Maximising your billing potential

There are great potential billings when using Management Plans and Team Care Arrangements for patients in the correct way.  Understanding the relevant MBS codes is crucial for accurate billing. Below is a refresher on how you can be maximising your billings by thoroughly understanding the care plan process and using it appropriately for the care of your patients.

Evaluating how to use a GPMP

• GPMP item 721 and TCAs item 723 are available to patients in the community, and private patients who are being discharged from a hospital.
• items 721 and 723 are not available to public in-patients of a hospital or care recipients in a residential aged care facility
• item 731 is available to care recipients in a residential aged care facility

GPMP item 721 requirements

• explain to your patient the steps involved in preparing the plan and record their agreement to proceed
• assess to identify and or confirm the patient’s health care needs, health problems and relevant conditions
• agree on management goals and identify actions to be taken with your patient
• identify treatment and services for your patient and make any necessary arrangements
• the GPMP must be a comprehensive written plan describing the above
• offer a copy of the plan to your patient and add a copy to the patient’s medical record

TCAs item 723 requirements

• explain to your patient the steps involved in the development of the TCAs and record their agreement to proceed
• consult with at least 2 collaborating providers, who will provide a different kind of treatment or service to the patient
• prepare a document describing:
  • treatment and service goals for the patient
  • treatment and services that collaborating providers have agreed to give
  • actions to be taken by the patient and specify a date to review the TCAs.
• MBS item 732 is recommended every 6 months
• discuss with the patient the collaborating providers who will contribute to the TCAs and provide treatment and services
• offer a copy of the TCAs to the patient, give copies of the relevant parts of the document to the collaborating providers and add a copy of the document to the patient’s medical record

Multidisciplinary team for the purpose of TCAs

• A GP plus at least 2 other collaborating health or care providers, 1 of whom may be another medical practitioner, who will be providing ongoing treatment or services for the patient.
• Each of the health or care providers must be providing a different type of ongoing treatment or service. The non-GP collaborating providers need not be providers of Medicare eligible services.
• GPMP and TCAs should be undertaken by the patient’s usual GP. The patient’s usual GP is considered to be the GP, or a GP working in the medical practice, who has provided the majority of care to the patient over the previous 12 months or will be providing the majority of GP Services to the patient over the next 12 months.

CDM items claiming restrictions

• General practitioners are restricted from billing Chronic Disease Management (CDM) items and GP attendance items for the same patient, on the same day. For a comprehensive understanding of these restrictions and best practices, consider exploring our workshop on Mastering Medicare billing.
• This restriction prevents co-claiming GP attendance items with chronic disease management (CDM) items:721, 723, or 732
• If a GP claims both an attendance item and a chronic disease management item for the same patient on the same day, benefits will only be paid for the chronic disease management item.
• If the patient needs to see a different GP on the same day, Medicare benefits will be paid for that consultation.

Claiming frequency

• The recommended frequency of GPMP or TCAs is once every 2 years, with regular reviews, recommended every 6 months, of the patient’s progress against the plan. This should be applied with regard to the patient’s requirements.
• The minimum claiming period is 12 months. Where there has been a significant change in the patient’s clinical condition or care circumstances, more frequent claims can be made.
• If you are unsure whether the patient currently has a GPMP and or TCAs in place, contact Medicare on 132 150 .
• We suggest that practices create a system to call and encourage patients to attend an appointment for a review of their care plan.
• Item 732 can be claimed twice on the same day for a review of a GPMP and for a review of TCAs, as long as the MBS item descriptor and explanatory notes for item 732 are met.

Source: https://www.humanservices.gov.au/health-professionals/enablers/education-guide-chronic-disease-gp-management-plans-and-team-care