At the behest of a local practice, the Federal MP for Page, Kevin Hogan, has resolved contradictory government advice about whether medical practitioners can bill Medicare for providing medical reports for NDIS clients.

Mr Hogan (and Health Minister, Greg Hunt) was contacted in early June by the Practice Manager of the Lismore GP Super Clinic, Terese Forzan, seeking clarification on whether GPs could “bill Medicare for a consult item for the time taken to complete a National Disability Insurance Agency (NDIS) form.”

Ms Forzan added, “Medicare has advised its Directions made under subsection 19(5) of the Health Insurance Act do not cover a consult item for the completion of a NDIS form.”

Calling this a matter of “national importance’, she said the situation was confusing to local doctors, and clear advice from the ministerial level was required.

A written response from the Department of Human Services Health Support & Business Services Division passed the parcel to another Department, advising that, “Policy for the National Disability Insurance Scheme (NDIS) and its administration, including medical reports to determine eligibility under the NDIS, is the responsibility of the Department of Social Services (DSS).”

It is reasonable to expect that doctors will perform an examination of some description…” – Federal Dept of Health

It added, “To date, there are no subsection 19(5) Directions in place which would allow Medicare benefits for a consultation to complete a NDIS form.”

Dissatisfied with this response, Ms Forzan contacted Mr Hogan again, seeking further information.

The MP has since replied, advising, “I can confirm that the time taken by medical practitioners to complete a medical report for the purposes of the NDIS may be claimed under a Medicare item when the report is completed as part of a consultation. 

When a treating doctor’s report is completed without an associated consultation and without the customer present, a Medicare rebate is not payable… In completing a treating doctor’s report, it is reasonable to expect that doctors will perform an examination of some description to assess or confirm the person’s current medical condition. This examination requires a consultation.

 “It is the doctor’s discretion to choose the Medicare item number relevant to the level of consultation and to the area of medicine in which s/he practices (be that as a General Practitioner, psychiatrist, paediatrician or another specialist).  This means that doctors claim the Medicare Schedule item number that most appropriately reflects the nature of the consultation.

 “It is for the doctor providing the service to judge the level of complexity and bill accordingly….”