Murrumbigee Medicare Local Desktop Guide to MBS Item numbers and care coordination services

Transcription

1 Murrumbigee Medicare Local Desktop Guide to MBS Item numbers and care coordination services Medicare Locals gratefully acknowledge the financial and other support from the Australian Government Department of Health. Murrumbidgee Medicare Local acknowledges the work of Northern Sydney Medicare Local in the production of this resource. May 2015 Disclaimer: While every effort is made by MML to ensure that accurate information is disseminated through this medium, MML makes no representation about the content and suitability of this information for any purpose. 1

2 CONTENTS Item Numbers Frequently Used Item Numbers 3 After Hours Item Numbers 3 Prolonged Attendance in Treatment of a Critical Condition 8 Individual Allied Health Services 9 Group Allied Health Services for Patients with Type 2 Diabetes 10 GP Multidisciplinary Case Conferences 11 Health Assessments 12 Residential Aged Care Facility Item Numbers 14 Systematic Care Claiming Rules 15 Flow Charts Healthy Kids Check Health Assessment 16 Type 2 Diabetes Risk Evaluation Health Assessment Year Old Health Assessment Years and Older Health Assessment 19 Aboriginal and Torres Strait Islander Health Assessment 20 Hepatitis B Positive Program Enrolment Flowchart 21 Hep B Pathology Item Numbers/Descriptors 22 Domiciliary Medication Management Review (DMMR) 23 Residential Medication Management Review (RMMR) 24 GP Management Plan (GPMP) 25 Team Care Arrangement (TCA) 26 Reviewing a GP Management Plan (GPMP) and/or a Team Care Arrangement (TCA) 27 Mental Health Treatment Plan 28 Review of the Mental Health Treatment Plan 29 Diabetes Annual Cycle of Care Service Incentive Payment (SIP) 30 Asthma Cycle of Care Service Incentive Payment (SIP) 31 MML Programs and Services ffcare Coordinated Supplementary Service (CCSS) 32 ffmedical Outreach Indigenous Chronic Disease Program 33 ffaboriginal and Torres Strait Islander Outreach Worker 34 ffparkinson s Support Nurse Program 35 ffmurrumbidgee Osteoporosis Fracture Prevention Service 36 ffmurrumbidgee Osteoarthritis Chronic Care Program 37 ffintegrated Chronic Disease Program 38 ffintegrated Allied Health Services 40 ffrural Health Outreach Fund 41 ffsmoking Cessation Program 42 ffaccess to Allied Psychological Services (ATAPS) 43 ffwagga Applied Psychology Services (WAPS) 44 ffperinatal Depression Initiative 45 ffcarer s Counselling 46 ffmighty Minds 47 ffpartners in Recovery (PIR) 48 ffheadspace 49 ffrefugee Health Patients 50 Practice Incentive and Service Incentive Items Regional Providers Contact Details 51 Practice Incentive Payments and Service Incentive Payments Summary 54 2

3 FREQUENTLY USED ITEM NUMBERS For a comprehensive explanation of each MBS Item number please refer to the Medicare Benefits Schedule website at COMMONLY USED ITEM NUMBERS ITEM NAME $ DESCRIPTION / RECOMMENDED FREQUENCY 3 Level A $ Brief see MBS for complexity of care requirements 23 Level B $ < 20 min see MBS for complexity of care requirements 36 Level C $ min see MBS for complexity of care requirements 44 Level D $ min see MBS for complexity of care requirements Bulk Billing Item $ Spirometry $ DVA, under 16s and Commonwealth Concession Card holders. Can be claimed concurrently for eligible patients Measurement of respiratory function before and after inhalation of bronchodilator ECG $ Twelve-lead Electrocardiography, tracing and report CHRONIC DISEASE MANAGEMENT ITEM NAME $ DESCRIPTION / RECOMMENDED FREQUENCY 721 GP Management Plan (GPMP) $ Team Care Arrangement (TCA) $ Review of GP Management Plan and/or Team Care Arrangement GP Contribution to, or Review of, Multidisciplinary Care Plan $ $ Management plan for patients with a chronic or terminal condition. Minimum claiming period 12 months. Development of Team Care Arrangements for patients with at least one medical condition present for at least six months or is terminal and requires ongoing care from a team including the GP and at least two other health or care providers. Enables referral for five rebated allied health services. Minimum claiming period 12 months. Each service to which item 732 applies may only be claimed once in a three-month period, except where there are exceptional circumstances that necessitate earlier performance of the service to the patient. Contribution to, or review of, a multidisciplinary care plan prepared by another provider (e.g. community, home or allied health providers, specialists), for patients with a chronic or terminal condition and complex needs requiring ongoing care from a team including the GP and at least two other health or care providers. Not residing in a RACF. Not more than once every three months. 731 GP Contribution to, or Review of, Multidisciplinary Care Plan prepared by RACF $ A GP contribution at the request of the facility, to a multidisciplinary care plan, or review of a care plan prepared by RACF, for patients with a chronic or terminal condition and complex needs requiring ongoing care from a team including the GP and at least two other Health or care providers. Not more than once every three months. 3

4 FREQUENTLY USED ITEM NUMBERS Continued COMMONLY USED ITEM NUMBERS ITEM NAME $ DESCRIPTION / RECOMMENDED FREQUENCY 701 Brief Health Assessment $ Lasting not more than 30 minutes* 703 Standard Health Assessment $ >30 <45 minutes see MBS for complexity of care requirements* 705 Long Health Assessment $ Prolonged Health Assessment $ Aboriginal and Torres Strait Islander Health Assessment 45 <60 minutes see MBS for complexity of care requirements* At least 60 minutes or more see MBS for complexity of care requirements* $ Not timed* PRACTICE NURSE ITEM NUMBERS AS OF 1 JANUARY 2012 ITEM NAME $ DESCRIPTION / RECOMMENDED FREQUENCY Telehealth in RACF $ Health Assessment - Healthy Kids Check by Nurse Follow Up Health Services for Indigenous people $ $ Chronic Disease Management $ Patient participating in video consult with specialist or consultant physician. Service by a Practice Nurse, Allied Health worker or Aboriginal and Torres Strait Islander health practitioner on behalf of and under supervision of GP Once only health check for children who have received or are receiving the four-year-old immunisation. Cannot be claimed if a health assessment item has been claimed. Follow up services for an Indigenous person who has received a Health Assessment, not an admitted patient of a hospital. Maximum of 10 services per patient, per calendar year Monitoring and support for patients being managed under a GPMP or TCA. Not more than five, per patient, per year MEDICATION MANAGEMENT AND CYCLES OF CARE ITEM NAME $ DESCRIPTION / RECOMMENDED FREQUENCY 900 Domiciliary Medication Management Review (DMMR) or Home Medicine Review (HMR) $ Review of medications in collaboration with a pharmacist for patients at risk of medication related misadventure. Once every 12 months* 903 Residential Medication Management Review (RMMR) $ For permanent residents of RACF who are at risk of medication related misadventure. Performed in collaboration with the resident s pharmacist. Once every 12 months* 2521 Diabetes Annual Cycle of Care Level C + SIP $ = For accredited practices. Used in place of usual attendance item when completing Diabetes Annual Cycle of Care. Once every months* 2552 Asthma Cycle of Care Level C + SIP $ = For accredited practices. Used in place of usual attendance item when completing the Asthma Cycle of Care for patients with moderate to severe asthma. Not more than once a year* * See flow charts in this guide for further information 4

5 FREQUENTLY USED ITEM NUMBERS Continued MENTAL HEALTH ITEM NUMBERS ITEM NAME $ DESCRIPTION / RECOMMENDED FREQUENCY 2700 GP Mental Health Treatment Plan $ Min 20 minutes Prepared by GP who has not undertaken Mental Health Skills Training. Assessment of patient and preparation of a care plan with option to refer for rebated psychological services. Not more than once a year 2701 GP Mental Health Treatment Plan $ Min 40 minutes Prepared by GP who has not undertaken Mental Health Skills Training. Assessment of patient and preparation of a care plan with option to refer for rebated psychological services. Not more than once a year 2715 GP Mental Health Treatment Plan $ Min 20 minutes - Prepared by GP who has undertaken Mental Health Skills Training. Assessment of patient and preparation of a care plan with option to refer for rebated psychological services. Not more than once a year 2717 GP Mental Health Treatment Plan $ Min 40 minutes - Prepared by GP who has undertaken Mental Health Skills Training. Assessment of patient and preparation of a care plan with option to refer for rebated psychological services. Not more than once a year 2712 Review of GP Mental Health Treatment Plan $ Plan should be reviewed between one to six months and no more than two per year (claim frequency in relation to other items) 2713 Mental Health Consultation $ Consultation 20 minutes For the ongoing management of a patient in relation to a mental disorder. No restriction on the number of these consultations per year 2721 GP Focussed Psychological Strategies $ Consultation between minutes Provision of focussed psychological strategies by an appropriately trained and registered GP, up to 10 per calendar year GP Focussed Psychological Strategies $ Consultation for 40 minutes Provision of focussed psychological strategies by an appropriately trained and registered GP, up to 10 per calendar year. Eligibility for provision of focussed psychological strategies by an appropriately trained and registered GP, as determined by the General Practice Mental Health Standards Collaboration (GPMHSC). 5

6 AFTER HOURS ITEM NUMBERS To access MBS item numbers online Non-Urgent After Hours Attendances in Consulting Rooms (Items 5000, 5020, 5040, 5060, 5200, 5203, 5207 and 5208) are to be used for non-urgent consultations at consulting rooms initiated either on a public holiday, on a Sunday, before 8am and after 1pm on a Saturday, or before 8am and after 8pm on any other day. Non-Urgent After Hours Attendances at a place other than Consulting Rooms (other than a Hospital or Residential Aged Care Facility) (items 5003, 5023, 5043, 5063, 5220, 5223, 5227 and 5228) and Non- Urgent After Hours Attendances in a Residential Aged Care Facility (Items 5010, 5028, 5049, 5067, 5260, 5263, 5265 and 5267) are to be used for non-urgent attendances on one or more patients on one occasion on a public holiday, on a Sunday, before 8am and after 12 noon on a Saturday, or before 8am and after 6pm on any other day. Urgent Attendance After Hours These items can only be used for the first patient, if more than one patient is seen on the one occasion. For the second and subsequent patients attending on the same occasion, standard (non-urgent) afterhours items apply. The urgent after-hours items can only be used where the patient has a medical condition that requires urgent treatment, which could not be delayed until the next in-hours period. For times and days these items apply, see table below: ATTENDANCE PERIOD LOCATION APPLICABLE TIME MONDAY TO FRIDAY SATURDAY SUNDAY OR PUBLIC HOLIDAY ITEMS Urgent after hours attendance Return to and specifically open consulting room or attend a place other than consulting rooms Between 7am 8am and 6pm 11pm Between 7am 8am and 12 noon 11pm Between 7am 11pm 597, 598 Urgent after hours in unsociable hours Return to and specifically open consulting room or attend a place other than consulting rooms Between 11pm 7am Between 11pm 7am Between 11pm 7am 599, 600 Non-urgent after hours In consulting rooms Consulting rooms Before 8am or after 8pm Before 8am or after 1pm 24 hours 5000, , , 5203, 5207, 5208 Non-urgent after hours at a place other than consulting rooms Patient s home Before 8am or after 6pm Before 8am or after 12 noon 24 hours 5003, 5023, 5043, 5063, 5220, 5523, 5227, 5228 Non-urgent after hours in an RACF RACF Before 8am or after 6pm Before 8am or after 12 noon 24 hours 5010, 5028, 5049, 5067, 5260, 5263, 5265,

