Medicare Benefits Schedule - Item 776

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Category 1 - PROFESSIONAL ATTENDANCES

776

776 - Additional Information

Item Start Date:
01-Jul-2018
Description Updated:
01-Nov-2023
Schedule Fee Updated:
01-Jul-2024

Group
A7 - Acupuncture and Non-Specialist Practitioner Items
Subgroup
10 - Prescribed Medical Practitioner after‑hours attendances to which no other item applies

Professional attendance (other than a service to which another item applies) at a residential aged care facility (other than a professional attendance at a self-contained unit) or professional attendance at consulting rooms situated within such a complex if the patient is accommodated in the residential aged care facility (other than accommodation in a self-contained unit) of more than 5 minutes in duration but not more than 25 minutes in duration by a prescribed medical practitioner—an attendance on one or more patients at one residential aged care facility on one occasion—each patient

The fee for item 737, plus $42.60 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 737 plus $3.00 per patient.
Ready Reckoner

(See para AN.0.9, AN.0.11, AN.0.15, AN.7.1, AN.7.2, AN.7.24, MN.1.3, MN.1.4, MN.1.5, MN.1.6, MN.1.7, MN.1.8 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500, whichever is the lesser amount.


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.9

Using time-tiered professional (general) attendance items

Last reviewed: 1 November 2023

SUMMARY

This note sets out the key common principles that apply when using the time-tiered professional attendance (also referred to as general attendance, time-tiered attendance, and Level A-E attendance) MBS items for general practitioners (GPs), medical practitioners (who are not GPs) and prescribed medical practitioners (i.e. medical practitioners who are not GPs, specialists or consultant physicians). These items are usually claimed in a general practice setting.

Unless otherwise stated these principles apply to all general attendance items, regardless of location (in consulting rooms, out of consulting rooms or residential aged care facilities), time (business or after-hours), or mode (face to face or telehealth). For some categories of attendances (e.g. telehealth) additional requirements may apply.

Note: that within the general practice context, prescribed medical practitioners and medical practitioners who are not GPs are sometimes referred to as Other Medical Practitioners (OMPs) or non-vocationally registered (non-VR) GPs. References to OMPs in this Explanatory Note include both prescribed medical practitioners and medical practitioners who are not GPs.

Information on the definition of a GP for Medicare purposes is available in GN.4.13 and prescribed medical practitioners in AN.7.1.

Tables setting out the item numbers for the various time-tiers and locations, times of day and modes are available in Note AN.0.74 for GPs, and AN.7.2 for OMPs.

USE OF THE ITEMS

General attendance items are claimed for a professional attendance when no other MBS item applies. It is a general principle of the MBS that the item that best describes the service is the item that should be claimed. This means that where a more specific MBS items exists (for example a skin biopsy under MBS item 30071), the more specific item should be claimed. If no other MBS item accurately reflects the service provided, and the requirements of a general attendance item are met, the general attendance item is claimed.

General attendance items generally require that the medical practitioner attends the patient and does at least one of the following:

  • taking a patient history
  • performing a clinical examination
  • arranging any necessary investigation
  • implementing a management plan
  • providing appropriate preventive health care.

Appropriate and contemporaneous records must be kept.

The time-tiers range from Level A short consultation for straightforward tasks to 60+ minute Level E consultations.

General attendance items are both professional and personal attendances.

What is a professional attendance?

The Regulations state that a professional attendance includes the "provision, for a patient, of any of the following services:

  • evaluating the patient’s condition or conditions including, if applicable, evaluation using a health screening service mentioned in subsection 19(5) of the [Health Insurance] Act
  • formulating a plan for the management and, if applicable, for the treatment of the patient’s condition or conditions
  • giving advice to the patient about the patient’s condition or conditions and, if applicable, about treatment
  • if authorised by the patient—giving advice to another person, or other persons, about the patient’s condition or conditions and, if applicable, about treatment
  • providing appropriate preventive health care
  • recording the clinical details of the service or services provided to the patient.”

Further information on professional attendances is at AN.0.3.

What is a personal attendance?

The Regulations specify that personal attendance items “apply to a service provided in the course of a personal attendance by a single medical practitioner on a single patient on a single occasion.” This means that:

  • the patient must be present and only time spent with the patient counts towards the attendance
  • another health practitioner (e.g. a practice nurse) cannot provide the service on behalf of a medical practitioner
  • benefits are not payable if more than one medical practitioner provides an attendance on the same patient at the same time.

