About

MBS (Medical Billing System) Answers was born out of the Covid-19 Pandemic.

On 13 March 2020, when the government introduced new Medicare telehealth services to deal with the Covid crisis, there was both excitement and chaos in the medical market.

So much changed so quickly. And whilst the rapid response of the government was welcome, confusion about how to correctly bill the new Covid services prevailed. Doctors urgently needed answers to important questions to avoid being prosecuted for incorrect billing post pandemic. A common question was around unprecedented forced bulk billing. Everyone was asking – can the government force us to bulk bill? What happens if I don’t? What is the penalty? There were no answers.

Like so many people, I wanted to help our front line health workers in whatever way I could but felt pretty useless. While I sat in my safe, comfortable, Covid free, home office, they put themselves at risk every day.

I thought, well the one thing I can do is help them understand how to bill the new services correctly, and it seemed the time was right to end decades of secret medical billing business in this country and put myself on the line, just as they were, by making my advice public. It felt right.

So, I started a blog on 16 March 2020 answering billing questions, hoping it might be of benefit, and it took off.

Before I knew it, I was sitting up late every night answering good questions from genuinely confused providers (not just doctors) who wanted to bill correctly but were really struggling to know how. The questions kept coming for months, are still coming, and the blog has now been posted over 50 times, answering near 250 questions, and subscriber numbers are through the roof.

It seemed the niche area I had accidentally carved out for myself over decades had some value for providers and the model seemed to work. For the first time in Australian history, providers felt safe asking medical billing questions (no matter how basic, naive or crazy) because they were posted anonymously, and the answers (written by a practising solicitor specialised in the field) were shared publicly so everyone could benefit and learn.

Knowing how to bill correctly is critical for the sustainability of fee-for-service systems like Medicare, which are inherently vulnerable to abuse, because correct billing relies heavily on system knowledge and the personal integrity of each provider. However, it is not always easy to know how to bill correctly when the ‘rules’ are opaque and confusing.

So, the Covid blog became what might be described as a community of clarity, and I enjoyed doing the work very much. I hope this new forum assists providers to know what they can and can’t do when billing to Medicare and other payers, because whilst demand for health is infinite, Australia’s health budget is not. So, it is in everyone’s interests to bill correctly and ethically, because the sustainability of our health system depends on it.

Margaret Faux, June 2020

Why are we providing this service?

Because continuing this service post-Covid is the right thing to do.

Feedback from the Covid Bulletins was overwhelmingly positive. We received so many generous and thoughtful comments from doctors and other health workers who expressed their gratitude for the initiative and who were impressed at the level of legal detail in the answers. Many described their experience following the blog as illuminating and said they had learnt things about Medicare they had never known in all their years of practice. They were keen for the service to continue. So, by the time this site went live, there was already a long queue of excellent, complex, non-Covid medical billing questions awaiting answers.

When you think about it, this service, or one like it, should always have been available somewhere. Medical billing rules should be clear, reliable, and easily accessible so that clinicians can go about their work without constant fear of being audited for something they didn’t even know was wrong.

How it works

We are retaining the Covid blog model described above where you submit a question through the online portal, and we will answer it as soon as we can, though the style and format on this platform is more formal than the Covid Bulletins.

Answers will be provided to medical billing questions relating to any aspect of the entire system of medical billing in Australia, in both the public and private sectors, including Medicare and the MBS, the Private Health Insurers, workers compensation and any other third party payer arrangements.

However, because the service is free and intended to resolve genuine challenges and areas of confusion, we cannot answer questions about which item numbers you can bill generally, or how to set up your practice.

Please contact your MDO with any questions not related to medical billing.

You must identify yourself to us as we may need to contact you personally about your question, but the answer to your question will be posted anonymously and shared publicly, so everyone can benefit and continue to improve their medical billing literacy.

You should also read our Terms of Use and Privacy Policy for more information.

Please be patient. Medical billing law is every bit as complex as tax law, and sometimes complex questions may take a while to answer.

Who writes the answers?

Answers are written exclusively by Dr Margaret Faux.

Dr Margaret Faux is a Solicitor of the Supreme Court of NSW and the High Court of Australia, having practiced law for over two decades. Margaret is an academic scholar of Medicare and health insurance law, has a PhD on the topic of Medicare claiming and compliance and has published in peer reviewed journals.

Margaret has also been administering medical billing since Medicare began (across every medical specialty), is a Registered Nurse, and the founder and CEO of global medtech company, Synapse Medical, which operates one of the largest medical billing services in Australia via an app based billing system with Australia’s only medical billing rules engine. Margaret is considered one of Australia’s leading experts on the operation of Medicare and contributes widely to the national health reform debate. You can read her publications here.

Can I rely on the answers?

Most modern law firms provide online information and answers to common questions across their areas of practice. Being the website of Dr Margaret Faux, Solicitor, this is no different. The answers on this website represent Dr Margaret Faux’s legal opinion in response to each question.

The answers will follow a standard legal format, which, as indicated above, is more formal and structured than the Covid blog.

Where the answer is definitive it will be written in clear unambiguous terms with a straight ‘Yes’ or ‘No’ answer. An example is the bulk billing signature law which applies to everyone and is absolutely correct.

However, medical billing law is often ambiguous and much of it has not been tested in our courts, so some answers will have limitations and qualifications which will be indicated such as by use of words and phrases like: ‘Yes, provided that…’, ‘In our opinion, no…’

We will also indicate who the answer applies to at the bottom of the template. For example, supervision rules that apply to oncologists and haematologists may not apply in the same way to neurologists and pain specialists.

Medicare law changes constantly so you should check this site regularly for updates. we will endeavour to update quickly when important changes occur, but cannot guarantee we will always do that the day it happens.

Changes will be made on the original post but all previous versions will be retained through our versioning system so you can flick through the history of each post to see when and what changes were made.

You should also read our Terms of Use and Privacy Policy for more information.

It’s free! What’s the catch?

There’s no catch. Honestly, we are doing this as a service to the medical community and are not being paid for it.