7 AFTER HOURS ITEM NUMBERS Continued The following table lists the MBS benefits for After Hours Home Visits. Amounts are per patient. NO OF PATIENTS AFTER HOURS HOME VISITS GROUP A1 LEVEL A ITEM 5003 LEVEL B ITEM 5023 LEVEL C ITEM 5043 LEVEL D ITEM 5063 AFTER HOURS HOME VISITS GROUP A2 BRIEF ITEM 5220 STD ITEM 5223 LONG ITEM 5227 PRO- LONGED ITEM 5228 ONE $54.95 $74.95 $ $ $34.00 $43.50 $61.00 $83.00 TWO $41.95 $61.95 $96.90 $ $26.25 $34.75 $53.25 $75.25 THREE $37.65 $57.65 $92.60 $ $23.65 $31.85 $50.65 $72.65 FOUR $35.50 $55.50 $90.45 $ $22.35 $30.35 $49.35 $71.35 FIVE $34.20 $54.20 $89.15 $ $21.60 $29.50 $48.60 $70.60 SIX $33.30 $53.30 $88.25 $ $21.10 $28.90 $48.10 $70.10 SEVEN + $31.00 $51.00 $85.95 $ $19.20 $26.70 $46.20 $68.20 The following table lists the MBS benefits for After Hours RACF visits NO OF PATIENTS AFTER HOURS RACF VISITS GROUP A1 LEVEL A ITEM 5010 LEVEL B ITEM 5028 LEVEL C ITEM 5049 LEVEL D ITEM 5067 AFTER HOURS RACF VISITS GROUP A2 BRIEF ITEM 5260 STD ITEM 5263 LONG ITEM 5265 PRO- LONGED ITEM 5267 ONE $75.70 $95.70 $ $ $46.45 $57.55 $73.45 $95.45 TWO $52.35 $72.35 $ $ $32.45 $41.75 $59.45 $81.45 THREE $44.55 $64.55 $99.50 $ $27.80 $36.50 $54.80 $76.80 FOUR $40.65 $60.65 $95.60 $ $25.50 $33.90 $52.50 $74.50 FIVE $38.35 $58.35 $93.30 $ $24.10 $32.30 $51.10 $73.10 SIX $36.80 $56.80 $91.75 $ $23.15 $31.25 $50.15 $72.15 SEVEN + $32.30 $52.30 $87.25 $ $19.75 $27.25 $46.75 $68.75 Group A1 - Vocationally Registered Group A2 - Non-Vocationally Registered All MBS items and rates are effective as of 1 December 2014 Level A - D - as per usual time and complexity requirements - see page 3. Brief < 5 minute Standard 6-25 minutes Long minutes Prolonged > 45 minutes 7

8 PROLONGED ATTENDANCE IN TREATMENT OF A CRITICAL CONDITION These items can be claimed at any time of the day and any day of the week. The patient must be in imminent danger of death One or more medical practitioners can claim these items for simultaneous attendance on one patient and The time spent by the practitioner does not have to be continuous. ITEM ITEM DESCRIPTION TIME MBS BENEFIT 160 CRITICAL CONDITION, prolonged attendance in treatment of 1 - < 2 Hours $ CRITICAL CONDITION, prolonged attendance in treatment of 2 - < 3 Hours $ CRITICAL CONDITION, prolonged attendance in treatment of 3 - < 4 Hours $ CRITICAL CONDITION, prolonged attendance in treatment of 4 - < 5 Hours $ CRITICAL CONDITION, prolonged attendance in treatment of 5+ Hours $

9 INDIVIDUAL ALLIED HEALTH SERVICES Allied Health Services for Chronic Conditions Requiring Multidisciplinary Team Care To access Medicare benefits for the following services, GPs must have completed a GP Management Plan (721) and Team Care Arrangement (723) or contributed to a Multidisciplinary Care Plan in a Residential Aged Care Facility (731) and the allied health service must be recommended in the patient s plan as part of the management of their chronic condition. It is not appropriate for AHPs to reverse refer to GPs, or pre-empt the GPs decision about the services required. ITEM NAME $ DESCRIPTION / RECOMMENDED FREQUENCY Aboriginal Health Worker Services Diabetes Educator Services Audiologist Services Exercise Physiologist Services Dietitian Services Occupational Therapist Services Physiotherapist Services Podiatrist Services Chiropractor Services Osteopath Services Speech Pathologist Services $62.25 Maximum five allied health services per calendar year Can be five sessions with one provider or a combination e.g. Three dietitian and two diabetes education sessions Separate referral form required for each provider/service type. Referral should state the number of services required by that provider. Allied Health Provider must be Medicare registered Allied Health Provider must supply written report to referring medical practitioner after the first and last service provided. business/audits/files/ pdf business/audits/files/ pdf business/audits/files/ pdf Mental Health Services Psychologist Services $62.25 Use Better Access Mental Health Care items for mental health conditions (GP Mental Health Treatment Items ) for referral to 10 allied health sessions and GPMP and TCA for chronic medical conditions - five sessions Aboriginal & Torres Strait Islander Patients Patients that have identified as Aboriginal and Torres Strait Islander and have undertaken the Item 715 Health Assessment can also be referred for Allied Health follow-up if required. Refer to MBS primary care items to Allied Health Service. This is in addition to the services available under individual allied health services, therefore they may access up to 10 sessions per calendar year. Out of pocket expenses: Allied health providers can determine their own fees for the services provided. Charges in excess of the Medicare benefit are the responsibility of the patient and should be discussed with them prior to referral. Patients cannot use private health insurance ancillary cover to pay for out of pocket expenses. 9

10 GROUP ALLIED HEALTH SERVICES FOR PATIENTS WITH TYPE 2 DIABETES For a comprehensive explanation of each MBS Item number please refer to the Medicare Benefits Schedule online at Assessment and Provision of Group Services GP must have completed a GP Management Plan (721), or reviewed an existing GPMP (732), or contributed to, or reviewed, a Multidisciplinary Care Plan in a Residential Aged Care Facility (731). There is no additional requirement for a Team Care Arrangement (723). Once referred, a patient will receive one individual assessment by one of the required providers, after which they may receive up to eight group services per calendar year. These services are available in addition to the five individual allied health services claimable. ITEM NAME $ DESCRIPTION / RECOMMENDED FREQUENCY Assessment for Group Services by Diabetes Educator Assessment for Group Services by Exercise Physiologist Assessment for Group Services by Dietitian $79.85 One assessment session only by either Diabetes Educator, Exercise Physiologist or Dietitian, per calendar year Use of Medicare Allied Health Group Services for Type 2 Diabetes Referral Form recommended Diabetes Education Group Services Exercise Physiologist Group services $19.90 Eight group services per calendar year, can be eight sessions with one provider or a combination e.g. three diabetes education, three dietitian and two exercise physiology sessions. Use of Medicare Allied Health Group Services for Type 2 Diabetes Referral Form recommended. Groups must comprise between 2-12 participants. Sessions must be at least 60 minutes Dietetics Group services Allied health provider must provide a report to the referring practitioner after the initial assessment and upon completion of the group program. Medicare rebates and private health insurance rebates cannot both be claimed for this service. 10

11 GP MULTIDISCIPLINARY CASE CONFERENCES For patients in the community, RACF or private in-patient hospital discharge. At least 2 other care or service providers must take part. ITEM NAME COSTS TIME 735 Organise and coordinate a case conference $ Organise and coordinate a case conference $ Organise and coordinate a case conference $ Participate in a case conference $ Participate in a case conference $ Participate in a case conference $ minutes. GP organises and coordinates case conference in RACF or community or on discharge. For patients with a chronic or terminal condition and complex, multidisciplinary care needs minutes. GP organises and coordinates case conference in RACF or community or on discharge. For patients with a chronic or terminal condition and complex, multidisciplinary care needs 40+ minutes. GP organises and coordinates case conference in RACF or community or on discharge. For patients with a chronic or terminal condition and complex, multidisciplinary care needs minutes. GP participates in a case conference in RACF or community or on discharge. For patients with a chronic or terminal condition and complex, multidisciplinary care needs minutes. GP participates in a case conference in RACF or community or on discharge. For patients with a chronic or terminal condition complex, and multidisciplinary care needs 40+ minutes, GP participates in a case conference in RACF or community or on discharge. For patients with a chronic or terminal condition and complex, multidisciplinary care needs The team case conference should: Discuss patient history Identify multidisciplinary care needs Identify outcomes to be achieved by all members Identify tasks required to achieve these outcomes and assign them to team members Assess if previously identified outcomes were achieved (if relevant). REGULATORY REQUIREMENTS To organise and coordinate case conference items 735, 739 and 743, the provider must: (a) explain to the patient the nature of a multidisciplinary case conference, and ask the patient for their agreement to the conference taking place; and (b) record the patient s agreement to the conference; and (c) record the day on which the conference was held, and the times at which the conference started and ended; and (d) record the names of the participants; and (e) offer the patient and the patient s carer (if any, and if the practitioner considers it appropriate and the patient agrees) a summary of the conference and provide this summary to other team members; and (f) discuss the outcomes of the conference with the patient and the patient s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and (g) record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient s medical records. To participate in multidisciplinary case conference items 747, 750 and 758, the provider must: (a) explain to the patient the nature of a multidisciplinary case conference, and ask the patient whether they agree to the medical practitioner s participation in the conference; and (b) record the patient s agreement to the medical practitioner s participation; and (c) record the day on which the conference was held, and the times at which the conference started and ended; and (d) record the names of the participants; and (e) record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient s medical records. 11

