Telehealth Billing

Telehealth Billing

The following information on funding schemes is currently available for OTs providing or considering telehealth services.

Medicare Benefits Scheme

Temporary MBS telehealth items have been made available to occupational therapists to reduce the risk of community transmission of COVID-19 and provide protection for patients and health care providers. All eligible Australians can access telehealth consultations where it is safe and clinically appropriate to do so.

Provider are expected to obtain informed financial consent from patients prior to providing the service; providing details regarding their fees, including any out-of-pocked costs. View more information on the MBS Telehealth Update to Bulk Billing here.

Latest MBS Telehealth Update 20 April
Occupational Therapy Australia advises that the Health Minister, the Hon. Greg Hunt, has amended telehealth legislation to provide allied health practitioners and other health professionals with the option to bulk-bill or patient-bill a wider range of MBS telehealth consultations.

Allied health practitioners may now charge a co-payment for services provided to children under 16, concession card holders and those vulnerable to COVID-19. These changes come into effect from today (20 April, 2020). The amended legislation helps ensure the continued viability of specialist and allied health services under Medicare.

The Minister noted the positive way in which government and the health professions have worked together to ensure the ongoing delivery of care in very difficult circumstances. Read the Minister’s media release here. Details of the additional telehealth items are on the MBS website.

Department of Veterans Affairs

Based on the Federal Governments announcement on further changes to primary and allied healthcare arrangements in response to the ongoing COVID-19 pandemic, the Department of Veterans’ Affairs (DVA) has updated fee schedules to allow all DVA clients to access allied health services via telehealth, where clinically necessary. 

DVA Schedule of Fees

DVA Schedule of Fees (Mental Health)

The schedules includes a new section which highlights those fee items that can be claimed under COVID-19 telehealth arrangements, as well as some treatment cycle clarifications that were previously circulated.

Telehealth Arrangements
Some existing fee items are now claimable for treatment provided by telehealth. Phone consultations are available but should only be provided when video conferencing is unavailable. The relevant items are also claimable for telehealth treatment delivered to clients in hospital or residential aged care facilities, where prior approval is not required.

Treatment cycle arrangements continue to apply for DVA clients seeking to access allied health services through telephone and video conferencing at this time.  Where required, clients may also access a GP referral or re-referral for clinically required allied health treatment via a telehealth consultation.

Allied health providers are able to claim for telehealth items from 1 April 2020 until 30 September 2020.  An assessment will be made by Government prior to 30 September to determine whether an extension of arrangements will be required.

DVA appreciates the commitment shown by our many allied health providers in continuing to provide essential services to our DVA clients. This commitment is even more important at this time of unprecedented national crisis.

NDIS

Allied Health Professions Australia (AHPA) advises that the National Disability Insurance Agency (NDIA) is soon likely to update its guidance for providers and participants, and that this guidance will be around the agency’s Telehealth provisions. Telehealth is available as an option for providers and providers can engage with participants and families now. Visit this page for general information—please check the page regularly.

Private Health Insurance

OTA has prepared a submission to the Private Health Insurance Funds, outlining what OT services can be effectively delivered by means of Telehealth. OTA has taken this opportunity to remind the funds, yet again, that – compared with other allied health professions – occupational therapy is regrettably undervalued. We have received the following communication so far regarding funding from private health insurers to provide telehealth services.

The Private Health Insurance Fund HCF has advised OTA of the following:

The COVID-19 pandemic is causing unprecedented changes to many of our lives. The reality is that during this period of restricted activities patients need solutions that empower them to seek appropriate treatment for their circumstances and make the most of their health benefits.

Your professional association provided a case for telehealth service provision during this time, and taking this into account, we are relaxing the requirement for one to one consultations to be delivered in person. 

HCF members will be able to claim for one-to-one consultations via telehealth as well as face to face from your members who are HCF recognised providers. This exception will be temporary – applying to services delivered between 30 March and 30 June 2020 (with the latter date subject to further review during the period). 

