In this episode we continue the discussion from Episode 56 about medical billing in Australia. Almost 500  million Medicare rebates are processed every year and for the most part these are claimed appropriately. But non-compliant billing could be costing the health system over 2 billion dollars annually. The vast majority of this comes down to misunderstanding of the conditions around MBS items, according to our guest Loryn Einstein of Medical Billing Experts.

Every year the Department of Health shifts its attention onto a different specialty area to look at the statistical spread of claiming behaviour. Practitioners at the top end of the curve receive warning letters and flagged practitioners who persist with unaccountable billing behaviour will have their practice audited more thoroughly. Finally, they may be referred to the Professional Services Review, a sort of judicial panel made up of clinical peers.

Questions have been raised by professional bodies and lawyers about the sensitivity of these processes to clinical nuance or procedural fairness, and the lack of education available to practitioners. We hear responses to such concerns from the Department of Health.

Finally, we take a look at the huge range of private medical fees in Australia. Loryn Einstein considers how factors like regulation and supply and demand shape this market.

Guest
Loryn Einstein (managing director, Medical Billing Experts) 

Production
Written and produced by Mic Cavazzini. Tracks courtesy of Free Music Archive include ‘Shadow Lines’ and ‘Le Hustle’ – Polyrhythmiques, ‘Mr S’—Tortue Super Sonic, ‘Un desert’- Komiku, ‘Undercover Vampire Policeman’- Chris Zabriskie, ‘Friends and Apples’- Alpha Hydrae. Image licenced from Getty Images. 

Editorial feedback for this episode was kindly provided by members of the RACP’s Podcast Editorial Group; Sern Wei Yeo, Rhiannon Mellor and Seema Radhakrishnan

Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.