12 HEALTH ASSESSMENTS For a comprehensive explanation of each MBS Item number please refer to the Medicare Benefits Schedule online at Health Assessments should be provided by patient s usual doctor. Primary Care Nurses may assist with performing the assessment. ITEM NAME DESCRIPTION / RECOMMENDED FREQUENCY Up to 30mins a) Collection of relevant information, including taking a patient history; b) A basic physical examination; c) Initiating interventions and referrals as indicated; and d) Providing the patient with preventive health care advice and information. 701 Brief Health Assessment $59.35 Incorporating: Health Assessment Healthy Kids Check Once only health check, by GP, for children who have received or are receiving the 4 year old immunisation Health Assessment Type 2 Diabetes Risk Evaluation Provision of lifestyle modification advice and interventions for patients aged years who score 12 on AUSDRISK. Once every three years Health Assessment Year Old Once only health assessment for patients years who are at risk of developing a chronic disease Health Assessment 75 Years and Older Health assessment for patients aged 75 years and older. Once every 12 months Health Assessment Comprehensive Medical Assessment Medical Assessment for permanent residents of RACF. Available for new and existing residents. Not more than once yearly Health Assessment for patient with an Intellectual Disability Health assessment for patient with an Intellectual Disability. Not more than once yearly Health Assessment for Refugees and other Humanitarian Entrants Once only health assessment for new refugees and other humanitarian Former serving members of the Australian Defense Force including former members of permanent and reserve forces Once only health assessment 703 Standard Health Assessment $ >30 - <45 mins a) Detailed information collection, including taking a patient history; b) An extensive physical examination; c) Initiating interventions and referrals as indicated; and d) Providing a preventive health care strategy for the patient. 12

13 HEALTH ASSESSMENTS Continued ITEM NAME DESCRIPTION / RECOMMENDED FREQUENCY 705 Long Health Assessment $ <60 minutes a) Comprehensive information collection, including taking a patient history; b) An extensive examination of the patient s medical condition and physical function; c) Initiating interventions and referrals as indicated; and d) Providing a basic preventive health care management plan for the patient. Incorporating the Health Assessment categories listed in Prolonged Health Assessment $ minutes or more a) Comprehensive information collection, including taking a patient history; b) An extensive examination of the patient s medical condition, and physical, psychological and social function. c) Initiating interventions and referrals as indicated; and d) Providing a comprehensive preventive health care management plan for the patient. Incorporating the Health Assessment categories listed in Aboriginal and Torres Strait Islander Peoples Health Assessment $ No designated time or complexity requirements Incorporating: ABORIGINAL AND TORRES STRAIT ISLANDER Child Health Assessment Health Assessment for ABORIGINAL AND TORRES STRAIT ISLANDER patients 0 14 years old. Not available to in-patients of a hospital or RACF. Not more than once every nine months ABORIGINAL AND TORRES STRAIT ISLANDER Adult Health Assessment Health Assessment for ABORIGINAL AND TORRES STRAIT ISLANDER patients years old. Not available to in-patients of a hospital or RACF. Not more than once every nine months ABORIGINAL AND TORRES STRAIT ISLANDER Health Assessment for an Older Person Health Assessment for ABORIGINAL AND TORRES STRAIT ISLANDER patients 55 years and over. Not available to in-patients of a hospital or RACF. Not more than once every nine months Health Assessment - Healthy Kids Check by Nurse $58.20 Once only health check for children who have received or are receiving the four-year-old immunisation Only if patient has not already received a Healthy Kid s Check under items

14 RESIDENTIAL AGED CARE FACILITY ITEM NUMBERS ITEM NAME DESCRIPTION / RECOMMENDED FREQUENCY < 30 minutes - see MBS for complexity of care requirements Incorporating: 701 Brief Health Assessment 703 Standard Health Assessment 705 Long Health Assessment 707 Prolonged Health Assessment Health Assessment - Comprehensive Medical Assessment Comprehensive Medical Assessment (CMA) for permanent residents of Residential Aged Care Facilities. Available for new and existing residents. Not more than one yearly minutes - see MBS for complexity of care requirements. Incorporating: Health Assessment - CMA minutes - see MBS for complexity of care requirements. Incorporating: Health Assessment - CMA > 60 minutes - see MBS for complexity of care requirements. Incorporating: Health Assessment - CMA CMA Activities: Time based, see MBS for complexity of care requirements for each items. CMA requires assessment of the resident s health and physical and psychological function, and must include: Obtaining and record resident s consent Information collection, including taking patient history and undertaking or arranging examinations and investigations as required Making an overall assessment of the patient Recommending appropriate interventions Providing advice and information to the patient Keeping a record of the Health Assessment - CMA, and offering the patient a written report about the health assessment, with recommendations about matters covered by the Health Assessment - CMA Providing a written summary of the outcomes of the Health Assessment - CMA for the resident s records and to inform the provision of care for the resident by the RACF, and assist in the provision of Medication Management Review services for the resident. ITEM NAME DESCRIPTION / RECOMMENDED FREQUENCY 731 GP Contribution to, or Review of, Multidisciplinary Care Plan prepared by RACF A GP contribution at the request of the facility, to a multidisciplinary care plan, or review of a care plan prepared by RACF, for patients with a chronic or terminal condition and complex needs requiring ongoing care from a team including the GP and at least two other Health or care providers. Not more than once every three months. Activites: Obtain and record resident s consent Prepare part of the plan or amendments to the plan and add a copy to the patient s medical records; or give advice to a person (e.g. Nursing staff in RACF) who prepares or reviews the plan and records in writing, on the patient s medical records, any advice provided. 14

15 SYSTEMATIC CARE CLAIMING RULES For a comprehensive explanation of each MBS Item number please refer to the Medicare Benefits Schedule online at No Claiming Restrictions 2546 Asthma Cycle of Care SIP 721 GP Management Plan (GPMP) 2700 / 2701 GP Mental Health Treatment Plan 723 Team Care Arrangement (TCA) 2712 Review of GP Mental Health Treatment Plan 732 Review of GPMP and/or TCA 2713 GP Mental Health Consultation 900 Home Medication Review 2715 / 2717 GP Mental Health Treatment Plan Months until Next Claim for Service 2517 Diabetes Cycle of Care 3/6/12 3/6/12 Month Claiming restrictions MBS ITEM NUMBERS *721 *723 ** / / 2717 * * ** / AS REQUIRED 2715/ Additional Claiming Rules *721 & 723 Recommended claiming period, minimum period 12 months except where exceptional circumstances require preparation of a new GPMP **732 Each service to which item 732 applies may only be claimed once in a three-month period, except where there are exceptional circumstances that necessitate earlier performance of the service to the patient 2517 Recommended not to be claimed within 3 months of Review Item 732, as services overlap 2546 Recommended not to be claimed within 12 months of claiming Item 721 alone, as services significantly overlap. Can be claimed on the same day if both 721 and 723 are completed, as the patient has multidisciplinary care needs. Recommended not to be claimed within 3 months of Review Item 732, as services overlap 2713 This item number can be billed within a GPMHTP or as a stand-alone consultation as many times as required 2712 Review recommended one to six months after 2700, 2701, 2715, 2717, with not more than two reviews in a 12 month period Notes: Where a service is provided earlier than minimum claiming periods the patient invoice and Medicare claim should be annotated. For example; clinically indicated/required, hospital discharge, exceptional circumstances, significant change. Standard consultations, health assessments, treatment plans and medication reviews should not be claimed on the same day. If provided on the same day the patient invoice and Medicare claim should be annotated, for example; clinically indicated/required, separate service. 15

16 HEALTHY KIDS CHECK HEALTH ASSESSMENT ITEMS 701/703/705/707 Ensure eligibility & obtain patient consent Children between three to five-years-old Children who have not previously had a health assessment (including 10986) Children who are receiving or have received their four-year-old immunisation Perform Health Check Document Relevant Information Clinical Content Explain Health Assessment process and gain parent s/carer s consent Information collection - take patient history and undertake, or arrange examinations and investigations as required Physical examinations and assessments must include: Height and Weight (plot and interpret growth curve/calculate BMI); Eyesight; Hearing; Oral health (teeth and gums); Toileting; and Allergies Discuss: eating habits; physical activity; speech and language development; fine and gross motor skills; behaviour and mood Other examinations considered necessary by GP/Practice Nurse Make an overall assessment of the patient Recommend appropriate interventions Provide advice and information Essential Documentation Requirements Record parent s/carer s consent to Health Assessment Record that 4-year-old immunisation was given Record the Health Assessment and offer the parent/carer a copy Update parent-held child health record Identify health concerns & arrange referrals Claiming All elements of the service must be completed to claim 701/703/705/707 (GP) or (PN). Claim MBS Item MBS ITEM NAME AGE RANGE RECOMMENDED FREQUENCY 701/703/705/ Health Assessment Healthy Kids Check by GP Health Assessment Healthy Kids Check by PN or registered Aboriginal Health Worker 3 5 years Once Only 3 5 years Once Only 16

17 TYPE 2 DIABETES RISK EVALUATION HEALTH ASSESSMENT ITEMS 701/703/705/707 Perform records search to identify at risk patients and actively recall Patients aged 40 to 49 years inclusive Patients must score 12 points (high risk) on Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) Not for patients in hospital Not for patients with newly diagnosed or existing diabetes. Perform AUSDRISK Within 3 months Clinical Content Explain Health Assessment process and gain consent Evaluate the patient s risk score determined by the AUSDRISK, which has been completed within a period of three months prior to undertaking the health assessment Update patient history and undertake physical examinations and clinical investigations in accordance with relevant guidelines Make an overall assessment of the patient s risk factors, and results of relevant examinations and investigations Initiate interventions where appropriate, including referral to relevant allied health and/or lifestyle modification or health coaching programs and follow-up Provide advice and information including strategies to achieve lifestyle and behaviour changes Perform Health Check Nurse may collect information GP must see patient Essential Documentation Requirements Record patient s consent to Health Assessment Completion of AUSDRISK is mandatory, with a score of 12 points required to claim; Update patient history Record the Health Assessment and offer the patient a copy Claiming All elements of the service must be completed to claim Requires personal attendance by GP with patient Claim MBS Item MBS ITEM NAME AGE RANGE RECOMMENDED FREQUENCY 701/703/705/707 Health Assessment Type 2 Diabetes Risk Evaluation years Once every 3 years 17

18 45 49 YEAR OLD HEALTH ASSESSMENT ITEMS 701/703/705/707 Perform records search to identify at risk patients and actively recall Perform Health Check Nurse may collect information GP must see patient Patients aged 45 to 49 years inclusive Must have an identified risk factor for chronic disease Not for patients in a hospital Risk Factors Include, but are not limited to: Lifestyle: smoking; physical inactivity; poor nutrition; Alcohol use Biomedical: high cholesterol; high BP; impaired glucose metabolism; excess weight Family history of chronic disease Mandatory Content Explain Health Assessment process and gain consent Information collection take patient history; undertake examinations and investigations as clinically required Overall assessment of the patient s health, including their readiness to make lifestyle changes Initiate interventions and referrals as clinically indicated Advice and information about lifestyle modification programs and strategies to achieve lifestyle and behaviour changes Arrange referrals as required Essential Documentation Requirements Record patient s consent to Health Assessment Record the Health Assessment and offer the patient a copy Claiming All elements of the service must be completed to claim Claim MBS Item MBS ITEM NAME AGE RANGE RECOMMENDED FREQUENCY 701/703/705/707 Health Assessment Year Old years Once only 18