WHAT HEALTH PROVIDERS NEED TO KNOW

The specific item numbers which are eligible for an HCF telehealth benefit are listed on the HCF Provider Telehealth Claim Form. This can be found HERE.  

Telehealth is not a defined term, and so we ask that health care providers conducting their consultation by telehealth, to complete and sign the telehealth claim form and attach it to their invoice so HCF members can claim. 

HCF members can claim for telehealth services using the HCF photo app.

OTA has received Telehealth Guidelines from BUPA to guide your telehealth practice. The private health funds are all independent entities, advised by but not beholden to, Private Healthcare Australia (PHA). OTA has in recent days liaised with AHPA, PHA and individual health funds, outlining those aspects of occupational therapy that can be effectively delivered by Telehealth. We will advise OTA members of each private health fund’s position as we are advised. View the Guidelines here. 

Latest Update
Private Healthcare Australia has introduced a new set of Telehealth items which Bupa will be adopting. It is important that practitioners make the switch to using these new codes to denote Telehealth consultations as this will allow retrospective examination of utilisation data to inform us as to how we might proceed with discussions regarding Telehealth services in the future.

Current Item

New Telehealth Item

100

601 Individual Initial/Referred Assessment by teleconsultation

200

602 Individual Subsequent Treatment by teleconsultation

HBF have approved some initial Item numbers for use via Telehealth

H601 Individual Initial Assessment Telehealth At least 45 minutes via video
H602 Individual Subsequent Treatment Telehealth At least 30 minutes via video
H602 *new* Individual Subsequent Treatment Telehealth 20-30 minutes via video

Telehealth benefits will be temporarily available on services certain occupational therapy treatments. It’s important to remember that benefits towards telehealth treatments are available only on a selection of specific treatments within each service category.

*HBF introduced a new temporary item number to allow claiming for subsequent Occupational Therapy treatments provided via telehealth with a duration of 20 - 30 minutes. Although the new item number was introduced on 11 May 2020, if a service was provided on or after 1 April 2020, and the treatment meets all eligibility criteria,  HBF will pay a benefit.

Currently benefits are available until 30 June 2020, however HBF will continue to monitor the impact of COVID-19 and notify any changes. Further information on HBF telehealth Item Numbers is available here https://www.hbf.com.au/members/useful-articles/telehealth-treatments

Account requirements

In addition to account requirements outlined in the HBF Approved Provider Terms & Conditions, the account must clearly indicate:

  • Required Delivery Method – i.e. phone call or video conference
  • Treatment start and end times (e.g. 1pm to 1.30pm)
  • Duration (e.g. 30 minutes)

HBF staff and systems will be utilising the following item numbers and descriptions.

For more information visit the HBF website: https://www.hbf.com.au/members/useful-articles/telehealth-treatments

Telehealth Item Number Guide for Occupational Therapists

ITEM NUMBER FULL DESCRIPTION ABBREVIATED DESCRIPTION
601 Individual Initial/Referred Assessment by teleconsultation IND INT ASMENT TC
602 Individual Subsequent Treatment by teleconsultation IND SUB ASMENT TC

Private health insurer, nib health funds, has announced that in light of COVID-19 it will fund individual telehealth occupational therapy services from 6 April until 30 June 2020, at which time it will be reviewed to ensure it meets the needs of their membership and, if required, extended.

The following services are eligible for funding.

Occupational Therapy

Item Code 601 Individual Initial/Referred Assessment by teleconsultation

INDIVID INIT ASSESS T/C

HiCaps code 602 Individual Subsequent Treatment by teleconsultation

INDIVID SUB TRMT T/C

  • Occupational therapists are expected to adhere to the standards/code of conduct of OTA  and any specific telehealth guidance and training including, but not limited to, these requirements:
    • Ensure that telehealth services are delivered with the adequate security, privacy and consent in place.
    • Adequate assessment is undertaken to ensure that services are only delivered via telehealth where it is safe and effective.
    • AHPRA’s published guidelines in relation to telehealth that are also observed. These can be accessed here
  • Service providers need to work with nib members, their patients, to ensure their presenting symptoms can be safely and effectively managed via a telehealth mode of delivery.
  • Service providers must ensure that they are working within their competency to deliver safe and effective care via telehealth.
  • nib members are eligible to receive benefits for telehealth where they are covered for the face to face service on their policy.
  • Normal fund rules and provider terms and conditions apply.
  • Individual consultations only are covered.

