Medicare watchdog focuses on inappropriate claims for skin items


By Michael Woodhead

25 Oct 2019

Medicare’s Professional Services Review has taken action to address inappropriate practices relating to claiming of skin medicine items by non-dermatologist practitioners .

In its annual report for 2018-19 the PSR said it had received a number of referrals relating to practitioners classified as ‘Other Medical Practitioner’ or ‘Specialist General Practitioner’ classification rather than ‘Specialist Dermatologist’ category.

Concerns identified in the claims for skin medicine items referred for PSR investigation included billed services not being provided, concerns over consent and lack of clinical input, poor or illegible recordkeeping and lack of contemporaneous records and concerns over billing for cosmetic procedures.

The PSR said it had also had reports of practitioners using identical pasted text across multiple entries in the same medical record and/or across multiple different patient records, and concerns over the use of the Medicare Safety Net

In response to issues highlighted in the referrals, the PSR said its director Professor Julie Quinlivan had made presentations at skin medicine conferences.

“Engagement by the profession was excellent and the concept of documenting consent in medical records and improving the quality of medical records has been embraced,” the report noted.

“The MBS Review has also added clarity to some item descriptors. The profession is to be commended for rapidly and positively responding to concerns.”

According to the annual report, the PSR recouped $29 million from practitioners for inappropriate Medicare claims in 2018-19.

This was a six-fold increase in the historical levels of around $5 million a year recovered from doctors, with the higher rate being attributed to the PSR widening its focus  of investigation from GPs Medicare claims to cover those of other specialists including dermatologists as well as practitioners in sleep medicine, radiology, endocrinology, oncology, and haematology.

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