19 75 YEARS AND OLDER HEALTH ASSESSMENT ITEMS 701/703/705/707 Perform records search to identify at risk patients and actively recall Perform Health Assessment Nurse may collect information GP must see patient Complete Documentation Patients aged 75 years and older Patient seen in consulting rooms and/or at home Not for patients in hospital or a Residential Aged Care Facility Mandatory Content Explain Health Assessment process and gain patient s/ carer s consent Information collection take patient history; undertake examinations and investigations as clinically required Measurement of: BP, Pulse rate and rhythm Assessment of: Medication; Continence; Immunisation status for influenza, tetanus and pneumococcus; Physical function including activities of daily living and falls in the last three months; Psychological function including cognition and mood; and Social function including availability and adequacy of paid and unpaid help and the patient s carer responsibilities Overall assessment of patient Recommend appropriate interventions Provide advice and information Discuss outcomes of the assessment and any recommendations with patient Non-Mandatory: Consider: Need for community support services; Social isolation; Oral health and dentition; and Nutrition status Additional matters as relevant to the patient Essential Documentation Requirements Record patient s/carer s consent to Health Assessment Record the Health Assessment and offer the patient a copy (with consent, offer to carer) Claiming All elements of the service must be completed to claim Claim MBS Item MBS ITEM NAME AGE RANGE RECOMMENDED FREQUENCY 701/703/705/707 Health Assessment 75 Years and Older 75 years and older Once every 12 months 19

20 ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH ASSESSMENT ITEM 715 GP performs Health Assessment 715 Claim MBS Item 715 Referral to Allied Health Service if required Allied Health Service Must be of a least 20 minutes duration Service must be performed personally by Allied Health Professional Eligibility Aboriginal or Torres Strait Islanders of any age Not for hospital inpatients or RACF residents Mandatory Content Patient must identify as Aboriginal and/or Torres Strait Islander Health Assessment includes physical, psychological and social wellbeing. It also assesses what preventative health care, education and other assistance that should be offered to improve the patient s health and wellbeing. It must include: Information collection of patient history and undertaking examinations and investigations as required. For more detail see notes A34, A35 and A36 of the MBS Overall assessment of the patient; Recommending appropriate interventions Providing advice and information to the patient Recording the health assessment; and Offering the patient and/or carer a written report with recommendations about matters covered by the health assessment Referral to Allied Health Services Item 715 Health Assessment must be in place before referral to Allied Health (Items to or to 10970) if required. Items to are in addition to Items to and provide an alternative to the referral pathway to access Allied Health Services, allowing up to 10 allied health services per calendar year. Items available to individual patients only, not as a group service. Allied health professionals may set their own fees. Charges in excess of the Medicare benefit for these items are the responsibility of the patient. Allied Health must provide written report to GP MBS ITEM NAME AGE RANGE RECOMMENDED FREQUENCY 715 Aboriginal and Torres Strait Islander Health Assessment All ages Once in a nine month period to Allied Health Services All ages Max five services per year Service provided by Practice Nurse or registered Aboriginal Health Worker All ages Max ten services per year to Allied Health referral (chronic disease) All ages Max five services per year 20

21 HEPATITIS B POSITIVE PROGRAM ENROLMENT FLOWCHART Check Patient Eligibility and Recall Search high risk population and create register: Males / female age > 35 years Family history of Liver Cancer (NB: Asian-born residents from high HBV endemic areas (e.g. China, Hong Kong, Vietnam, Cambodia) and other migrant residents diagnosed with Chronic Hepatitis B (CHB)) Generate recall letter or contact patients to make appointment Discuss lifestyle/family/patient history. Generate pathology tests: HBsAg (Hep B Surface Antigen) HBeAg (Marker of HBV infectivity) HBV DNA (Viral load) ALT Arrange follow up appointment (1-2 weeks) to review results. Arrange appropriate tests Review results: if the blood test HBsAg is positive, then patient is eligible for Cancer Council Hep B Positive Program. GP to complete Enrolment Case Record Form. Enrolment to Program Generates $25 If result is negative, set recall in software for six months review consultation and pathology tests. Follow Up Appointment to Discuss Results and Enrolment Please refer to Hep B program enrolment pack for guidance on tests and management. MBS ITEM NUMBER 23, 36 (or 721 can be claimed if patient has GPMP or 723 if Hep B positive and patient presents with another chronic co-morbidity e.g. Diabetes, respiratory etc.) Follow up Review of Hep B Program Enrolled Patients Generates $25. Recommended every six months. 21

22 HEP B PATHOLOGY ITEM NUMBERS/DESCRIPTORS Item 69482: Quantitation of Hepatitis B viral DNA in patients who are Hepatitis B surface antigen positive and have chronic hepatitis B, but are not receiving antiviral therapy 1 test Applicable no more than once yearly. Bulk Billing Fee: $ Item 69483: Quantitation of Hepatitis B viral DNA in patients who are Hepatitis B surface antigen positive and who have chronic hepatitis B and are receiving antiviral therapy 1 test Applicable not more than 4 times in a 12 month period. Bulk Billing Fee: $ Item 69475: One test for hepatitis antigen or antibodies to determine immune status or viral carriage following exposure or vaccination to Hepatitis A, Hepatitis B, Hepatitis C or Hepatitis D Bulk Billing Fee: $15.65 Item 69478: 2 tests described in Bulk Billing Fee: $29.25 Item 69481: Investigation of infectious causes of acute or chronic hepatitis 3 tests for hepatitis antibodies or antigens. Bulk Billing Fee: $40.55 Items 69475, 69478, 69481: Only one of these 3 items can be claimed per patient encounter. Item 66500: Quantitation in serum, plasma, urine or other body fluid (except amniotic fluid), by any method except reagent tablet or reagent strip (with or without reflectance meter) of: acid phosphatase, alanine aminotransferase, albumin, alkaline phosphatase, ammonia, amylase, aspartate aminotransferase, bicarbonate, bilirubin (total), bilirubin (any fractions), C-reactive protein, calcium (total or corrected for albumin), chloride, creatine kinase, creatinine, gamma glutamyl transferase, globulin, glucose, lactate dehydrogenase, lipase, magnesium, phosphate, potassium, sodium, total protein, total cholesterol, triglycerides, urate or urea 1 test. Bulk Billing Fee: $ : 5 or more tests described in item Bulk Billing Fee: $

23 DOMICILIARY MEDICATION MANAGEMENT REVIEW (DMMR) ITEM 900 Also known as Home Medicines Review (HMR) Ensure Patient Eligibility Patients at risk of medication related problems or for whom quality use of medicines may be an issue Not for patients in a hospital or RACF Should be performed by patient s usual GP First GP Visit Discussion and referral to pharmacist Initial Visit with GP Explain purpose, possible outcomes, process, and information sharing with pharmacist and possible out of pocket costs Gain and record patient s consent to DMMR Assess patient s medication management needs Inform patient of need to return for second visit Complete DMMR referral and send to patient s preferred pharmacy or accredited pharmacist HMR Interview Conducted by accredited pharmacist Second GP Visit Discuss and develop medication management plan DMMR Interview Pharmacist holds review in patient s home unless patient prefers another location Pharmacist prepares a report and sends to the GP covering review findings and suggested medication management strategies Pharmacist and GP discuss findings and suggestions Second GP Visit Discuss summary of findings and develop medication management plan Discuss plan with patient and offer copy of completed plan Send copy of plan to pharmacist Claiming All elements of the service must be completed to claim Requires personal attendance by GP with patient Claim MBS Item Example risk factors known to predispose people to medication related adverse events are: Currently taking five or more regular medications Taking more than 12 doses of medication per day Significant changes made to medication treatment regimen in last 3 months Medication with a narrow therapeutic index or medications requiring therapeutic monitoring Symptoms suggestive of an adverse drug reaction Sub-optimal response to treatment with medicines Suspected non-compliance or inability to manage medication related therapeutic devices Patients having difficulty managing their own medicines because of literacy or language difficulties, dexterity problems or impaired sight, confusion/dementia or other cognitive difficulties Patients attending a number of different doctors, both GPs and specialists Recent discharge from a facility / hospital (in the last four weeks) MBS ITEM NAME RECOMMENDED FREQUENCY 900 Domiciliary Medication Management Review Once every 12 months 23

24 RESIDENTIAL MEDICATION MANAGEMENT REVIEW (RMMR) ITEM 903 Ensure Patient Eligibility Patients likely to benefit from a review For permanent residents (new or existing) of a RACF (includes veterans) Patients at risk of medication related misadventure or for whom quality use of medicines may be an issue Not for patients in a hospital or respite patients in RACF The potential need for a RMMR can be identified by the GP, reviewing pharmacist, supply pharmacist, RACF staff, the resident, their carers or other members of their healthcare team Collaborate with reviewing pharmacist GP Requirements Explain RMMR process and gain resident s consent Collaborate with reviewing pharmacist Provide input from Comprehensive Medical Assessment or relevant clinical information for RMMR and the resident s records Medication Review By pharmacist Post Review Discussion Face to face or by phone Complete Documentation Accredited Pharmacist Requirements Review resident s clinical notes and interview resident Prepare Medication Review report and send to GP GP and Pharmacist Post Review Discussion Discuss: Findings and recommendations of the Pharmacist; Medication management strategies; issues; implementation; follow up; outcomes If no (or only minor) changes recommended a post review discussion is not mandatory Essential Documentation Requirements Record resident s consent to RMMR Develop and/or revise Medication Management Plan which should identify medication management goals and medication regimen after discussion with pharmacist Finalise Plan after discussion with resident Offer copy of Plan to resident/carer, provide copy for resident s records and for nursing staff at RACF, discuss plan with nursing staff if necessary Claim MBS Item Claiming All elements of the service must be completed to claim Derived fee arrangements do not apply to RMMR MBS ITEM NAME RECOMMENDED FREQUENCY 903 Residential Medication Management Review Once every 12 months unless significant changes occur 24

25 GP MANAGEMENT PLAN (GPMP) ITEM 721 Ensure Patient Eligibility Develop Plan Nurse may collect information GP must see patient No age restrictions for patients Patients with a chronic or terminal condition Patients who will benefit from a structured approach to their care Not for public patients in a hospital or in an RACF For patients in the community and private patients being discharged from hospital A GP Mental Health Treatment Plan (Item 2700/2701/2715/2717) is suggested for patients with a mental disorder Should be performed by patient s usual GP Clinical Content Explain steps involved in GPMP, possible out of pocket costs, gain consent Assess health care needs, health problems and relevant conditions Agree on management goals with the patient Confirm actions to be taken by the patient Identify treatments and services required Arrangements for providing the treatments and services Review using item 732 at least once over the life of the plan Complete Documentation Essential Documentation Requirements Record patient s consent to GPMP Patient s health problems and relevant conditions, needs and goals, patient actions, and treatments/services required Set review date Offer copy to patient (with consent, offer to carer), keep copy in patient file Claim MBS Item Claiming All elements of the service must be completed to claim Requires personal attendance by GP with patient Review using item 732 at least once during the life of the plan MBS ITEM NAME RECOMMENDED FREQUENCY MINIMUM CLAIMING PERIOD 721 GP Management Plan Two yearly 12 months 25

