June 23, 2023

Let's talk Medicare!

Medicare is an insurance scheme that gives Australian citizens and permanent residents access to healthcare, including a wide range of health and hospital services at low or no cost.

Medicare is funded by Australian taxpayers who annually pay 2% of their taxable income to help cover costs.

To access Medicare, you need to register via the MyGov platform. If you are deemed eligible, you will receive a Medicare number and card. 

If you’re a parent or guardian, your Medicare card will show family members names and individual reference numbers, under a single Medicare number.

You can use this card to receive a wide range of medical services at little to no cost depending on the service you access.

It is worth noting that not all services are paid for or subsidised by Medicare.

Let’s explore how Medicare can be used to access podiatry and other allied health services such as Dietetics, Physiotherapy, Osteopathy, Exercise Physiology and a whole lot more.

There is a national wide scheme known commonly as “Enhanced Primary Care Plan” or more recently referred to as the “Chronic Disease Management (CDM) Plan”. 

For ease we will just refer to them as GP Care Plans.

To be eligible for a GP Care Plan, your GP must identify that you have a chronic medical condition that has been, or is likely to be, present for six months or longer. 

While there is no actual list of eligible conditions; examples on the Department of Health’s website include: 

- musculoskeletal conditions, 

- asthma, 

- cancer, 

- cardiovascular disease, 

- diabetes and stroke. 

Under a GP Care Plan, you may have a total of 5 fully funded or subsidized visits to an allied health provider in one calendar year (1st of January - 31st of December)

You will need to coordinate with your GP as to how you would like your visits distributed. Your GP will then issue you with a GP Care Plan referral or multiple referral’s accordingly.  

Those 5 visits may be all allocated to one allied health provider such as podiatry or be spread between several providers such as podiatry and Physiotherapy.

Please note you cannot access 5 visits to each service, it is a combination of 5 visits for all allied health in total for the entire calendar year.

GP Care Plans may be issued by your GP at any time of the year and remain open until the  number of services the GP has specified on the referral form(s) have been used. 

Any unused services by 31st of December can roll over and continue to be used in the new year. You do not “lose” any remaining visits.

This being said you must not exceed 5 claims per calendar year from 1st of January to the 31st of December. 

This is often the point that is overlooked by clients, and as a result see’s them over claiming their allied health visits.

For further clarity let’s take a look at an example. 

Joan visited her general practitioner on the 1st of April 2023.
Her GP deemed her eligible to access a “ GP Care Plan”.
Joan’s GP has written her a referral for 5 Podiatry visits. 

It is at the responsibility of the consulting allied health practitioner to work in conjunction with Joan to achieve her health goals and scheduling her appointments accordingly.

It is worth noting regardless of the frequency of attendance Joan cannot be issued with any further GP care plans until the annual anniversary date of her GP Care Plan.

In Joan’s case this would be the 1st of April 2024.

If Joan needs more than 5 visits from April to April Joan would be more than welcome to attend the clinic, perhaps she has private health insurance with podiatry cover with private health insurers such as Bupa, Medibank, AHM etc.

This would see the insurer pay a portion of the consultation fee leaving Joan to take care of the remaining “gap”. 

If Joan does not have any private health insurance she is again welcome to attend the clinic paying the clinics scheduled fee’s without any form of “rebate”. 

The billing method for private practice allied health Services is not determined or dictated by the government.

Continuing on with our example let’s presume Joan attending every 3 months for general skin and nail care.

This would see Joan visit the clinic 

April 2023

July 2023

October 2023

December 2023

February 2024

Joan then returns to her doctor in April 2024 to have a new GP Care Plan written. However, Joan has recently developed a sore shoulder and would like to include podiatry and physiotherapy on the new GP care plan

In conjunction with her GP she decides to allocate 3 visits to physiotherapy and 2 visits to podiatry. This totals 5 visits Joan can attend over a 12 month period with a Medicare rebate. 

This is the part that often causes the most confusion. Despite Joan being issued a further 5 visits you may recall one of her podiatry visits carried over into 2024.

Joan saw the podiatrist for her foot care in February. Although this is on the old referral it will still count towards her claims for 2024.

Joan can only make a further 4 claims in 2024. Again leaving 1 visit (for either physiotherapy or podiatry) to carry over to 2025.

Let’s shift our focus on how billing with a GP Care plan works. 

It is at the discretion of the individual clinic or health care practitioner to determine their billing method. There are two common billing methods available for clients who attend allied health practices with a GP Care Plan.

Method 1 : 

Some clinics may bulk bill their client’s visits using Medicare, in other words clients attending this clinic would not need to pay anything on the day of their consultations. This is what we would call a “bulk billing” clinic.

Method 2 and by far the most common method seen in Australia now is referred to as “mixed billing”

A growing number of general practitioners as well as allied health practices that have adopted the mixed billing method, this requires the client to pay their standard fee schedule at the conclusion of each consultation. 

A Medicare rebate will then be electronically processed and the scheduled Medicare fee set out by the government will land back in the clients bank account within 24 to 48 hours. This method will often leave the client with an out of pocket “gap fee”.

The current Medicare rebate, at the time of this publication is $56.00.  

You may ask why there are two different options ?

This decision is made by each individual clinic and may have several factors that help determine this. Such as

  • the cost of operating that service,
  • consultation times (ie 15 minutes vs 45 minute consultations)
  • demand for the service
  • practitioner experience, training and expertise
  • high value equipment required to provide the client with the best health outcome ,just to name a few. 

If you are referred to the team at Undefeeted Podiatry on a GP Care Plan, you will be allocated the same amount of time as our private paying clients (we run appointments far longer than the Medicare guidelines)

We have adopted a mixed billing method, this means clients pay our standard fee schedule at the conclusion of each consultation. 

Our reception team will then process your Medicare rebate on the same day, this will return to the clients bank account within 24/48 hours.

Please be aware if Medicare has already provided you with 5 visits attracting Medicare rebates in that year (January to December) you will not receive your rebate. 

Unfortunately, due to privacy this is not something we the health care provider can predict or tell at the time of the consultations so it’s vital you keep track of your claims. This can be done easily by visiting your MyGov app. 

If you have never been to a specialist such as a cardiologist , endocrinologist etc that is deemed a mixed billing practitioner you may not have your bank details listed with Medicare to receive your rebate.

Do not fear if this is the case simply log into your MyGov account and add in the bank details. 

It is worth noting if your bank account details are not registered with Medicare at the time of your visit with us you will not lose your rebate, instead your rebate will sit waiting until such time you add in your bank details.

If you have any questions please do not hesitate to contact our wonderful ladies on reception on 8358 9929 or send us an email at info@undefeetedpodiatry.com