The Department of Human Services have recently completed the first phase of compliance activities relating to Medicare Benefits Schedule (MBS) items 104, 105, 110, 116 and 119. The first phase identified claiming of referred attendance items without a valid referral, as well as identifying a secondary concern that many health professionals claimed more than one initial attendance (MBS items 104 or 110) for the same course of treatment.
The ASO has been advised that a second phase of compliance activities relating to these items has now commenced. These compliance activities will involve a mixture of randomly selected of health professionals and targeted health professionals where it appears that they have claimed the following:
- more than one initial attendance (MBS item 104 or 110) for the same patient using the same referral details (referring health professional and date of referral);
- subsequent attendances (MBS item 105, 116 or 119) where the department cannot identify an initial attendance for that patient with the same referral details;
- initial attendances (MBS item 104 or 110) where our data shows the referral date is more than 12 months prior to the date of the attendance.
If you have any concerns or would like to discuss this matter further please contact the ASO on (07) 3831 3006 or email firstname.lastname@example.org
A full copy of the correspondence can be viewed here.