Frequently Asked Questions

Transcription

1 Frequently Asked Questions I am a member of ATMS. Why can t I be a provider for all health funds? All health funds have set criteria that all associations must abide by. This criterion is sometimes higher than membership criteria for ATMS. In order to be a recognised provider you must hold the qualifications required by that fund, as well as being an ATMS Member. My client has had their claim rejected. What do I do? Check with your client that their fund package has coverage for your modality. Check you receipt. Funds require the receipt to be either stamped or computer generated. Have you put your ATMS number and provider number on the receipt? If all seems to be in order your end then call ATMS to check on your status. We do not recommend you call the fund. Why do I need to send you my insurance policy and First Aid Certificate when I renew them? All health funds require a provider to hold the following: Current professional Indemnity insurance with a minimum coverage of 1 million dollars Current Senior First Aid. The certificate must be valid for 3 years and be Workcover approved. Please note: CPR certificates are NOT accepted as Senior First Aid. Exemptions for First Aid certificates are available for Registered Nurses, Medical Doctors and paramedics. However, you will still need to send in your current registration certificate. If you do not hold a current registration certificate then you will need to hold a current senior first aid. All associations including ATMS may be audited by health funds to ensure we are meeting their requirements. These include that your policy/certificate MUST be on file or the health fund can demand we remove your details as an approved provider. I am going to take a break from my practice and I want to suspend my membership until I return. How does this affect my health fund status? Health Fund criteria changes from time to time. ATMS can only give you information that is correct on the day it was given. We do not know what the fund requirements will be when you re-activate your membership. If the funds change their requirements while your membership lapsed then you may NOT be able to automatically recognised as a provider for a fund you previously had provider status for. In order to become a provider with that fund again, you may need to upgrade your qualification to the criteria currently set by the health fund. What information do I need to put on my receipts? Health Funds require approved providers to issue a professional receipt. Hand written receipts are NOT accepted and will be rejected. Receipts must either be professional printed receipts, such as those receipts printed by Scolina services, or computer generated. Information that must be included:

2 Name of the provider who performed the consultation* Street address where the consultation took place* ATMS number* Provider number (if given)* ABN number if applicable* Description of consultation. Please note that if supplements are given these MUST be listed separately. Health Funds do not rebate on supplements, only consultations. Date of consultation *If using a non computer generated receipt then you must have a stamp made with these details. Can I issue a duplicate receipt? Yes you can. However you must clearly put duplicate or copy on the receipt. This must be done so that funds are aware that there are two receipts for the same service issued. How long does it take for health funds to receive my information? Health fund listings are generated on the last day of the month and are sent between the 1 st and 7 th of each month. This is due to Health Fund requirements. HCF and Doctors health fund are also sent on the 15 th of the month as well as the 1 st. A listing for NIB is sent each Tuesday. Once the fund has received the list from ATMS it can take up to 6 weeks for a provider number to be issued. Once the number is issued it will be sent to the clinic address that it has been issued for. Adding, removing or changing clinic details also have this timeline. This is unfortunately due to health fund administration, and ATMS is unable to shorten this time period. If you send in change of clinic details after the funds listings have been generated, you will have to wait until the next list for the details to be sent across. Health funds do NOT accept individual requests for updates. Why do I have so many provider numbers? Most funds will use your ATMS number as your provider number. However some funds require different numbers for their data bases. You may be allocated a provider number per clinic that will cover all modalities you have been approved by that fund for, or you may be allocated a separate provider number for each modality at each clinic. For example, if you are approved for 3 modalities with a fund and you practice at 3 separate clinics, that one fund will issue you with 9 provider numbers. These numbers are allocated by the funds, NOT ATMS. Health Training Package qualifications were not available when I studied. Why can t my clinic experience be used? The health funds set their own criteria for eligibility. They are constantly reviewing their standards and will regularly update their criteria to fall into line with current accepted minimum requirements. If a member applies and is accepted by a fund they will generally not have to meet the new criteria whilst they keep their provider status active. This is achieved by maintaining membership with

