• Increases the number of audits undertaken by Medicare Australia.
• Expands the audit program to include allied health providers and to allow better coverage of specialists.
• Requires providers to produce evidence to verify their Medicare claiming when audited. 
• Introduces a financial penalty for Medicare providers whose incorrect claims are above a certain amount.

In response to this announcement Medicare Australia are in the process of conducting random Audits within local General Practices to check the correlation between the Practice Nurse Items claimed and the consult items claimed. Medicare will examine patient records to confirm that when a consult/GP item and PN item are claimed together there is proof, within the patient record that both the GP and PN in fact have seen the patient. Proof is provided when both the PN and the GP have made a notation within the patient records and that the notation provides sufficient information as to meet the Consult item requirement for example Consult A, B, C or D.

The following provides a brief description as to what is required in each consult

• Consult A- Item 3 - $15.35 Medicare rebate

Professional attendance for an obvious problem characterised by the straight forward nature of the task that requires a short patient history and a limited examination and management.

•   Consult B - Item 23 - $33.55 Medicare rebate

Professional attendance, involving taking a selective history and examination of the patient with implementation of a management plan in relation to one or more problems

• Consult C - Item 36 - $63.75 Medicare rebate

Professional attendance, involving taking a detailed history, examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more problems and lasting at least 20 minutes.

• Consult D - Item 44 - $93.80 Medicare rebate

Professional attendance involving taking an exhaustive history, comprehensive examination of multiple systems arranging any necessary investigations and implementation of a management plan in relation to one or more complex, lasting at least 40 minutes.

The GP and the PN can, of course both see the patient. When this occurs, as long as all requirements for both the Consult Items and the PN item are met, then it is appropriate to claim both item numbers together.

Practice Nurses may undertake patient care without the GP seeing the patient.

•  RNs who have completed The College of Nursing Immunisation for registered Nurses accreditation Course - item 10993
• RNs who have completed Family Planning NSW Sexual and Reproductive Health (Nursing) Diploma or Well Women's Screening Course - Item 10994 and 10995 (and 10998 and 10999).

If you would like further information about this program please contact the Practice Support Team at 4220 7600.