RM 2020/0714
Answer
No.
Context
Dr A was a rehabilitation physician who had heard that some geriatricians and physicians claim items 170, 171 and 172 for family meetings. Dr A described the family meetings as being different from usual case conferences or MDT meetings, which include allied health. Family meetings are basically the treating physician having a meeting with the family. The MBS description states ‘family therapy’ so the doctor wanted to know if that was the same as a family meeting.
Relevant legislative provisions
Other Relevant Materials
N/A
Case law
N/A
Departmental interpretation
“AN.0.5
Services not Attracting Medicare Benefits
Telephone consultations, letters of advice by medical practitioners, the issue of repeat prescriptions when the patient is not in attendance, post mortem examinations, the issue of death certificates, cremation certificates, counselling of relatives (Note ‑ items 348, 350 and 352 are not counselling services), group attendances (other than group attendances covered by items 170, 171, 172, 342, 344 and 346) such as group counselling, health education, weight reduction or fitness classes do not qualify for benefit.“
“AN.0.28
Family Group Therapy (Items 170, 171, 172)
These items refer to family group therapy supervised by general practitioner, specialist or consultant physician (other than consultant psychiatrists). To be used, these items require that a formal intervention with a specific therapeutic outcome, such as improved family function and/or communication, is undertaken. Other types of group attendances do not attract benefits. It should be noted that only one fee applies in respect of each group of patients.“
Detailed Reasoning
The starting point here is to understand that not everything you do attracts a Medicare benefit, because some things are just part of your job.
For example, putting up a drip, giving a steroid injection into a joint and taking blood are just some examples of common tasks that do not attract a separate rebate because they are covered by billing an attendance item.
Another service that does not now and has never attracted a separate rebate is talking to relatives.
As with all Medicare billing, you must satisfy all requirements of every item you claim. Items 170-172 specifically use the term ‘therapy’ and this has been interpreted by Medicare as requiring a formal intervention with a clear and specific therapeutic outcome.
This is not the usual work of rehabilitation physicians, nor geriatricians nor general physicians, though there may be some exceptions if specific practitioners have additional experience or training in delivering therapy.
In this scenario, if the most accurate description of the encounter is that you (the doctor) spends an hour with the patient’s relatives to discuss the patient, this is not therapy, because there is no formal intervention, it is just you doing your job bringing the family up to speed with progress and plans for their relative. Whether or not the patient is present does not change this. A family meeting is not therapy unless it’s purpose is to deliver a formal intervention with a specific therapeutic outcome, both of which should be clearly described in the adequate and contemporaneous records you keep in the patient’s file.
Based on the information in the question, these items cannot be claimed because the item descriptor requirements have not been met.
However, if you wish, you can charge a private fee to the relatives, without an item number, so the service is not claimed through Medicare.
Examples and other relevant information
N/A
Who this applies to
All medical practitioners able to claim items 170-172
When this applies
Always