Medicare Provider Number - Application by Medical ...



Canberra Health ServicesOperational ProcedureMedicare Provider Number - Application by Medical Practitioners Contents TOC \h \z \t "Heading 1,1" Contents PAGEREF _Toc30585906 \h 1Purpose PAGEREF _Toc30585907 \h 2Scope PAGEREF _Toc30585908 \h 2Procedure PAGEREF _Toc30585909 \h 2Implementation PAGEREF _Toc30585910 \h 4Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc30585911 \h 4References PAGEREF _Toc30585912 \h 4Definition of Terms PAGEREF _Toc30585913 \h 4Search Terms PAGEREF _Toc30585914 \h 5PurposeThis procedure outlines the process by which Medical Practitioners can apply for a Medicare Provider Number.Back to Table of ContentsScopeThis procedure applies to all ELIGIBLE Medical Practitioners who refer patients to other Medical Practitioners and/or to utilise the Medicare Benefits Schedule (MBS) for billing purposes, as part of their employment or engagement including but not limited to:Canberra Health Services (CHS) including all services provided in the community and through Justice Health ServicesUniversity of Canberra Hospital Centenary Hospital for Women and ChildrenThis constitutes most Medical Practitioners who work for CHS.Responsibility for management of Medical Practitioner’s provider number rests with the Medical Practitioner, however the Clinical/Executive Director of the recruiting Division will provide written support of any applications for Medicare Provider Numbers where required.Out of ScopeThis procedure does not apply to Medical Practitioners who are unable to obtain a Medicare Provider Number.Back to Table of ContentsProcedureA Medicare Provider Number uniquely identifies the Medical Practitioner and the location from which a service is rendered or referred. The Department of Human Services allocates provider numbers, pursuant to sections 19AA and 19AB of the Health Insurance Act 1973. On allocation, Department of Human Services clearly specifies the valid use of the provider number i.e. for billing and/or referral purposes, at what level of rebate and for what period of time. Medical Officer Support Credentialing Education and Training Unit (MOSCETU) CHS, provides an information pack to all new Junior Medical Practitioners as part of their offer of employment. This includes information to support the application for a Medicare Provider number and steps to take when there may be restrictions such as 19AA and 19AB.It is recommended that Junior Medical Practitioners apply for a provider number on acceptance of an offer of employment with CHS, in advance of commencement as far as possible. Referral or billing of patients cannot commence until the provider number is received and Medicare eligibility is confirmed. All Senior Medical Practitioners will be approached by the Patient Accounts team to discuss the No Out of Pocket Expense (NOOPEX) program, for the admission of private patients into our facilities. To support the application process for billing, the Practitioner will be required to complete other revenue-based documents, including but not limited to:Medicare – Online Claiming Provider AgreementAustralian Health Service Alliance (AHSA) Provider Details and Direct Credit Authority –Provider ApplicationQuestions about the establishment of billing or NOOPEX are to be directed through to the Manager of the Patient Accounts team: Email: CHHSBilling@.au Contact: (02) 6207 6131.Responsibility for management of the Medical Practitioner provider number rests with the Medical Practitioner, however the Clinical/Executive Director of the recruiting Division will provide written support of any applications for Medicare Provider Numbers where required.If a Medical Practitioners application is declined, the Medical Practitioner should seek support and guidance in this process from the relevant Clinical Director and or Executive Director. Assistance with this process is also available from MOSCETU: tchmosu@.au Further information is available from: Department of Human Services: Workforce Regulation Section Fax: (02) 6289 7900 Email: 19AB@.auMedicare Australia: 132 150 (all states) or medicare.prov@.au EvaluationOutcome MeasuresMedical PractitionersMedical Practitioners will have a valid provider number for referring and billing purpose, prior to commencement of providing service to patients.Patient AccountsWill report on those Medical Practitioners that do not have a valid provider number through to the Medical Practitioner’s Division Executive Director.Back to Table of Contents Implementation This procedure will be available to staff on the policy register and will be communicated to relevant staff through their line managers during orientation.Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationPolicyCredentialing and Defining the Scope of Clinical Practice for Senior Medical and Dental PractitionersCharges for Medicare Non-eligible patients presenting for outpatient treatmentLegislation Health Insurance Act 1973Health Insurance (Section 19AB Exemptions) Guidelines 2012Migration Act 1958Health Practitioner Regulation National Law Act 2009Back to Table of ContentsReferencesDepartment of Health and Ageing Doctor Connect website: Department of Human Services Medicare website: Australian Government Federal Register of Legislation website: Back to Table of ContentsDefinition of Terms Medicare Provider Number: means a location specific number allocated by Medicare Australia to a Medical Practitioner or other eligible health professionals to allow claiming of a Medicare benefit. Throughout this document the simple term provider number is generally used.Medical Practitioner – means a Specialist, Senior Specialist, Visiting Medical Officer (VMO), Resident Medical Officer (RMO), Career Medical Officer (CMO), Registrar, Senior Registrar or Fellow level appointment employed by CHS. Specialist - means a person who a) Is a registered Medical Practitioner; andb) After full registration has spent not less than five years in the practice of medicine; andc) Has spent not less than three years in supervised specialist training and/or experience; andd) Has obtained an appropriate higher medical qualification in his or her specialty acceptable to the Health Directorate.Medical Benefits Schedule (MBS): means a listing of the Medicare services subsidised by the Australian Government. The schedule is part of the wider Medicare Benefits Scheme managed by the Department of Health. (changed its name).Back to Table of ContentsSearch Terms 19AB, Billing, Waiver, Medical Practitioner, Financial Information, Medicare, Revenue, Invoicing, Medicare Number, Provider Number, NOOPEX, Doctor, MOSCETUDisclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Policy Team ONLY to complete the following:Date AmendedSection AmendedDivisional ApprovalFinal Approval 18/09/2019Complete ReviewAndrew Gay, ED FBICHS Policy CommitteeThis document supersedes the following: Document NumberDocument NameDGD13-039Medicare Provider number Application by Medical Practioners ................
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