Medicare - Osteopathy

Medicare

Back to Centre Osteopathy now offers Medicare rebates for a maximum of five osteopathic treatments per patient over a one year period. In order for these treatments to take place, the individual must consult their general practitioner regarding an Enhanced Primary Care Plan (EPC). These services are available to those suffering from chronic conditions and those with complex care needs. In order for these treatments to take place, the practitioner will need to provide the patient with an Enhanced Primary Care (EPC) referral form for osteopathic health services under Medicare. This form can be located on the Department of Health and Ageing website listed below: www.health.gov.au/strengtheningmedicare
Terms and conditions: The items can only be claimed where all of the following conditions are met: (a) The service is provided by an allied health professional registered with Medicare Australia for this initiative; (b) The service is provided on referral from a medical practitioner (including a general practitioner but not including a specialist or consultant physician); (c) The service is specified in an EPC allied health referral form; (d) The person is being managed under an EPC plan; (e) The person is not an admitted patient of a hospital or day-hospital facility; (f) The service provided is of at least 20 minutes duration, to an individual patient, in person; (g) The allied health professional has provided a written report on the service to the referring practitioner (NOTE: where the allied health professional has provided more than one service to a patient under the same referral from the referring practitioner, the allied health professional is required to provide a written report to the referring practitioner on the first and last service only, and more often if clinically relevant); (h) The person has not received more than 5 services to which items 10950-10970 apply, in a calendar year; and (i) The service has not been funded through other State or Commonwealth programs (see Other publicly funded programs).
Rebates: When the allied health professional has provided the service s/he may then: Seek payment for the service from the patient. The patient then takes the itemised receipt from the allied health professional to Medicare to claim the Medicare rebate. Out of pocket costs will count toward the Medicare safety net; or Seek payment for the service directly from Medicare. The patient must first sign an assignment of benefit form and the allied health professional will send that to Medicare for payment. To claim direct payment from Medicare in this way, the allied health professional accepts the value of the Medicare rebate in full payment for the service and will not be able to charge the patient a gap.
The following information must be shown on patients’ itemised accounts/receipts: Patient’s name and date of service; MBS item number and/or description of service; Name and practice address or name and provider number of servicing allied health professional; Name and practice address or name and provider number of referring GP and date of referral; and Amount charged, total amount paid, and any amount outstanding in relation to the service. (NOTE: Before a rebate can be paid for the allied health service provided on referral from a GP, either the patient must have already claimed a rebate, or the GP must have already lodged a claim for direct payment from Medicare for the relevant EPC planning item(s). Allied health professionals may wish to check their responsibilities for Medicare claiming and payment processes with Medicare Australia on 132 150.) A copy of the MBS booklet Medicare Benefits for allied health and dental care services provided to people with chronic conditions and complex care needs is sent to all registered allied health professionals. Updated annually, it contains item descriptors and explanatory notes including information on billing and claiming the items. Alternatively the patient may refer to the Medicare Australia website listed below.
What if I have private health insurance? Patients have the choice of using the Medicare referral given to them by their general practitioner, or alternatively they may decide to use their private health insurance ancillary cover. Here, patients can either: Access rebates from Medicare under the allied health items by following the claiming processes; or See allied health professionals of their choice and claim on their insurance’s ancillary benefits. (No referral form is required in this case. Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate.) It is important for patients to check with their health fund which ancillary services are covered and what they are expected to be out of pocket overall for these services. A fact sheet regarding Enhanced primary care chronic disease management can be found at the Department of Health and Ageing website, at: www.health.gov.au And information regarding Medicare rebates can be found on the Medicare website highlighted below: www.medicareaustralia.gov.au