26 TEAM CARE ARRANGEMENT (TCA) ITEM 723 Ensure Patient Eligibility Develop TCA Nurse may collect information and collaborate with providers GP must see patient No age restrictions for patients Patients with a chronic or terminal condition and complex care needs Patients who need ongoing care from a multidisciplinary team including the GP and at least two other health or care providers, one of whom may be another medical practitioner Each provider must be providing a different type of ongoing treatment/service For patients in the community and private patients being discharged from the hospital Not for public patients in a hospital or RACF Clinical Content Explain steps involved in TCA, possible out of pocket costs, gain consent Treatment and service goals for the patient Discuss with patient which providers the GP will collaborate with and the treatment and services the providers will deliver Actions to be taken by the patient Gain patient s agreement on what information will be shared with other providers Ideally list all health and care services required by the patient Obtain potential collaborating providers agreement to participate Consult with collaborating providers and obtain feedback on treatments/services they will provide to achieve patient goals Complete Documentation Essential Documentation Requirements Record patient s consent to TCA Goals, collaborating providers, treatments/services, actions to be taken by patient Set review date Send copy of relevant parts to collaborating providers Offer copy to patient (with consent, offer to carer), keep copy in patient file Claim MBS Item Claiming All elements of the service must be completed to claim Requires personal attendance by GP with patient Review using item 732 at least once during the life of the plan Claiming a GPMP and TCA enables eligible patients to receive five rebated services per calendar year from allied health providers MBS ITEM NAME RECOMMENDED FREQUENCY MINIMUM CLAIMING PERIOD 723 Team Care Arrangement Two yearly 12 months * May be provided more frequently in exceptional circumstances. 26

27 REVIEWING A GP MANAGEMENT PLAN (GPMP) AND/OR TEAM CARE ARRANGEMENT (TCA) ITEM 732 GPMP Review Nurse can assist GP must see patient Reviewing a GP Management Plan (GPMP) Clinical Content Explain steps involved in the review and gain consent Review all matters in relevant plan Essential Documentation Requirements Record patient s agreement to review Make any required amendments to plan Set new review date Offer copy to patient (with consent, offer to carer), keep copy in patient file Claim MBS Item Claiming All elements of the service must be completed to claim Item 732 should be claimed at least once over the life of the GPMP Cannot be claimed within three months of a GPMP (item 721) Item 732 can be claimed twice on same day if reviews of both GPMP and TCA are completed, in this case the Medicare claim should be annotated or flagged as not duplicate TCA Review Nurse can assist GP must see patient Claim MBS Item Reviewing a Team Care Arrangement (TCA) Clinical Content Explain steps involved in the review and gain consent Consult with two collaborating providers to review all matters in plan Essential Documentation Requirements Record patient s consent to review Make any required amendments to plan Set new review date Send copy of relevant parts of amended TCA to collaborating providers Offer copy to patient (with consent, offer to carer), keep copy in patient file Claiming All elements of the service must be completed to claim Requires personal attendance by GP with patient Item 732 should be claimed at least once over the life of the TCA Cannot be claimed within three months of a TCA (item 723) Item 732 can be claimed twice on same day if review of both GPMP and TCA are completed, in this case the Medicare claim should be annotated or flagged as not duplicate MBS ITEM NAME RECOMMENDED FREQUENCY 732 Review of GP Management Plan and/or Team Care Arrangement Six monthly MINIMUM CLAIMING PERIOD Three months 27

28 MENTAL HEALTH TREATMENT PLAN ITEM 2700/2701/2715/2717 Ensure Patient Eligibility No age restrictions for patients Patients with a mental disorder, excluding dementia, delirium, tobacco use disorder and mental retardation (without mental health disorder) Patients who will benefit from a structured approach to their treatment For patients in the community and private inpatients being discharged from hospital Not for public patients in a hospital or a RACF Develop Plan Only a specialist mental health nurse may assist in the development of the plan Complete Documentation Claim MBS Item Clinical Content Explain steps involved, possible out of pocket costs and gain patient s consent Relevant history biological, psychological, social and presenting complaint Mental state examination, assessment of risk and co-morbidity, diagnosis of mental disorder and/or formulation Outcome measurement tool score (e.g. K10), unless clinically inappropriate Discuss diagnosis/formulation, referral and treatment options with the patient Provide psycho-education Plan for crisis intervention/relapse prevention, if appropriate Agree on management goals with the patient and confirm actions to be taken by the patient Identify treatments/services required and make arrangements for these Arrange for review and follow up Essential Documentation Requirements Record patient s consent to GP Mental Health Treatment Plan Document diagnosis of mental disorder Results of outcome measurement tool Patient needs and goals, patient actions, and treatments/services required Set review date Offer copy to patient (with consent, offer to carer), keep copy in patient file Claiming All elements of the service must be completed to claim Requires personal attendance by GP with patient Review using item 2712 at least once during the life of the plan Claiming enables a patient to be referred for up to 10 rebateable allied mental health services per calendar year (psychological therapy or focussed psychological strategies). Plus a further 10 group therapy services. * Provided they have not received ATAPS in the same calendar year. 2700/2701 prepared by a GP who has not undertaken mental health skills training 2715/2717 prepared by a GP who has undertaken mental health skills training MBS ITEM NAME RECOMMENDED FREQUENCY MINIMUM CLAIMING PERIOD 2700, 2701, 2715, 2717 GP Mental Health Treatment Plan Only when clinically required 12 monthly 28

29 REVIEW OF THE MENTAL HEALTH TREATMENT PLAN ITEM 2712 Reviewing the Plan Only a specialist mental health nurse may assist in reviewing the plan Clinical Content Explain steps involved, possible out of pocket costs and gain patient s consent Review patient s progress against goals outlined in the GP Mental Health Treatment Plan Check, reinforce and expand psycho-education Plan for crisis intervention and/or relapse prevention, if appropriate and if not previously provided Re-administer the outcome measurement tool used when developing the GP Mental Health Treatment Plan (item 2700/2701/2715/2717), except where considered clinically inappropriate Complete Documentation Claim MBS Item Essential Documentation Requirements Record patient s consent to review Results of re-administered outcome measurement tool Document relevant changes to GP Mental Health Treatment Plan Offer copy to patient (with consent, offer to carer), keep copy in patient file Claiming All elements of the service must be completed to claim Requires personal attendance by GP with patient Item 2712 should be claimed at least once over the life of the GP Mental Health Treatment Plan A review can be claimed one to six months after completion of the GP Mental Health Treatment Plan If required, an additional review can be performed three months after the first review Claiming a 2712 enables patients to receive four further rebated individual and group psychology services MBS ITEM NAME RECOMMENDED FREQUENCY 2712 Review of GP Mental Health Treatment Plan One to six months after GP Mental Health Treatment Plan MINIMUM CLAIMING PERIOD Three monthly 29

30 Diabetes Annual Cycle of Care Service Incentive Payment (SIP) Ensure Practice Eligibility Only accredited and PIP registered practices may claim the SIP No age restrictions for patients Patients with established Diabetes Mellitus For patients in the community and in RACFs Essential Clinical and Documentation Requirements Explain Annual Cycle of Care process, gain and record patient s consent Care Requirements This item certifies that the minimum requirements of the annual cycle of care have been completed. Six Monthly Measure height, weight and calculate BMI Measure BP Examine feet Yearly Measure HbA1c, total cholesterol, triglycerides and HDL cholesterol Kidney Function Test egfr Test for microalbuminuria Provide patient education regarding diabetes management including self-care education Review diet and levels of physical activity reinforce information about appropriate dietary choices and levels of physical activity Check smoking status encourage smoking cessation Review medication Claim SIP item in place of usual attendance item Two Yearly Comprehensive eye examination by ophthalmologist or optometrist to detect and prevent complications requires dilation of pupils Claiming SIP Available to GPs in accredited practices, registered for the Diabetes SIP All elements of the service must be completed to claim Only paid once every month period NAME FREQUENCY IN SURGERY OUT OF SURGERY SIP REBATE Diabetes SIP Standard Consult. (Level B) Diabetes SIP Long Consult. (Level C) Diabetes SIP Prolonged Consult. (Level D) monthly $ Level B monthly $ Level C monthly $ Level D 30

31 Asthma Cycle of Care Service Incentive Payment (SIP) Ensure Practice Eligibility Only accredited and PIP registered practices may claim the SIP No age restrictions for patients Patients with moderate to severe asthma For patients in the community and in Residential Aged Care Facilities Essential Clinical and Documentation Requirements At least two asthma consultations within 12 months One of the consultations must be for a review Review must be planned during previous consultation Note: A specialist consultation does not constitute one of the two visits - both must be with the same GP or in exceptional circumstances with another GP from the same practice Claim SIP item in place of usual attendance item Clinical Content Explain Cycle of Care process and gain patient s consent Diagnosis and assessment of level of asthma control and severity Review use of and access to asthma-related medication and devices Give patient written Asthma Action Plan (if the patient is unable to use a written Asthma Action Plan, discussion with the patient about an alternative method of providing an Asthma Action Plan) Provide asthma self-management education Review of written or documented Asthma Action Plan Essential Documentation Requirements Record patient s consent to Cycle of Care Document diagnosis and assessment of level of asthma control and severity Include documentation of the above requirements and clinical content in the patient file, including clinical content of the patient-held written Asthma Action Plan Claiming SIP Available to GPs in accredited practices, registered for the Asthma SIP All elements of the service must be completed to claim Only paid once every 12 months NAME FREQUENCY IN SURGERY OUT OF SURGERY SIP REBATE Asthma SIP Standard Consult. (Level B) Asthma SIP Long Consult. (Level C) Asthma SIP Prolonged Consult. (Level D) 12 monthly $100 + Level B 12 monthly $100 + Level C 12 monthly $100 + Level D 31

32 XXCare Coordination and Supplementary Services The Care Coordination and Supplementary Services (CCSS) Program aims to improve self-management of Aboriginal and Torres Strait clients with a chronic disease and reduce the number of unplanned and avoidable presentations to hospital. CCSS staff provide care coordination for Aboriginal and Torres Strait Islander clients with a diagnosed chronic disease. Client support is available to assist with access to specialists, allied health professionals, and approved equipment. Ensure Client Eligibility Referral Process GP completes referral form located on MML website, or the GP can phone the MML to provide details of referral, after which the form will be forwarded back to the GP for signing prior to any care coordination activities commencing. GP provides current GP Management Plan and/or Team Care Arrangement. Client Support Feedback to GPs Client must identify as being of Aboriginal and/or Torres Strait Islander descent. Patient must have a confirmed diagnosis of at least one of the following: diabetes cardiovascular disease chronic respiratory disease chronic renal disease cancer Require care coordination to better manage their complex chronic conditions. Essential Clinical / Documentation Requirements Current GP Management Plan and/or Team Care Arrangement Services Care coordination services may include: Arranging the services required. Ensuring arrangements are in place for client appointments. Assisting clients to participate in regular reviews with their primary care provider. Participating in case conferencing. Liaison with other local services to avoid duplication and service gaps. Providers Patient s referral and care plan to be faxed to the appropriate MML Care Coordinator in your region. Wagga and Young Leeton and Narrandera Hay Lake Cargelligo Or please phone for phone referral. Relevant MBS Items (inc. SIPs) and Claiming Patients enrolled in this program may be eligible for Item number 715. A Case Conference including a care coordinator and other allied health professionals or practice nurse may attract item numbers for Case Conferencing. Refer to page 9 and 15 of the MBS Desktop Guide. 32

