Navigating the Medicare Benefits Schedule (MBS) can be tricky, especially when supporting someone with a Complex Neurodevelopmental Disorder or another eligible disability. The Medicare Benefits Schedule includes specific items that help families access assessments, diagnoses, and treatment through their doctors and allied health professionals but understanding how to bill and apply these correctly is important for everyone involved.
When it comes to Medicare claims, the health professional must provide the service in person, and the patient needs to be present for the service to be eligible. Allied health assessments and treatments can only be billed when provided as non-admitted or outpatient services, and these can’t be claimed until the initial medical practitioner item has been paid.
Referrals
Referrals are also an essential part of the process. Medical practitioners can refer patients for up to four allied health assessment sessions when further input is needed to support a diagnosis. Each of these sessions must run for at least 50 minutes. After the assessment, the allied health professional provides a written report back to the referring doctor, outlining their findings and any recommendations.
Once a diagnosis has been made, the next step is developing a treatment and management plan. Only one of these plans can be claimed per eligible patient’s lifetime, so it’s important to get it right. This plan can include referrals for up to 10 allied health treatment sessions per course of treatment, with a lifetime maximum of 20 sessions. Each treatment session must last at least 30 minutes, and there’s a daily limit of four allied health services per patient.
Good documentation supports good care.
The treatment and management plan should include details such as assessment results, recommended therapies, medications (if relevant), and any environmental or social risk factors. Allied health professionals also provide progress reports after treatment, helping to ensure everyone involved, including families, schools, and clinicians can be on the same page.
Need more Info?
Autism Advisory & Support Service are information sharing these details for our followers. For full details, item numbers, and official guidance, please visit the Services Australia’s website and or the MBS Online page.
