, 10954, 10956, 10958, 10960, 10962, 10964, 10966, 10968, 10970 | 30 September, 2020 |
| Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by telehealth attendance to a child aged under 13 years | 93033 | $75.95 | 82005, 82010, 82030 | 30 September, 2020 |
| Speech pathology, occupational therapy, audiology, optometry, orthoptic or physiotherapy health service provided by telehealth attendance to a child aged under 15 years for treatment of a pervasive developmental disorder (PDD) or eligible disability | 93036 | $75.95 | 82020, 82025, 82035 | 30 September, 2020 |
| Chronic disease management services c for people Aboriginal or Torres Strait Islander descent | 93048 | $53.80 | 81300, 81305, 81310, 81315, 81320, 81325, 81330, 81335, 81340, 81345, 81350, 81355, 81360 | 30 September, 2020 |
2. Department of Veteran Affairs & Telehealth Reimbursement
The Department of Veteran Affairs (DVA) has introduced Telehealth item numbers that are valid until the end of September 2020. For an up-to-date list, please refer to the DVA’s website.
DVA COVID-19 Telehealth Item Numbers
| Service | Code | Fee | Expiry |
|---|---|---|---|
| Initial Consultation | PH10 | $65.30 | 30 September, 2020 |
| Standard Consultation | PH20 | $65.30 | 30 September, 2020 |
| Extended Consultation | PH30 | $69.20 | 30 September, 2020 |
| Subsequent Consultation – Extended Presentations | DT30 | $68.35 | 30 September, 2020 |
3. National Disability Insurance Scheme (NDIS) & Telehealth Reimbursement
Prior to COVID-19, the NDIS had already taken steps to make funding available for occupational therapy services delivered through Telehealth. This means that providers would submit payment requests as they would usually do if they were offering face-to-face services. They have increased the price limits for a limited number of Core Supports and Capacity Building Supports by 10% to cover the cost of technical upgrades. All the details are available on the NDIS website.
IMPORTANT UPDATE: 1 July, 2020
The first stages of post-coronavirus NDIS have been announced that include the conclusion of some of the temporary measures that were made available while the pandemic was at its peak.
As of 1 July, 2020 the NDIS has:
- Removed the temporary 10% price loading;
- Reduced the cancellation period to previous levels, and
- Returned the Medium Term Accommodation period to 90 days (rolled back from 180 days).
All the details are here.
4. My Aged Care & Telehealth Reimbursement
The Commonwealth Home Support Programme (CHSP) and Home Care Packages Programme (HCP) are funding allied health services through Telehealth, and have been since before COVID-19. They allow for the reimbursement of Telehealth services as is available for in-person services. The full details can be seen in the CHSP Programme Manual, or in the HCP Guide.
5. Private Health Insurance & Telehealth Reimbursement
Coverage of Telehealth for allied health professionals varies widely between health insurers, so it’s important to speak to the specific insurance provider to confirm what Telehealth reimbursements they have available.
Private Health Insurance Telehealth Items
| Insurer | Service | Code | Expiry | Reference |
|---|---|---|---|---|
| Bupa | Individual Initial/Referred Assessment by teleconsultation | 811 | 30 September, 2020 | HICAPS Allied Health Item Numbers |
| Bupa | Individual Subsequent Treatment by teleconsultation | 812 | 30 September, 2020 | HICAPS Allied Health Item Numbers |
| HBF | Individual Initial Assessment Telehealth. At least 30 minutes via video | T811 | 30 December, 2020 | HBF Telehealth Information for Providers |
| HBF | Individual Subsequent Treatment Telehealth. At least 45 minutes via video | T812 | 30 December, 2020 | HBF Telehealth Information for Providers |
| HCF | HCF requires providers to complete and sign a Telehealth Extras Claim Form for members to claim | – | 30 September, 2020 | HCF Telehealth Extras |
| Medibank | Individual Initial/Referred Assessment by teleconsultation | 811 | 30 September, 2020 | Medibank for Providers |
| Medibank | Individual Subsequent Treatment by teleconsultation | 812 | 30 September, 2020 | Medibank for Providers |
| nib | As per face-to-face appointments | – | 30 September, 2020 | nib Telehealth and your cover |
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With nearly 70% of Australia’s healthcare funding provided by the government, it’s helpful to know that Medicare is on-board with the shift to Telehealth solutions for allied health practitioners. It’s also essential in this unprecedented time of social distancing. Reimbursements for Telehealth appointments are making it easier for providers to offer necessary services for their clients, and for patients to access the care they need. We hope this resource will make the transition smoother for private practices as we all move towards a ‘new normal’.
If you know of a private practice that is struggling to navigate Telehealth claims, please pass on this article for their reference.