33 XXMedical Outreach Indigenous Chronic Disease Program The Medical Outreach Indigenous Chronic Disease Program (MOICDP) aims to increase access to specialists and allied health providers for Aboriginal and Torres Strait Islander people. MOICDP services are based on identified need. The program is administered through NSW Rural Doctors Network with the MML coordinating service delivery. Ensure Patient Eligibility Client must identify as being of Aboriginal and/or Torres Strait Islander descent No age restrictions for patients Patients seen in consultation rooms Not for patients in hospital or residential aged care facilities Referral Process Referral from GP, self, allied health worker, other. Phone call to be made to book client into clinic by GP, practice staff, self or other. Clinic The program will focus service delivery on chronic conditions. Case discussions, preparation of reports to other relevant health professionals and support of patients as required. Providers Specialists Endocrinologist Narrandera Cardiologist Griffith Allied health Diabetes educator Narrandera, Lake Cargelligo, Brungle Dietitian Brungle, Darlington Point, Leeton, Narrandera, Lake Cargelligo Podiatrist Lake Cargelligo, Narrandera, Hay, Leeton Asthma educator Lake Cargelligo Aboriginal health nurse Narrandera, Lake Cargelligo Please see page 51 for contact details. Referral Written referral required for cardiologist and endocrinologist. Feedback to GPs 33

34 XXAboriginal and Torres Strait Islander Outreach Worker The Aboriginal and Torres Strait Islander Outreach Worker (ATSIOW) Program aims to link clients with local health and social support services. Ensure Patient Eligibility Client must identify as being of Aboriginal and/or Torres Strait Islander descent. Referral Aboriginal Outreach Workers cover the whole area of the Murrumbidgee Medicare Local. Consent GP or practice nurse obtains verbal consent from client. Please phone: Wagga Leeton Services An Aboriginal outreach worker is someone who can assist in a nonclinical role with practical support such as: Referral Client Support Encouraging Aboriginal and Torres Strait Islander people to selfidentify and provide support to general practices. Encourage and assist individuals to return for follow up appointments with their local doctor or practice nurse (health assessment). Link individuals into local health services or community programs in their town e.g. transport. Attend medical appointments with patients if they need support, or if the doctor feels the patient might need support (must have patient s consent). Advocate on patient s behalf with other service providers; speak with other services regarding access issues (must have patient s consent). Communication and Feedback to GPs Other Relevant Information The Aboriginal and Torres Strait Islander outreach worker can support general practice by co-locating within a practice to assist with annual registration to the Indigenous PIP program. The length of co-location is negotiated dependant on the practice s requirements. Aboriginal Project Officers Can support general practice and primary health care providers with: Methods to encourage Aboriginal/Torres Strait Islander individuals to self-identify Managing specific health needs and local issues relating to Aboriginal health needs Informing and disseminating updated information regarding Closing the Gap, and Care Coordination and Supplementary Services programs Promoting general practice as a trusted and valid first point of contact to local Aboriginal individuals and communities 34

35 XXParkinson s Support Nurse Program The Parkinson s support nurse aims to improve access to support, care coordination and information to enable overall improved management of Parkinson s disease. Ensure Eligibility All people with Parkinson s disease, their families, and carers within the boundary of the MML. Referral GPs or self-refer. Referral GPs Self-refer For further information and referral to this service contact Services The Parkinson s support nurse: Initial Meeting Explain program and gain consent. Establish into support group. Explains the program, determines existing services, and records patient s consent. Established goals and entry into a support group. Completes initial assessment template and provides copy to GP and specialist. The Parkinson s support nurse provides: Assessment / Review Assess needs as per GP MP / TCA. Determine other services engaged. Establish goals. Initial assessment template sent to GP and specialist. Care Coordination Collaboration with appropriate health and medical professionals. Support group attendance. Case conference with GP and client. Coordination of health care needs as identified on the GP Management Plan / Team Care Arrangement. Liaison with and linkages to appropriate health and medical professionals to assist in assessment and management of the long term needs of the person with Parkinson s (PWP) and their families. Case conference with the GP and client, (with client consent and GP knowledge). Regular face to face or phone contact with the client. Regular progress reports to the GP. Support, information and self-management education. Provision of information and resources specific to Parkinson s. Participation in the allied health clinic in a nursing role, and referring PWP/carer/family as required to other services. Relevant MBS Items (inc. SIPs) and Claiming A Case Conference including the Parkinson s support nurse and other allied health professionals or practice nurse may attract item numbers for Case Conferencing. Communication Regular feedback to GP. Self-management education. Provide information and resources. 35

36 XXMurrumbidgee Osteoporosis Refracture Prevention Service The Murrumbidgee Osteoporosis Refracture Prevention Service aims to improve the health of the community at high risk of osteoporosis and further fractures. The service provides a Fracture Liaison Nurse (FLN) whose role is to oversee the service including: Provision of an osteoporosis risk assessment for the patient, which is forwarded to the GP for further investigation / follow-up. Provision of patient education about osteoporosis or osteopenia and disease management strategies. Patient follow-up to support adherence to treatment plans. Community education and awareness. Ensure Patient Eligibility People over the age of 50 who have sustained a minimal trauma fracture. Essential Clinical / Documentation Requirements Previous DEXA results and vitamin D level if available. Intake Process Patients are identified by the FLN. Patients can be referred via GP or allied health professional to the FLN. Comprehensive Assessment Assessment is completed including an osteoporosis risk assessment. Care Planning & Referral Feedback to GP regarding patient s assessment, goals and referral to appropriate services. Diagnosis / Treatment GP provides diagnosis and treatment and initiates GP Management Plan if appropriate. FLN provides education to patient. Providers Fracture Liaison Nurse Referral Patients are identified by the Fracture Liaison Nurse upon presentation to WWBH Emergency Department post minimal trauma fracture (MTF). Patients can also be referred via their GP or allied health professional, upon meeting the eligibility criteria, by phoning the FLN on Services An initial assessment including an osteoporosis risk assessment is completed for each new client of the service. Patient goals are developed in partnership with the client / carer. Appropriate referrals to services (i.e. falls prevention, home care services) are made if required. Patient s GP is provided with feedback on the patient s assessment for follow-up of investigations and diagnosis. Patient goals and referral to appropriate services (e.g. falls prevention, home care services) are also provided to the GP. GP provides diagnosis and treatment and initiates GP Management Plan if appropriate. FLN provides education to assist in compliance with prescribed treatment. Patients are followed up at 6-8 weeks post assessment to review progress on agreed actions and determine if additional referral to services is required. Relevant MBS Items (inc. SIPs) and Claiming Patients enrolled in this program may be eligible for Chronic Disease Item numbers (GPMP and TCA) at the GP s initiation. Follow-up by FLN 36

37 XXMurrumbidgee Osteoarthritis Chronic Care Program The Osteoarthritis Chronic Care Program (OACCP) Model of Care uses best practice evidence to improve the coordination of care by implementing an inter-disciplinary, conservative management model for individuals with osteoarthritis. The objective of the OACCP is to: Reduce pain Improve function Improve quality of life of osteoarthritis clients Ensure Patient Eligibility Intake Process All patients submitting a RFA are contacted for participation. Orthopaedic surgeons and GPs can refer directly. Comprehensive Assessment Assessment is completed by local contracted physiotherapists. Care Planning & Referral Feedback to GP on patient s assessment and recommended actions and referrals. GP initiates referrals to allied health providers where appropriate. Reviews Patient reviewed at 12, 26, 38 and 52 weeks or at pre-surgery time if their admission falls before any of these time points at surgery. Patients with osteoarthritis who are currently on the waiting list at Wagga Base Hospital for hip or knee replacement surgery. OR People with osteoarthritis of the hip or knee and with a pain rating >4 out of 10 on most days of the week. Providers Musculoskeletal Coordinator: physiotherapist Musculoskeletal Coordinator: orthopaedic nurse Physiotherapy Provider Panel (private physiotherapists under contract with the MML) Referral Patients are identified via the Wagga Base Hospital once they have submitted their Recommendation For Admission (RFA). GPs and orthopaedic surgeons can refer directly to the MML MSK Coordinators by phoning Services Patients are provided with a comprehensive assessment of: Physical measures including BMI, heart rate, blood pressure and oxygen saturation Physical activity and smoking status Assessment of pain Depression, anxiety and stress screening Falls risk Range of motion Timed Up and Go and 6 minute walk test Quality of life Participants goals are established and agreed actions developed and communicated with the patient s GP. Patients are referred to local programs where available to support lifestyle changes including: Quit smoking Falls prevention Gentle exercise classes Healthy lifestyle programs Chronic care coordination Patients are reviewed at 12, 26, 38 and 52 weeks or at pre-surgery time if their admission falls before any of these time points at surgery. Relevant MBS Items (inc. SIPs) and Claiming Patients currently accessing this service are funded for their assessments by the program. However, patients enrolled in this program may be eligible for Chronic Disease Item numbers (GPMP and TCA) at the GP s initiation. 37

38 XXIntegrated Chronic Disease Program The Integrated Chronic Disease Program (ICDP) aims to improve self-management of clients with a chronic disease and reduce the number of unplanned and avoidable presentations to hospital. ICDP nurses provide client-centred chronic disease support and education in collaboration with the client s GP. Ensure Client Eligibility People over the age of 18 years with a diagnosed chronic disease and: At risk of frequent or unplanned admissions to hospital At risk of re-admission to hospital following discharge People not eligible for the program: Referral include GP Management Plan Assessment and Review Clients with a primary and single diagnosis involving a mental health condition. Please note: People with physical/mental health comorbidity may be referred for care coordination of their physical illness, providing they are also referred to appropriate mental health services to manage their psychological condition as required. In residential aged care facilities. Receiving assistance through the Coordinated Veterans Affairs program. Receiving Transition Care from MLHD. Clients eligible to receive palliative care services from another organisation. Clients receiving chronic disease care coordination from another source or program with a different name. Receiving Extended Aged Care at Home and Extended Aged Care at Home Dementia packages. Care Coordination Essential Clinical / Documentation Requirements GP Management Plan Communication and Feedback to GPs Referral GPs Self-refer Other health professionals Please Argus: [email protected] OR Send to secure fax number: Referral form template compatible with practice software can be downloaded from MML website: 38