In the case of telehealth (video) and telephone attendances this requirement is modified to be “a service that is an attendance by a single health professional on a single person”.

A guide on substantiating a patient’s attendance is available on the Department of Health and Aged Care’s website.

Further information on personal attendances is at AN.0.1.

How do I choose which general attendance item to use?

The correct general attendance item will depend on:

  • practitioner type – GP, medical practitioner (excluding GPs) or prescribed medical practitioner
  • length of time spent with the patient (i.e. the personal attendance time)
  • location of the consultation – in consulting rooms, out of consulting rooms or residential aged care facility
  • time of the consulting – business or after-hours
  • mode of the consultation – face to face, telephone or telehealth (video), and
  • for prescribed medical practitioners only – the location (by Modified Monash area) of the practice.

Reference tables setting out the relevant general attendance items are available at AN.0.74 for GPs and AN.7.2 for OMPs.

Can I address more than one issue in a general attendance?

Yes. All general attendance items can be claimed to address multiple issues with a patient.

When multiple issues are addressed in a single consultation, and more specific MBS items do not apply for any of these issues, medical practitioners should use the appropriate MBS general attendance item for the total time of the consultation. In these circumstances, medical practitioners should not claim each issue as a separate attendance.

What activities count towards the consultation time?

Only time spent with the patient (or on the telephone/video call with the patient in the case of telehealth) performing clinically relevant tasks can be included in the consultation time. Clinically relevant tasks include, but are not limited to:

  • undertaking any of the activities described in the item descriptor
  • communicating with the patient (and where relevant their carer)
  • writing clinical notes, prescriptions or referrals, completing forms, reports or other paperwork relating to the patient while the patient is present
  • reviewing, creating or updating entries in the patient’s My Health Record while the patient is present.

Time taken to write clinical notes, complete forms, reports or other paperwork, upload records in My Health Record (or other systems), or talk to carers or relatives when the patient is not present cannot be included in the consultation time.

If the patient has particular needs that mean good communication takes longer than average can this time be included?

Yes, communicating effectively with patients is crucial to achieving clinical outcomes and a key part of a clinical service. A wide range of factors may affect the time needed to communicate effectively with a patient during a consultation. These include, but are not limited to, situations where a language barrier exists between the medical practitioner and patient (including when an interpreter is required), or when a patient has hearing problems, difficulty with speech, an intellectual disability, and/or dementia.

When claiming for time-tiered MBS items, the total consultation time includes the time required to communicate effectively with the patient. Where more time than usual is required to communicate effectively with a particular patient, it is considered reasonable to claim a longer attendance item than might otherwise be expected for the service. This applies to both face to face and telehealth services.

In such situations, medical practitioners and other providers should make a brief record in the patient’s notes including details about why the additional time was required. For example, stating ‘consultation extended due to use of interpreter’ and, if relevant, citing the Translating and Interpreting Service (TIS) job number.

Can I provide another medical service that is not a general attendance (e.g. a procedure or diagnostic test) and a general attendance to the same patient on the same day?

In general, yes. However, there are some limitations including:

  • both services must be clinically relevant and distinct services
  • the other item must not have restrictions on same day claiming as a general attendance item, and
  • the other item is not listed in MBS Group T6 (Anaesthetics) or T9 (Assistance at Operation).

Where more than one service is provided to a patient on the same day, the time taken for the second service (e.g. a procedure) must not be included in the consultation time for the general attendance.

Procedural items include all necessary components required to provide the service. This would include obtaining informed procedural and financial consent, the procedure itself, a discussion of the results of the procedure and (unless stated otherwise) the provision of routine aftercare.

Where the results of a procedure inform a further consultation on management, the consultation may be eligible for a Medicare benefit.

Can I provide more than one general attendance service to the same patient on the same day?

Yes, provided that the subsequent attendance is not a continuation of the first attendance, both services are clinically relevant and distinct, and the item requirements are met for both attendances. Further information is available in AN.0.7.

Are there specific requirements for any of the general attendance items?

Yes, several general attendance items have additional, specific requirements:

  • Telephone and telehealth (video) – patients can only access these services through their “usual medical practitioner” with limited exemptions. See AN.1.1 for further information. Some longer telephone items also require the patient to be registered with MyMedicare and can only be claimed at their registered practice.
  • After-hours attendance items – can only be claimed in specific time periods. See AN.0.19 (GPs) and AN.7.24 (OMPs) for further information.
  • Out of consulting rooms attendance items – have derived fee structures that vary with the number of patients attended or, in the case of some residential aged care facilities items, may be co-claimed with a flag fall item. See AN.0.11 (derived fees) and AN.35.1 and AN.35.2 (flag falls) for further information.
  • Residential aged care facility items – See AN.0.15, AN.35.1 and AN.35.2 for further information.
  • Items 179, 185, 189, 203, 301, 91906, 91916, 19794, 91806, 91807, 91808, 91926 – can only be claimed when the service is provided at a practice located in a Modified Monash 2-7 area. Practice locations can be checked on the Health Workforce Locator.

