Program Guidelines: Financial Incentives for Telehealth (2011-12)



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Program Guidelines: Financial Incentives for Telehealth (2011-12)


1Background 1

1.1Telehealth Bulk Billing Incentive 3

1.2RACF On-Board Incentive 3

2GST Treatment 4

3Administration of Payments 5

4 Further information 5




    1. Background


On 1 July 2011, Medicare rebates and financial incentives for specialist video consultations were introduced to address some of the barriers to accessing medical services, particularly specialist services, for Australians in remote, regional and outer metropolitan areas. In many cases, these telehealth consultations provide patients in eligible areas with access to specialists sooner than would otherwise be the case and without the time and expense involved in travelling to major cities.

New Medicare Benefits Schedule (MBS) items were introduced to provide for telehealth consultations rendered by specialists, consultant physicians and consultant psychiatrists. These items allow a range of existing MBS attendance items to be provided via video conferencing, with a derived fee adding to the base item fee.

New MBS items were also introduced for Patient-end Services. These items enable GPs, other medical practitioners, nurse practitioners, midwives, Aboriginal health workers and practice nurses to provide face-to-face clinical services to the patient during the consultation with the specialist.

Telehealth MBS items may be billed where a specialist consultation is conducted via video conferencing with a patient who is:



  • not an admitted patient; and

  • is eligible for Medicare rebates; and

  • located in an Eligible Geographical Area (see www.mbsonline.gov.au/telehealth); or

  • a care recipient at an eligible Residential Aged Care Facility (RACF); or

  • in an eligible Aboriginal Medical Service (AMS).

This document sets out the eligibility criteria, payment and administrative arrangements for incentives which apply to services provided in the 2011-12 financial year.


Incentive Program

A range of non-MBS financial incentives linked to the telehealth MBS items were also introduced on 1 July 2011 to encourage and support the initial and ongoing provision of telehealth services to eligible patients by practitioners.

The incentives are paid to encourage change in the way in which services are provided, recognising that incorporating telehealth into everyday workflows can represent a significant change to traditional practice that will affect billing and scheduling systems, IT systems, staff training and capital improvements to establish telehealth-appropriate rooms at a practice. Practitioners can decide how to invest the incentive payment.

Five types of Incentives are available for practitioners and RACFs:



  • Telehealth On-Board Incentive;

  • Telehealth Service Incentive;

  • Telehealth Bulk Billing Incentive;

  • RACF On-Board Incentive; and

  • Telehealth Hosting Service Incentive.

  • Telehealth On-Board Incentive

A Telehealth On-Board Incentive is a time limited payment to encourage Eligible Practitioners to adopt telehealth as part of their normal practice. A Telehealth On-Board Incentive will be paid to an Eligible Practitioner upon the first occasion that a Medicare benefit is paid for a Telehealth MBS Item billed against a practitioner’s provider number.

Human Services will automatically determine eligibility based on Medicare claiming information and make the first instalment payment to the bank account listed for the relevant provider number.

Telehealth On-Board Incentive payments are calculated using the amount shown in Table 2.1-.

Table 2.1  Telehealth On-Board Incentive Payment Amounts



Incentive

2011-12

Total On-Board Incentive

$6,000

Telehealth Service Incentive

A Telehealth Service Incentive is a time-limited, per service payment to encourage Eligible Practitioners to continue to provide Eligible Telehealth Services. Human Services will automatically determine eligibility based on Medicare claiming information (once a Telehealth MBS item is bulk billed or claimed by a patient).

A Telehealth Service Incentive will accrue to a practitioner each time a Medicare benefit is processed for a Telehealth MBS item and a single payment will be made once per Payment Quarter. Where benefits for an eligible Telehealth Service are paid after the closing date for a payment run, the amount will be accrued toward the next quarterly payment.

Two different payment levels are available for this type of incentive, depending on whether the practitioner provides a specialist, or Patient-end Service. Telehealth Service Incentive payments will be calculated using the amount shown in Table 2.2-1.



Table 2.2  Telehealth Service Incentive Payment Amounts

Incentive

2011-12

Telehealth Service Incentive (specialist)

$60

Telehealth Service Incentive (patient-end)

$40
      1. Telehealth Bulk Billing Incentive


A Telehealth Bulk Billing Incentive is a time-limited, per service payment to encourage Eligible Practitioners to bulk bill telehealth consultations. A Telehealth Bulk Billing Incentive will accrue to a practitioner each time a Telehealth MBS item is bulk billed against a practitioner’s provider number and a single payment will be made once per Payment Quarter. Where a Telehealth MBS item is bulk billed after the closing date for a payment run, the incentive will be accrued toward the next quarterly payment.

Human Services will automatically determine eligibility based on Medicare claiming information (once a Telehealth MBS item is bulk billed), and make incentive payments to the bank account listed for the relevant provider number.

Telehealth Bulk Billing Incentive payments will be calculated using the amount shown in Table 2.3-.