39 XXIntegrated Chronic Disease Program... continued Services Care coordination services may include: Arranging the services required. Ensuring arrangements are in place for client appointments. Assisting clients to participate in regular reviews with their primary care provider. Participating in case conferencing. Liaison with other local services to avoid duplication and service gaps. Care coordination should aim to assist clients to: Access specialist, primary and allied health services required for their ongoing care in consultation with the GP. Adhere to treatment regimens, such as assisting with medication compliance through arranging home medicine reviews. Develop chronic condition self-management skills. Connect with appropriate community based services such as those providing support for daily living. Relevant MBS Items (inc. SIPs) and Claiming A Case Conference including a care coordinator and other allied health professionals or practice nurse may attract item numbers for Case Conferencing. Refer to page 9 and 15 of the MBS Desktop Guide. 39

40 XXIntegrated Allied Health Services The Integrated Allied Health Services Program aims to increase access to allied health services in rural and remote communities. The program operates on an integrated and coordinated model of care, providing discipline specific individual and group allied health intervention delivered predominantly in general practices in a variety of rural locations. Select appropriate allied health professional Referral Process Give patient s details to reception staff at medical practice or hospital to book into allied health clinic. No restrictions Providers Allied health services provided: Physiotherapy Dietetics Diabetes education Podiatry and foot care Occupational therapy Asthma education Referral Services are provided at the practice and require internal referral. Please see pages for contact details. For further information on this service contact Treatment Relevant MBS Items (inc. SIPs) and Claiming Refer to page 9 Allied Health Item numbers in the MBS Desktop Guide. Feedback to GP 40

41 XXRural Health Outreach Fund The Rural Health Outreach Fund (RHOF) aims to improve access to multidisciplinary care in rural and remote primary health care settings by increasing the range of services offered by visiting health professionals to prevent, detect and manage chronic disease more effectively. Ensure Eligibility No age restriction for patients Patients seen in consulting rooms Not for patients in hospital or residential aged care facilities Referral Clinics Consultations, follow-up and review of patient. Medical procedures as required. Consultation and reporting to other health professionals. Providers Dermatology Griffith Psychiatry Leeton and Griffith Opthalmology Hay Orthopaedic surgeon Leeton Rheumatology Wagga Pain specialist physician Wagga Respiratory physician Young Paediatricians Wagga Midwife (can be self-referred) Hillston and Young Referral GPs Written referral required for all specialists. Please see page 51 for contact details. Feedback to GP Treatment Consultations, follow-up and review of patients. Medical procedures as required. Case discussions, preparation of reports for other relevant health professionals, and support of patients as required. 41

42 XXSmoking Cessation Program The Smoking Cessation program offers the opportunity for individuals and groups to access support and services to assist with giving up smoking. Program options are flexible and can involve one on one consultation or group workshops. The MML Quit trained health professionals provide support to participants to gain the skills and knowledge to assist with giving up smoking and staying quit. Ensure Eligibility Nil Providers MML has a number of trained staff to support individuals to quit. Referral Referral GPs Self-refer Other health professionals Please phone to refer. Clinics Consultations, follow-up and review of patient. Medical procedures as required. Consultation and reporting to other health professionals. Treatment One on one consultations and group workshops available. Other Relevant Information Resources have been developed to support pregnant women who are thinking about quitting, these are available via contacting the MML Wagga Wagga office phone MML can provide your practice with copies of resources. List of resources: Feedback to GP Wallet cards A4 poster A5 life script pad 42

43 XXAccess to Allied Psychological Services The Access to Allied Psychological Services (ATAPS) aims to provide psychological interventions to those aged 16 years and over who have a mild to moderate mental illness. The service is offered out of GP practices in a variety of locations. Ensure Client Eligibility Individuals aged 16 and over who have been diagnosed with a mental illness and would benefit from short term psychological intervention. Individuals who are at risk of harm or suicide and need immediate intervention are not suitable. Referral Process Referring GP to supply Mental Health Treatment Plan Essential Clinical / Documentation Requirements Mental Health Treatment Plan Providers ATAPS clinicians predominantly operate within a range of GP practices. For further information on this service contact Client Care Referral GPs Feedback to GP Treatment Focused psychological strategies are a range of evidence-based interventions used to treat a range of mental health concerns. Included in these strategies, but not limited to, are Cognitive Behaviour Therapy, Interpersonal Therapy and Psycho-education. 43

44 XXWagga Applied Psychology Services The Wagga Applied Psychological Services (WAPS) Program aims to provide access to early intervention, appropriate referral and management of people aged 16 and over who have, or are at risk of developing, a mental illness. The service is offered from Wagga Wagga and provides evidence-based counselling (e.g., CBT, IPT) for individuals at risk of or experiencing mental ill health. Ensure Client Eligibility Individuals, aged 16 and over, who have been diagnosed with a mental illness and would benefit from short term focused psychological strategies. Clients must be willing and able to participate in psychological treatments. Referral Process Referring GP to supply Mental Health Treatment Plan Essential Clinical / Documentation Requirements Mental Health Treatment Plan Providers For appointments please phone reception on Client Care Feedback to GP Referral GPs Treatment Focused psychological strategies are a range of evidence-based interventions used to treat a range of mental health concerns. Included in these strategies, but not limited to, are Cognitive Behaviour therapy, Interpersonal therapy and Psycho-education. Relevant MBS Items (inc. SIPs) and Claiming Item number can be used a maximum of ten visits per calendar year. GPs must bill a 2715 (Mental Health Treatment Plan) or 2712 (Review of MHTP) prior to visiting. 44

45 XXPerinatal Depression Initiative The Perinatal Depression Initiative provides access to evidence-based counselling (e.g., CBT, IPT) for individuals at risk of or experiencing mental ill health in the perinatal period. Ensure Client Eligibility Client must be pregnant or have had a pregnancy that has occurred in the last 12 months. Essential Clinical / Documentation Requirements A referral and Mental Health Treatment Plan from GP Referral Process Referring GP to supply Mental Health Treatment Plan Providers For appointments please phone Client Care Feedback to GP Referral GPs Obstetricians Midwives Child health nurses involved with the mother Treatment Focused psychological strategies are a range of evidence-based interventions used to treat a range of mental health concerns. Included in these strategies, but not limited to, are Cognitive Behaviour Therapy, Interpersonal Therapy and Psycho-education. 45

46 XXCarer s Counselling Carers Counselling provides access to counselling and support for carers. Ensure Client Eligibility Client must be aged 16 years or older and a carer. Essential Clinical / Documentation Requirements Nil required Referral Process Client to make appointment Providers Intereach Referral Nil required Client Care Treatment The carer s counselling program is a generalised counselling service which focuses on helping the client build resilience in a caring role. For Appointments Please contact Intereach 93 Morgan Street, Wagga Wagga NSW 2650 Phone: or [email protected] 46

47 XXMighty Minds Mighty Minds provides access to evidence based counselling for children aged under 16 at risk of or experiencing mental ill health. Ensure Client Eligibility Children must not be accessing mental health services through statefunded mental health services and be under the age of: 12 years if accessing Wagga Wagga service 16 years if accessing Leeton, Griffith or Young service Referral Process Appointment to be made Essential Clinical / Documentation Requirements Nil required Providers To access the service call the intake and liaison officer on Client Care Referral GPs Parents or other family member Schools Non-government organisations, such as Early Intervention Service. Feedback Treatment Mighty Minds counsellors use short-term focused psychological strategies. Services are tailored to meet each child s needs. This may include behavioural interventions, parenting and family-based interventions, and cognitive behavioural therapy. 47

48 XXPartners In Recovery The Partners in Recovery (PIR) program aims to improve access to services for severe and chronic mentally ill clients and improve responsiveness, connectedness, and quality of services provided. Ensure Client Eligibility Client must have a severe and persistent mental illness along with complex needs. Referral Process Formal mental health diagnosis is not required upon referral. However, for continued involvement this will be initiated and supported by PIR. Essential Clinical / Documentation Requirements A formal mental health diagnosis is not required upon referral however it must be provided for continuing involvement within the program. This process is initiated and supported by Partners in Recovery. Providers Murrumbidgee Partners In Recovery Referral Self-refer Friend, carer or family member Existing services Client Care Treatment Support Facilitators will work with clients to identify their recovery goals and the supports required for clients to work towards these goals. Feedback and Communication with Medical Specialists For Further Information Please contact Murrumbidgee Partners In Recovery Tel Fax Mobile: [email protected] 48

49 XXheadspace headspace provides access to a range of services to young people (aged 12-25) including general practice, psycho-education, supportive case management, community development and clinical mental healthcare. Ensure Patient Eligibility Referral Process Appointment to be made Clients must be: years of age An Australian Citizen Have a Medicare card Have mild to moderate mental health issues Willing to participate in the program as this is a voluntary service Essential Clinical / Documentation Requirements Client membership form Consent form Treatment plan Introduction & Assessment Explain the process of the program. Discuss the purpose of a care plan. Gather information as per the psycho-social assessment. Providers headspace Wagga Wagga Referral GPs Parents or other family member Schools Non-government organisations, such as Early Intervention Service. Client Care Treatment Focused psychological strategies are a range of evidence-based interventions used to treat a range of mental health concerns. Included in these strategies, but not limited to, are Cognitive Behaviour Therapy, Interpersonal Therapy and Psycho-education. Feedback Relevant MBS Items (inc. SIPs) and Claiming Item number can be used for a maximum of ten visits in one calendar year. 49

50 XXRefugee Health Patients Utilise the TIS Service: Health Assessment Initial prolonged health assessment with GP and practice nurse. Obtain full medical history, general examinations, order investigations, review immunisation status. Refugee or asylum seeker patient. Essential Clinical / Documentation Requirements Health manifest Detention health summary Visa medical record Health Care Review of test results, commence management, continue immunisation catch-up. Consider GPMP and TCA for patients with chronic conditions. Continued Care Review medical conditions, continue immunisation catch-up. Refer to appropriate allied health services, review mental health status, consider further investigations. Providers GP and practice nurse Referral Specialist clinics Dental clinics Allied and mental health clinics Treatment Refugee health assessment Immunisation status Preventative health screening Relevant MBS Items (inc. SIPs) and Claiming 707, 721, 723, 44, 2700 Other Relevant Information Patients have an initial Refugee Health Assessment with the GP and practice nurse, then follow-up and review visits for continuity of care. Review Continue immunisation catch-up. Review health status and mental health concerns. Additional Care Address women/men health issues. Review health status for continuity of care. 50