3 ATMS, having both current professional indemnity insurance and senior level first aid on file with ATMS and completing the CPE requirement each year. If you apply as a provider with qualifications that are not in line with current standards you will not be eligible unless you upgrade to the current standard. In these circumstances the funds require the formal health training package qualification. They do not assess or accept clinical experience. There are very limited exceptions to this rule. If you are moving from one Association to ATMS and can prove continual membership with the first Association while maintaining continual insurance, first aid and CPE with them, the fund in question will generally allow you to stay a registered provider. However, if there has been a gap of more than 6 weeks the fund may reject your application and you will need to upgrade. What is a Health Training Package qualification? All Health Training Package (HLT) qualifications must be delivered by a Registered Training Organisation (RTO). You will see this symbol on your qualification if your college was registered as a RTO at the time of your course: However not all qualifications issued by an RTO will be a Health training Package qualification. In addition to the above symbol, your qualification will also need to show the relevant Health Training Package Code. The codes are: Naturopathy: Advanced Diploma HLT60502 or HLT60507 Herbal Medicine: Advanced Diploma HLT60102 or HLT60107 Nutrition: Advanced Diploma HLT61007 Homoeopathy: Advanced Diploma HLT60602 or HLT60607 Remedial Massage: HLT50302 or HLT50307 Shiatsu: Diploma HLT50202 or HLT50207 Chinese Massage: HLT50102 or HLT50107 Kinesiology: Diploma HLT51507 Aromatherapy: Diploma HLT51407 Reflexology: HLT51707 Sports Therapies: Diploma HLT50403 or HLT50406 Acupuncture and Chinese Herbal Medicine do not have Health Training Package codes, so the qualification need only show it is a Advanced Diploma Acupuncture with the RTO symbol, or an Advanced Diploma Chinese Herbal Medicine with the RTO symbol.

4 A Bachelor of Acupuncture or a Bachelor of Chinese herbal Medicine awarded by an Australian Uni will also be accepted.. I have heard that First Aid certificates are extended for 3 months past their expiry date. Is this correct?. No. All First Aid Certificates have an expiry date on the actual certificate. This is the date the health funds take as the expiry date. ATMS sends out a reminder a minimum of 3 calendar months before a First Aid certificate is due to expire. It is the members responsibility to check on when a First Aid is due to expire. If you live in a remote location it is strongly advised you begin to look at renewing your certificate up to 6 months prior as remote locations generally do not have very many dates available. How does ATMS inform me what funds I am registered for? Contact the office after you have sent in your current Insurance and First Aid to check on what funds you have been accepted for and when your details will be submitted. Which health funds have their own provider numbers? Medibank Private (including AHM) and BUPA (including HBA, MBF and MBF Alliance) will issue you with separate provider numbers if you are eligible. ARHG (includes 23 regional funds) will use a variation of your ATMS number. All other funds will use your ATMS number. While some funds such as HCF use internal provider numbers they still require you to put your ATMS on the receipt. As a basic rule, always have your ATMS number on your receipt and add any additional number if one is given by the fund. I paid for my insurance before it was due. Why Have I fallen off some lists? All funds require associations to put members expiry dates for both insurance and first aid in the listings sent to them. It is completely at the discretion of the fund as to how much leeway they apply to this. Most funds allow a 2 month grace period. Once we receive the updated policy, and there is no gap between policies, the funds will allow claims again. You will be active from the date you were de-activated so there will be no gap for your clients. I only do mobile visits and do not want to put my home address on receipts. What can I do? In order to be a provider you must supply the fund with a street address. Po Boxes are not accepted. Whatever address you register with the funds must be the same as the address on the receipt. If you do not want to register an address your clients will NOT be able to claim a rebate on your services. Can my provider number be used by anyone else who works in my clinic? NO. Your provider number is only to be used by you. It is health fund fraud to allow any other practitioner to use your number. Each member of a clinic must apply and be approved individually for registration as a provider with funds. ATMS and the health funds do not register clinics, only individuals. Penalties for health fund fraud can include permanent de-registration as a provider and expulsion from ATMS.

5 There has been a delay in having my details updated. What do I tell my patients? Updating of details to health funds can take up to 4 weeks. There is then a time frame for the health funds to update their own records. Your clients will be able to claim their receipts for this period of time that your details are being updated. Please ask your clients to wait for a period of between 4 to 6 weeks before claiming. It is vital that ATMS members update head office with clinic details as they happen. If you do not notify us, your client might have their claim rejected. Remembering that once you notify ATMS it can take between 4 to 6 weeks before your client can claim their rebate. Prompt notification of these details will ensure a much smoother transition for your new clinic.