Table 2.3  Telehealth Bulk Billing Payment Amounts



Incentive

2011-12

Telehealth Bulk Billing Incentive

$20
      1. RACF On-Board Incentive


Telehealth is available to residential aged care services that provide care and accommodation to residents under the Aged Care Act 1997.

A RACF On-Board Incentive is a one-off payment which is made to an Eligible RACF to encourage the provision of appropriate facilities and resources to host telehealth consultations.

To be eligible for a RACF On-Board Incentive, a RACF must:


  • possesses sufficient equipment and facilities to host a telehealth consultation;

  • be registered with Human Services; and

  • provide at least one Hosting Service (no incentives will be paid until a valid service is processed by Human Services).

After hosting at least one telehealth service, RACFs applying for this Incentive will then need to submit the following forms to Human Services: Residential Aged Care Service Application for Telehealth On-Board Incentive Payment along with a Residential Aged Care Service Claim for Telehealth Hosting Service Incentive (available from the Health Professionals section of the Human Services web site: www.humanservices.gov.au).

The completed forms must be faxed to: 1300 587 696

or posted to:

Telehealth Incentives Program


GPO Box 2572
ADELAIDE SA 5001

For assistance with completing the form, call Human Services on 1800 222 032.

RACF On-Board Incentive payments will be calculated using the amount shown in Table 2.4-.

Table 2.4  RACF On-Board Incentive Payments Amounts



Incentive

2011-12

RACF On-Board Incentive

$6,000

The RACF On-Board Incentive payment will be deposited via electronic funds transfer (EFT) to the bank account where aged care payments are usually made for the RACF. This payment will be included in the next monthly Aged Care Services payment run.

Telehealth Hosting Service Incentive

A Telehealth Hosting Service Incentive is a time-limited, per service payment to encourage Eligible RACFs to provide ongoing Hosting Services.

To be eligible for a Telehealth Hosting Service Incentive Payment, the RACF must:



  • be an Eligible RACF

  • have provided one or more Telehealth Hosting Services, to patient(s) within the claim period;

To receive Telehealth Hosting Service Incentives, a RACF must submit a claim for payment to Human Services, using the following form: Residential Aged Care Service Claim for Telehealth Hosting Service Incentive (available from the Health Professionals section of the Human Services web site: www.humanservices.gov.au).

The completed form must be:

Faxed to: 1300 587 696

or posted to:

Telehealth Incentives Program
GPO Box 2572
ADELAIDE SA 5001

For assistance with completing the form, call Human Services on 1800 222 032.

The Telehealth Hosting Service Incentive payment claims should be lodged on a monthly basis.

Telehealth Hosting Service Incentive payments will be calculated using the amount shown in Table 2.5-.

Table 2.5  Telehealth Hosting Service Incentive Payment Amount

Incentive

2011-12

Telehealth Hosting Service Incentive

$60

The Telehealth Hosting Service Incentive payment will be deposited via EFT to the bank account where aged care payments are usually made for the RACF. This payment will be included in the next monthly Aged Care Services payment run.

Exclusions

Telehealth Incentives are not payable and may be recovered in the following circumstances:



  • where the recipient would be a public hospital or other government or government owned organisation, except where payments are subsequently passed on to practitioners;

  • if the doctor cannot validate that the service was provided on the date for which the claim was made;

  • where a Telehealth MBS claim is declined or reversed.



    1. GST Treatment


GST is not applicable to Telehealth Incentives.
    1. Administration of Payments


Telehealth On-Board, Service and Bulk Billing Incentives are payments for individual practitioners who provide telehealth services. These incentives are paid into the bank account that has been nominated by the servicing practitioner for the payment of Medicare benefits. This account is the same account into which Medicare benefits are paid.

In some instances this may be an account which is associated with a private practice or business owner, rather than an individual practitioner.

Where incentives are paid by Human Services into an account other than that of the servicing practitioner, it is a matter for the servicing practitioner and the owner of the account to discuss the distribution of these incentives.

Changes to guidelines

These guidelines, including incentive amounts and eligibility criteria, may be amended by the Australian Government at any time.

Cessation of incentives

Telehealth Incentives may be adjusted or ceased by the Australian Government at any time, without notice. Should the Australian Government announce the early cessation of the Telehealth Incentives program, no further new claims for RACF On-Board Incentives, or Telehealth Hosting Service Incentives will be payable, and practitioners will no longer be eligible for Telehealth On-Board Incentives Telehealth Service Incentives or Telehealth Bulk Billing Incentives.