51 Regional Providers Contact Details SERVICE/PROVIDER LOCATION REFERRAL CONTACT DETAILS MOICDP Diabetes Educator Narrandera Narrandera Medical Centre Lake Cargelligo Lake Cargelligo Family Practice Brungle Brungle Health & Community Aboriginal Corporation Tuesdays and Thursdays Dietitian Brungle Brungle Health & Community Aboriginal Corporation Tuesdays and Thursdays Darlington Point Darlington Point Medical Centre Leeton Leeton Medicare Local Clinic held out of Leeton Physiotherapy Centre Lake Cargelligo Lake Cargelligo Family Practice Narrandera Narrandera Medical Centre Cardiologist Griffith Griffith Aboriginal Medical Service Podiatrist Lake Cargelligo Lake Cargelligo Family Practice Narrandera Narrandera Medical Centre Hay Tristar Medical Group Hay Leeton Leeton Medicare Local Clinic held out of Leeton Physiotherapy Centre Asthma Educator Lake Cargelligo Lake Cargelligo Family Practice Aboriginal Health Nurse Narrandera Narrandera Medical Centre Lake Cargelligo Lake Cargelligo Family Practice Endocrinologist Narrandera Narrandera Medical Centre RHOF Dermatology Griffith Griffith Medical Centre Psychiatry Leeton Leeton Medical Centre Griffith Kookora Surgery Ophthalmology Hay Tristar Medical Group Hay Orthopaedic Surgeon Leeton Leeton Medical Centre Rheumatology Wagga Piercy Place Pain Specialist Physician Wagga Piercy Place Respiratory Physician Young Young District Medical Centre Maternity Midwife Hillston Hillston Medical Centre Young Young Community Health Paediatrician Haematology Neurology Respiratory Nephrology Wagga Riverina Paediatrics

52 SERVICE/PROVIDER LOCATION REFERRAL CONTACT DETAILS IAHS Physiotherapy Lake Cargelligo Lake Cargelligo Hospital West Wyalong West Wyalong Hospital Temora Temora Hospital Dietetics Adelong Adelong Medical Centre Leeton Murrumbidgee Medical and Primary Care Centre Leeton Leeton Medical Centre Lockhart Lockhart Medical Practice Narrandera Narrandera Medical Centre Temora Temora Medical Complex Tumbarumba Roth s Corner Medical Centre Tumbarumba Tumbarumba Medical Practice Tumut Fitzroy Medical Centre Tumut West Wyalong Bland Medical Centre West Wyalong West Wyalong West Wyalong Medical Centre Diabetes Education Temora Victoria Street Surgery Temora Adelong Adelong Medical Centre Leeton Murrumbidgee Medical and Primary Care Centre Leeton Leeton Family Clinic Leeton Leeton Medical Centre Griffith Your Health Griffith Griffith Griffith Medical Centre Griffith Griffith Aboriginal Medical Centre Hay Tristar Hay Young Young District Medical Centre Lockhart Lockhart Medical Practice Hillston Hillston Medical Centre Podiatry and Foot Care Hay Tristar Hay Young Boorowa Street Practice Young Young Young District Medical Centre Hillston Hillston Medical Centre Harden Kruger Medical Centre Temora Temora Victoria Street Medical Centre Temora Temora Medical Complex Griffith Griffith Aboriginal Medical Centre

53 SERVICE/PROVIDER LOCATION REFERRAL CONTACT DETAILS Occupational Therapy Lake Cargelligo Lake Cargelligo Hospital Hillston Hillston Library Asthma Education Hay Tristar Hay West Wyalong Bland Medical Centre West Wyalong West Wyalong Tristar West Wyalong West Wyalong West Wyalong Medical Centre Leeton Leeton Family Clinic Tumbarumba Tumbarumba Medical Practice Tumbarumba Roth s Corner Medical Centre Tumbarumba Hanwood Hanwood Surgery

54 Practice Incentive Payments and Service Incentive Payments Summary ITEM ACTIVITY ITEM NUMBER & TYPE OF CONSULT PIP ($ PER SWPE) SIP ($ PER PATIENT) NOTES PIP Enquiry Line Patient register and recall/ reminder system N/A $1.00 (Approx $1000 per FTE GP) One-off payment only Practice must be registered for PIP Incentive payable with quarterly PIP payments DIABETES Annual Cycle of Care for patients with diabetes Level B 2517 or 2518 Level C 2521 or 2522 Level D 2525 or 2526 $40 per diabetic patient These item numbers should be used in place of the usual attendance items, when a consultation completes the minimum annual requirements of care Outcomes payment N/A $20 per Diabetic patient, per annum Payment only made to practices that have a min. of 2% of their patient population as diagnosed diabetics Payment made to practices where 50% of diabetes patients have a completed Annual Cycle of Care Sign-on payment N/A $0.25 (Approx. $250 per FTE GP) One-off payment only Practice must be registered for PIP Incentive payable with quarterly PIP payments ASTHMA Asthma Cycle of Care Level B 2546 or 2547 Level C 2552 or 2553 Level D 2558 or 2559 $100 per patient, per annum plus consultation fees These item numbers should be used in place of the usual attendance items, when a consultation completes the minimum requirements for the Asthma Cycle of Care. The Asthma Cycle of Care targets patients with moderate to severe asthma Sign-on payment N/A $0.25 (Approx. $250 per FTE GP) One-off payment only Practice must be registered for PIP Incentive payable with quarterly PIP payments CERVICAL SCREENING Screening women aged years inclusive, who have not been screened in the past four years Outcomes payment Level A 2497 Level B 2501 or 2503 Level C 2504 or 2506 Level D 2507 or 2509 N/A $ 3.00 per female WPE aged between 20 and 69, per annum $35 per patient These MBS items must be used instead of the standard consultation items, in order to be eligible for this payment Payment is made to practices where a minimum of 75% of women aged between 20 and 69 years inclusive have been screened in the past 30 months (paid on a quarterly basis) IMMUNISATION Completing an age-appropriate immunisation schedule N/A $6.00 ACIR Information Payment Notification Payment of $6 is given by the Australian Childhood Immunisation Register (ACIR) when a GP makes a notification on the completion of an age appropriate immunisation. GPs must complete a registration form - ACIR Payment Account Details For Immunisation Providers which is lodged with Medicare Australia ACIR Enquiry Line: or 54

55 ITEM ACTIVITY PIP ($ PER SWPE) NOTES PIP Enquiry Line EHEALTH Requirement 1: Integrating Healthcare Identifiers into Electronic Practice Records Requirement 2: Secure Messaging Capability Requirement 3: Data Records and Clinical Coding Requirement 4: Electronic Transfer of Prescriptions (ETP) Capability Requirement 5: Personally Controlled Electronic Health Record System $6.50 per SWPE per annum Requirement 1: The practice must: (i) apply to Human Services to obtain a Healthcare Provider Identifier Organisation (HPI O) for the practice, and store the HPI O in a compliant clinical software system (ii) ensure that each general practitioner within the practice has their Healthcare Provider Identifier Individual (HPI I) stored in a compliant clinical software system, and (iii) use a compliant clinical software system to access, retrieve and store verified Individual Healthcare Identifiers (IHI) for presenting patients Requirement 2: The practice must have a standardscompliant secure messaging capability to electronically transmit and receive clinical messages to and from other healthcare providers, use it where feasible, and have a written policy to encourage its use in place Requirement 3: Practices must ensure that where clinically relevant, they are working towards recording the majority of diagnoses for active patients electronically, using a medical vocabulary that can be mapped against a nationally recognised disease classification or terminology system. Practices must provide a written policy to this effect to all GPs within the practice Requirement 4: The practice must ensure that the majority of their prescriptions are sent electronically to a Prescription Exchange Service (PES) Requirement 5: From 1 August use compliant software for accessing the personally controlled electronic health (ehealth) record system, and creating and posting shared health summaries and when available, event summaries - apply to participate in the ehealth record system upon obtaining a HPI O PRACTICE NURSE Practice employs or retains the services of a primary health care practice nurse e.g. $25,000 per 1000 SWPE per year Contact PIP Enquiry Line on for further information on nurses hours, Grand Parenting and Top Up payments. QUALITY PRESCRIBING Practice participation in quality use of medicines programs, endorsed by the National Prescribing Service $1.00 per SWPE This incentive is to assist practices in keeping up to date with information on the quality use of medicines. Payment will only be made if the practice meets a minimum participation level, set at an average of three activities per FTE GP per year. TEACHING Teaching of medical students $ per session (from 1 Jan 2015) Payments are made to practices that host university medical student placements. Maximum two sessions per GP per day. Minimum 3 hours per session. 55

56 ITEM ACTIVITY PIP SIP NOTES PIP Enquiry Line AGED CARE ACCESS INDIGENOUS HEALTH Provision of primary care services for patients in Residential Aged Care Facilities (RACFs). Tier 1: GP completes the Qualifying Service Level (QSL) 1 60 MBS services in RACF claimed in a financial year Tier 2: GP completes the QSL MBS services in RACF claimed in a financial year Provision of better health care for Indigenous patients, including best practice management of chronic disease. Sign-on payment Annual patient registration payments Tier 1 Outcomes payment: Chronic Disease Management Tier 2 Outcomes payment: Total Patient Care $1500 $3500 MBS items that count towards QSLs include attendances in RACF, contributions to multidisciplinary care plans and Residential Medication Management Reviews. GPs need to provide the service using their PIP linked Medicare provider number. GPs do not need to apply to participate in the Incentive. Medicare will request bank details from GPs eligible to receive payments once they have reached the QSL. Maximum payment a GP can receive in one financial year is $5000. $1000 One-off payment only. Practice must be registered for PIP $250 per registered patient, per calendar year $100 per registered patient, per calendar year $150 per registered patient, per calendar year Practice: - Seeks consent to register their Aboriginal and/or Torres Strait Islander patients (regardless of age) who have, or are at risk of, chronic disease, with Medicare and the practice for chronic disease management in a calendar year - Establishes a mechanism to ensure their patients aged 15 years and over with a chronic disease, are followed up e.g. recall/reminder system, to ensure they return for ongoing care - At least two staff members (including a GP) undertakes cultural awareness training within 12 months of joining incentive - Annotates PBS prescriptions for eligible patients for the PBS Co-payment Practice registers their eligible patients with Medicare for the PIP Indigenous Health Incentive or PBS Co-payment Measure Practice must actively plan and manage care of their patients with chronic disease for a calendar year Payment made to practice for each patient who: - Is aged 15 years or over - Has a chronic disease - Has had (or has been offered) a Health Assessment (Item No 715) - Has provided informed consent to be registered for the PIP Indigenous Health Incentive The patient s registration period commences from the date they provide consent to participate in the incentive, and will end on 31 December that year. Practices are required to obtain consent to re-register patients each year Payment made to practices that (in a calendar year): 1. Develop a 721 GP Management Plan or 723 Team Care Arrangement for the patient and undertake at least one 732 Review of the GPMP or TCA; or 2. Undertake two 732 Reviews of GPMP or TCA; or 3. Complete 731 contribute to, or review, a care plan for a patient in a RACF, on two occasions Payment made to practices that provide the majority (i.e. the highest number) of MBS services for the patient (with a minimum of 5 MBS services) in a calendar year. This may include the MBS services provided to qualify for Tier 1 56