Medibank and ahm have recently announced that eligible customers with extras cover will be able to claim for selected services where telehealth can be delivered effectively as an alternative to a face-to-face consultation.

These services include physiotherapy, dietetics, occupational therapy, podiatry, exercise physiology, and speech therapy. This follows the introduction of psychology telehealth on 30 March 2020. Both Medibank and ahm will pay benefits towards individual (one-on-one) telehealth consultations for services by 14 April 2020 through to 30 September 2020. Some conditions apply.

Cover is available for eligible Medibank and ahm members, who have an extras product that includes cover for the occupational therapy where*:

  • The patients is undergoing an existing course of treatment or has been a patient of the clinic/health professional in the past six months, (as preference for efficacy supported by telehealth outcomes
  • For new patients, consultations will remain available but preference for GP or treating specialist to provide recommendation for treatment options where possible

Note, the clinician should use their clinical reasoning to determine if the patient is clinically appropriate to receive the service via telehealth. The clinician must work within their scope of practice and the service should be undertaken in accordance with Occupational Therapy Australia’s telehealth policy and guidelines.

* Normal waiting periods and annual limits apply to telehealth consultations.

New Item numbers and Submitting Claims

Medibank members can submit claims through usual channels including My Medibank and the MyMedibank app. When they login to My Medibank, there will be a message on that page providing directions on how to make these claims.

ahm members can submit claims through channels including online, ahm app or email.

Please note, telehealth claims will not be able to be submitted via electronic claiming channels (HICAPS and Healthpoint).

Medibank and ahm will accept the following new telehealth item numbers and descriptions. These telehealth item numbers are available for all Medibank and ahm recognised providers, not just our Medibank Members’ Choice providers.

The benefits paid towards these telehealth consultations the same as the equivalent face-to-face consultation

Modality

New code

New description

Established /Equivalent code

 Established /Equivalent description

Occupational Therapy

601

Individual Initial/Referred Assessment by teleconsultation 

100

initial Individual assessment

Occupational Therapy

602 

 Individual Subsequent Treatment by teleconsultation

200

individual assessment/Treatment

With regard to the recent announcement here is the link to the Medibank newsroom.

https://www.medibank.com.au/livebetter/newsroom/post/medibank-and-ahm-boost-access-to-telehealth-during-covid-19-pandemic

Further information for providers can be found here.

The following Telehealth benefits for Occupational Therapy have been introduced by Police Health and Emergency Services Health, effective from 1 April 2020 in response to the COVID-19 pandemic.

Services for Telehealth Individual Initial Assessment and telehealth Individual Subsequent Treatment  have been approved for benefits within these health funds.

The rules around Telehealth claims for Occupational Therapy are reasonably straightforward:

Telehealth services are applicable where:

  • The patient is undergoing an existing course of treatment, and has seen the physiotherapist providing the telehealth consultation over the past 6 months, or
  • For new patients, the telehealth service has been recommended by their general Practitioner, relevant medical specialist or continuation of care in a health management or hospital discharge plan, and
  • The service is delivered using audio and visual communication (such as Zoom, Skype or Facetime), and
  • The service is undertaken in accordance with the Occupational Therapy Scope of Practice Framework.
  • Services are provided from 1 April 2020 to 30 September 2020.

For services meeting the above criteria, an account issued to the member, appropriately itemised and including a notation for telehealth or video consultation will be sufficient for member benefit purposes.

The Funds note the possible introduction of telehealth services within HICAPS, but advise that Police Health and Emergency Services Health membership cards will not be enabled for Key Entry of the card number and as such all claims will need to be submitted by the member.