    1. Further information


Further information on MBS items and Financial Incentives for telehealth is available from http://www.mbsonline.gov.au/telehealth.
Enquiries regarding incentives eligibility, payments and Aged care facility registration can be directed to Human Services:

Tel: 1800 222 032


Fax: 1300 587 696

Email: telehealth@humanservices.gov.au


Enquiries regarding Telehealth MBS items can be directed to the Human Services Provider Enquiry line: Tel: 132 150.
Definitions

Telehealth Consultation


A referred consultation between a patient (including patient-end practitioner if applicable) and a specialist performed by video conferencing.
        1. Telehealth Incentive


A payment (outside the MBS) to an Eligible Telehealth Practitioner or an Eligible Residential Aged Care Facility for providing a telehealth consultation, which is a:

  • Telehealth On-Board Incentive

  • Telehealth Service Incentive;

  • Telehealth Bulk Billing Incentive;

  • RACF On-Board Incentive; or

  • Telehealth Hosting Service Incentive.
        1. Telehealth On-Board Incentive


A Telehealth Incentive Payment to an Eligible Telehealth Practitioner which is paid upon the first occasion that a Medicare benefit is paid for a Telehealth MBS Item billed against that practitioner’s provider number.
        1. Telehealth Bulk Billing Incentive


A Telehealth Incentive Payment to an Eligible Telehealth Practitioner which is made on each occasion that an Eligible Telehealth Practitioner bulk bills Telehealth MBS item.
        1. Telehealth Service Incentive


A Telehealth Incentive Payment to an eligible telehealth practitioner which is made on each occasion that a Medicare benefit is paid for a Telehealth MBS item billed against that practitioner’s provider number.
        1. RACF On-Board Incentive


A Telehealth Incentive Payment to an Eligible Residential Aged Care Facility which is made upon confirmation of eligible status, including confirmation of service provision, by Human Services.
        1. Telehealth Hosting Service Incentive


A Telehealth Incentive Payment to an Eligible Residential Aged Care Facility which is made monthly, based on the number of Hosting Services provided.
        1. Telehealth MBS Item


The following MBS items (and updated from time to time): 99, 112, 149, 288, 389, 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2220, 2820, 2195, 2199, 3015, 6016, 10983, 10984, 13210, 16399, 17609, 82150, 82151, 82152, 82220, 82221, 82222, 82223, 82224, 82225.

Telehealth MBS items do not include telepsychiatry items (353, 355, 356, 357, 358, 359, 361, 364, 366, 367, 369 and 370.)


        1. Eligible Aboriginal Medical Service


A facility, including Aboriginal Community Controlled Health Services, which holds a current exemption under s19(2) of the Health Insurance Act 1973.
        1. Eligible Geographical Area


An area (outside inner metropolitan) defined as Telehealth Eligible by the Department of Health and Ageing on the website: www.mbsonline.gov.au/telehealth, and updated from time to time.
        1. Eligible Telehealth Practitioner


For the purposes of receiving financial incentives under this program, an Eligible Telehealth Practitioner is any medical practitioner who is eligible to claim one or more Telehealth MBS items.

Eligible Telehealth Practitioners who hold more than one provider number are eligible for a single Telehealth On-Board Incentive Payment only.


        1. Eligible Residential Aged Care Facility


An Eligible Residential Aged Care Facility is a facility where care and accommodation are provided to residents under the Aged Care Act 1997 (including Residential Aged Care Services) and which meets the following eligibility requirements:

  • possesses sufficient equipment and facilities to host a telehealth consultation;

  • is registered with Human Services; and

  • has been assessed by Human Services as meeting the above eligibility requirements.

Eligible Telehealth Service


An Eligible Telehealth Service is a Specialist Service or a Patient-end Service which is provided under a Telehealth MBS item. To be eligible the patient must not be a hospital or admitted patient and be eligible for MBS rebates for that service if the consultation with the specialist was provided face-to-face. For example, the usual referral arrangements that apply to other consultations also apply to telehealth services.
        1. Specialist Services


Specialist Services are Eligible Telehealth Services provided by specialists and consultant physicians to patients:

  • in an Eligible Geographical Area;

  • in an Eligible Aboriginal Medical Service; or

  • who are care recipients at an Eligible Residential Aged Care Facility

Patient-end Services


Patient-end Services are Eligible Telehealth Services provided by a GP, other medical practitioner/midwife/ nurse practitioner/ practice nurse or Aboriginal health worker co located with a patient who is receiving a Specialist Service.
          1. A Patient-end Service is only an eligible service if the service provided by the specialist is also an eligible service. That is, these items can only be claimed where the specialist is also providing an MBS funded telehealth service.
          2. If the specialist is not eligible to claim for MBS rebates for any reason, the GP, practice nurse, midwife or nurse practitioner cannot claim the MBS items for patient-end support and is not eligible for any incentive payments.
        1. Hosting Service


A service provided by an Eligible Residential Aged Care Facility which enables a patient to participate in an Eligible Telehealth Service with a remote specialist, where the Eligible Telehealth Service attracts a MBS rebate for the specialist end of the consultation. A Telehealth Hosting Service must provide a patient with:

  • use of all necessary equipment and facilities; and

  • access to appropriate support (if needed)

to participate in a consultation with a medical specialist via video conference.
        1. Payment Quarter


The period during which Telehealth Service Incentives accrue for a single payment. Currently:


Quarter

Paid

July - September

Mid October

October - December

Mid January

January - March

Mid April

April - June

Mid July






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