Speech Pathologist: Telehealth claiming guide

Adrian Miles | May 27, 2020

With approximately 30% of the Australian population living in regional, rural or remote areas, telehealth provision has been essential in addressing the disparities in the availability of speech therapy practitioners in these areas compared to urban areas for the past decade [1]. 

As of 13 March 2020, Medicare announced the release of new temporary Medicare Benefits Scheme (MBS) telehealth items for speech therapists as part of the mission to reduce the community transmission of COVID-19. As aspects of telehealth provision and regulations are a confusing topic for many, we’ve answered the most common enquiries regarding telehealth services for speech therapists, including provider and patient eligibility and claiming processes, below.

Provider eligibility

As a speech therapist practising in Australia, you do not require any additional accreditation or approval to start providing telehealth services under the MBS, aside from your standard Medicare provider number. This remains consistent regardless of the COVID-19 temporary benefits.

Provider technology

To satisfy MBS criteria, telehealth consultations can be completed via either videoconferencing or audio-only. The items you claim will differ depending on whether you have consulted via video or audio. The MBS states that there are no specific equipment requirements, and widely available video calling apps like Zoom and Facetime can be used. Speech Pathology Australia (SPA), however, recommends that the technology used should be driven by your client’s needs, and that you should familiarise yourself with a variety of technology options including for webcams, audio, interactivity platforms and your connectivity. Read more on these options here

Provider location

You do not need to be in your regular practice to provide telehealth, but you should use your provider number for your primary location throughout COVID-19. 

Practice recommendations

Aside from meeting the MBS eligibility, SPA recommends taking appropriate steps to reduce your professional and clinical risk including obtaining informed consent, having indemnity insurance, respecting privacy requirements, having an emergency plan, and considering whether a recording of the session is clinically justified.

Patient eligibility

From 13 March 2020 to 30 September 2020 (inclusive), all Australian residents that hold a valid Medicare card and are not admitted into hospital or an emergency room at the time of consultation are eligible to receive both new existing MBS telehealth services and existing MBS telehealth services. There are no geographical restrictions between the patient and provider, and the services do not need to have any relation to diagnosing, treating or suspecting COVID-19. 

Patient technology and other requirements

It is important that you let your patients know if they require any additional tools or technology to complete a consultation with you, especially where it is a video consultation. You should also make it clear to your client, or their carer, whether a carer or facilitator is required at their appointment. This can include parents, partners, health assistants, support workers and other professionals.

Speech Pathology Australia 

Aside from government regulations, SPA has provided guidance and resources to ensure that practitioners are following the Association’s code of ethics, are familiar with SPA’s position statement when it comes to telepractice in speech pathology, and understand that they are bound by other core documents.

MBS, insurers & telehealth

Medicare benefits scheme

Under the MBS scheme, you are able to claim for telehealth consultations for:

  • Chronic disease management

  • Autism management - assessment/diagnosis - early intervention for children with autism, pervasive developmental disorder or disability, under 13 years

  • Autism management - treatment - for children with autism, pervasive developmental disorder or disability, under 15 years

  • Follow-up chronic disease management for those of Aboriginal or Torres Strait Islander descent

You will find the item codes to claim for the appropriate appointment length on the noted pages of this document. You will find three item codes for each item, depending on whether it’s a video telehealth item under the temporary MBS benefits, audio telehealth item under the temporary MBS benefits, or is an existing item (outside of the COVID-19 temporary items) where geographical restrictions may apply.

All services provided using the MBS telehealth items must be bulk billed for Commonwealth concession cardholders, children under 16 years of age, and patients who are more vulnerable to COVID-19. For a full list of those that are considered vulnerable at this time, see page 2 here.

Funding telehealth services

There are a number of funding streams that support telehealth for speech pathology, alongside standard payment directly from the client. This includes:

  • NDIS - clients under NDIS may claim telehealth speech pathology services, regardless of how their plan is being managed
  • MBS - as per the above, MBS is covering specific speech pathology services up to and including 30 September 2020
  • DVA - consultations and clinical assessments may be delivered by speech pathologists to all eligible DVA clients via telephone or video conferencing attendance for the period 1 April to 30 September 2020

Private health funds

A number of private health funds, including ahm, Bupa, Medibank, NIB and others have made provision where customers that already have extras cover for speech pathology can access these services via telehealth. To confirm if your client is eligible, either you or they must contact their private health insurer and assess their level of cover and extras inclusions. If they are eligible, you must bill the patient directly for their consultations, and they must then make a claim to their insurer online. Remember, different time periods apply for different health funds, with many ending this extension on June 30, 2020.

While speech therapists were previously required to bulk-bill all telehealth consultations claimed under MBS during COVID-19, as of April 14th, this is no longer necessary and you may charge a gap fee if your patient is not aged under 16 or considered vulnerable. 

Claiming telehealth with Medipass

Medipass is an innovative cloud-based claiming platform that is helping speech therapists raise and settle claims from anywhere without a physical terminal. Medipass supports all claiming pathways including existing and new MBS telehealth bulk-billing, other Medicare claims, private health insurers and DVA claims. For private health insurers, the ‘patient-funded’ functionality means an SMS will be sent to your patient to collect payment, which they can then claim back.

The platform is accessed from your smartphone, laptop or tablet, integrating seamlessly with your existing software. Internal validation features mean that your claims are checked for missing information before you hit submit, reducing the bounce-back of unprocessed claims for Medicare, as well as over 19 health funds and insurers. During this complicated time, Medipass is here to keep health service provision simple, allowing reporting and reconciliation to be easily completed within the platform.

To support our clients, Medipass will not be charging any fees relating to all bulk-billed telehealth services for Medicare and DVA claims until at least 30 September 2020.

[1] - https://www.aph.gov.au/DocumentStore.ashx?id=5188284d-97f9-43fd-ac7e-6703aee48152&subId=205928

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