Defence Health is recognising occupational therapy telehealth consultations (effective from 13 March 2020). This is an important benefit available for ongoing therapy as well as newly referred clients. The information can now be found on this document.

State/Territory Based Compensable Schemes

In the current environment of the COVID-19 virus, SIRA supports the use of telehealth services delivered by Occupational Therapists (OT) where it is appropriate and reasonably necessary for an OT to deliver that service via telehealth.

Practitioners must consider the appropriateness of this mode of service delivery for each worker on a case-by-case basis. Practitioners are responsible for delivering telehealth services in accordance with the principles of professional conduct and the relevant professional and practice guidelines to ensure that all care is taken to ensure the safety, appropriateness and effectiveness of the service.

Please note all Telehealth services require pre-approval from the insurer and must be consented to by all parties – the worker, practitioner and insurer.

There are no Fees Orders for Occupational Therapists, however for services delivered by a non SIRA approved practitioner that are similar in nature to that of a SIRA approved practitioner (eg hand therapy by an occupational therapist is similar service delivered by a physiotherapist) it is recommended the relevant gazetted Physiotherapy Fees Order  be used as a guide for the cost of services.

NIISQ Agency aim to ensure that treatment, care and support for NIISQ participants continues to be provided with no, or minimal, disruption.

  • NIISQ Agency will fund the provision of necessary and reasonable treatment, care and support services via tele-health and these will be assessed on a case-by-case basis
  • Service providers can continue to provide quotes for their services, based on the services that are required for each individual participant. Refer to the NDIS Price Guide to benchmark fees for services.
  • There is a delay finalising re-registration for those who sought registration as case management service providers – current registration status will be maintained through any delay
  • For more information visit the NIISQ Agency Covid-19 webpage

Workcover Queensland supports telehealth as a method of delivery.

Telehealth services are only related to video consultations. Phone consultations are not covered under the current Table of Costs.

The following should be considered prior to delivering the service:

  • Providers must consider the appropriateness of this mode of service delivery for each worker on a case-bycase basis i.e. the principles and considerations of good clinical care continue to be essential in telehealth services.
  • Providers are responsible for delivering telehealth services in accordance with the principles of professional conduct and the relevant professional and practice guidelines to ensure that all care is taken to ensure the privacy, confidentiality, safety, appropriateness and effectiveness of the service.
  • As with any consultation, it is important to provide sufficient information to enable workers to make informed decisions regarding their care.
  • All telehealth services require prior approval from the insurer and must be consented to by all parties – the worker, provider and insurer.

For billing purposes, telehealth services do not have specific item codes and should be invoiced in line with the current item codes and descriptors in each Table of Costs. “Telehealth” must be noted in the comments section on any invoice submitted to the insurer when this service has been utilised.

ReturnToWorkSA has created two new occupational therapy telehealth fee items in response to the COVID-19 health emergency. Some points to highlight regarding the new fees are: these fees are available to workers with an existing claim, an Occupational Therapy Management Plan is required and there is a maximum of 10 sessions. These new fees are available to download here.

After significant lobbying from OTA, TAC is now implementing telehealth item codes for occupational therapists, GPs and other allied health services. The new rates will allow you to be paid at your current TAC face-to-face rate when you deliver telehealth services to TAC clients. These arrangements will remain in place until 30 September 2020 to ensure TAC clients can continue to access essential treatments and services during these challenging times. Telehealth invoices can be backdated to 13 March 2020.

Telehealth items have now been added to LanternPay allowing you to invoice us online and get next business day payments. Go to lanternpay.com/providers to sign in or register, or visit tac.vic.gov.au/lanternpay for more information.

WorkSafe Victoria is introducing temporary measures to support the continuation of essential health services for injured workers. WorkSafe will introduce temporary item codes to allow occupational therapists to deliver services via telehealth. Learn more here

To help minimise social contact, WorkCover WA is allowing allied health telehealth consultations using the relevant service code (and fees) that apply to consultations generally. Learn more on the WorkCover WA website

Last updated: 9 April 2020

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