Can I claim a general attendance for providing aftercare?

No, you cannot claim a general attendance item if you performed the procedure that resulted in the need for aftercare.

However, the Health Insurance (Subsection 3(5) General Practitioner Post-Operative Treatment) Direction 2017 allows a medical practitioner working in general practice to use a general attendance item to provide aftercare provided that they did not perform the initial service that caused the need for aftercare. See AN.0.71 for further information.

ELIGIBLE PATIENTS

Any patient who is eligible to receive Medicare benefits is eligible for face to face (in consulting rooms and out of consulting rooms) general attendance items (business hours or after-hours).

Residential aged care facility-specific items are only available to Medicare-eligible patients that are residents of a residential aged care facility.

Patients must meet the “usual medical practitioner” requirement to access telehealth (video) and telephone items, unless an exemption applies (see AN.1.1 for more information). In the case of telephone items 91900, 91903, 91906, 91910, 91913, 91916, the patient must also be registered with the practice providing the service through MyMedicare.

ELIGIBLE PRACTITIONERS

General attendance items are available for different practitioner types:

  • general practitioner items can be claimed by general practitioners only (see GN.4.13).
  • medical practitioner items can be claimed by any medical practitioner that is not explicitly excluded in the relevant item descriptor.
  • prescribed medical practitioner items can be claimed by prescribed medical practitioners only (see AN.7.1).

CO-CLAIMING RESTRICTIONS

To co-claim a general attendance item and another item both services must be clinically relevant and distinct services.

General attendance items and chronic disease management items 229, 230, 233, 721, 723 and 732 cannot be claimed on the same day for the same patient. This restriction is set out in clause 2.16.11 of the Health Insurance (General Medical Services Table) Regulations 2021.
Further information on co-claiming of general attendance items and other MBS items is available in the AskMBS Advisory – General Practice Services #2.

RECORD KEEPING AND REPORTING REQUIREMENTS

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item(s) can be found on the Federal Register of Legislation at www.legislation.gov.au. Attendance items are set out in three regulatory instruments:

Related Items: 3 4 23 24 36 37 44 47 52 53 54 57 58 59 60 65 123 124 151 165 179 181 185 187 189 191 203 206 301 303 733 737 741 745 761 763 766 769 772 776 788 789 2197 2198 2200 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067 5071 5076 5077 5200 5203 5207 5208 5209 5220 5223 5227 5228 5260 5261 5262 5263 5265 5267 90020 90035 90043 90051 90054 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215 91790 91792 91794 91800 91801 91802 91803 91804 91805 91806 91807 91808 91890 91891 91892 91893 91900 91903 91906 91910 91913 91916 91920 91923 91926

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.11

Derived fee items for general practice

Last reviewed: 1 November 2023

Derived fees apply to a range of attendance items that are used when services are provided outside of consulting rooms, including some MBS items used in residential aged care facilities.

An item is a derived fee item if the MBS benefit payable depends on the number of patients that are seen at the location. Not all out of consulting rooms items are derived fee items. Some out of consulting rooms items attract a flag fall, instead of using a derived fee. See AN.35.1, AN.35.2 and AN.44.1 for further information on flag falls.

To facilitate assessment of the correct Medicare rebate in respect of a number of patients attended on the one occasion at one location, it is important that the total number of patients seen be recorded on each individual account, receipt or assignment form. For example, where ten patients were visited (for a brief consultation) in the one facility on the one occasion, each account, receipt or assignment form would show "Item 4 - 1 of 10 patients" for a general practitioner. 

The number of patients seen should not include attendances which do not attract a Medicare rebate (e.g. public in-patients, attendances for normal after-care), or where a Medicare rebate is payable under an item other than these derived fee items (e.g. health assessments, care planning, emergency after-hours attendance - first patient).
 

Related Items: 4 24 37 47 58 59 60 65 124 165 181 187 191 206 303 761 763 766 769 772 776 788 789 2198 2200 5003 5010 5023 5028 5043 5049 5063 5067