Tracking split referrals under Medicare EPC

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Many patients who are referred under the Medicare EPC have their allocated services split between more than one Allied Health Provider type. 
 
In our clinic we see a few scenarios:
1. patient's referral specifies visits for us and those to be used elsewhere
2. patient is aware of visits they have used, or will use elsewhere
3. patient's referral specifies visits for us only, but we later learn that visits have been used elsewhere
4. patient is unaware of visits they have used/will use elsewhere

Scenarios 1 and 2 are easy to deal with, but 3 and 4 are difficult, especially when patient's claims are declined by Medicare. 

Is there a way of adding another field to the EPC tracking, where we can add in visits that have been used by another AHP service?  Currently we have to make notes, which can get confusing.

Does anyone else have any suggestions on how to deal with these split referrals?  Thanks!
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Anita

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Posted 1 year ago

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Barry

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The biggest problem I find with medicare referrals is the need to phone medicare to confirm the number of visits remaining and the time spent on the phone.  Would it be possible to have a confirm number of remaining visits button similar to the verify button on the medicare tab?
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Anita

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That would be great Barry. 

I don't know how you manage to call Medicare before each EPC patient!  Some days we would see 20, up to 30 patients.  That's a lot of time on the phone.
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Barry

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I don't call all, just the ones where my gut says I'm not sure they have visits left but it would be easy to check everyone if it was the same as verifying medicare details.
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Timothy, Business Care Manager

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If a patient presents to the practice and they have indicated that their EPC plan has partly been used with another practitioner, it will then be important to ascertain how many treatments are remaining and available. For example, if there are 5 treatments remaining, simply set the Treatment Plan’s 'No. of treatments' figure to 5 instead of 10. The 'Alert after' figure should be adjusted accordingly. This assumes that the patient will only be seeing your practitioner for the remainder of their EPC plan. 



If the patient is seeing multiple practitioners on one EPC plan, it is important that the patient keeps a track of how many treatments they have had with other providers. They must also be aware that they are responsible for any outstanding amounts not covered by this plan to protect the practitioner. 

I can confirm that there is currently no way to check the number of treatments remaining on a EPC plan through the Medicare/DVA Online functionality as this data is not made available by Medicare.
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Paul Bramley

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I know this is not software related, but, I cannot understand why Medicare does not enable this info to be accessed through a terminal? Swipe a card and check how many visits remain prior to treatment?
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Barry

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Paul, it's another classic example of the government saying one thing "removing red tape to help small business" but doing the opposite.  Remember when EPCs first came in, you needed to have the patient in the room to confirm their details when you called Medicare (privacy act), so there is always potential for Medicare to allow a number of visits check via the software in the future. 
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Julienne Locke

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You can log into your PRODA accou, then into HPOS, and see your clients availability per Medicare number on the day of service.  I'll post a screen shot
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Barry

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Thanks Julienne, I was unaware this could be done.
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Andrea

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Our EPC patients pay on the day, we lodge their claim and they get their rebate the next day.  Makes them take responsibility for making sure the $ land in their account, and following it up if it doesn't.  
  
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Timothy, Business Care Manager

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Particularly when patients are seeing more than one practitioner on one EPC plan, it is important to put the responsibility back on the patient, and your way of managing this works well. The only other workable option is to ensure that patients enter into an agreement that they are responsible for any treatment costs that are not covered by third-parties, which should be done on the pre-intake form. 
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Paul Bramley

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Thanks for the info Andrea,  I have been thinking of doing this for some time, but not 100% sure how it is achieved.  I assume the patient must have their bank account linked to Medicare?  Is there some info about there how this is done?
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Timothy, Business Care Manager

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Hi Paul. I suspect that Andrea is submitting Medicare claims online through Front Desk. This is a Medicare PCI claim, where the patient pays the full amount and you send the claim to Medicare on their behalf. The rebate is then paid by Medicare into the bank account they have registered for the patient. 

If you are already using Medicare/DVA Online Claiming in Front Desk, this is a matter of choosing the Medicare PCI claim option instead of Bulk Bill. 
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Andrea

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Sorry for delay ... that's exactly what we do.  We explain payment details when pts  book their appt ... they pay in full, we lodge their claim online, and the refund lands in their acct the following day.  Patients v. happy with this.  Also reduces patient perception of 'free' treatment, which means they value our service more bc they've paid for it.  
(Edited)
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In Stride Health Clinic

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We get our clients to pay for the consult and then process the EPC through on online system through FrontDesk.  Works great.  On the very few we bulk bill (our longterm podiatry clients) - they usually are only coming to us and the practitioner monitors their visits and we can always check through the transactions if needed.

We use the Treatment Plans to monitor their EPC's across different practitioners, physio, podiatry, dietitian - listed to the number of visits allocated.

Yes through the PRODA/HPOS system you can check their current status.

Online processing - payments go back into the clients account that is linked to their Medicare Account. 

Sharon


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Michael Reid

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We take the simple approach, the patient pays us in full and we issue them the receipt which they then submit to Medicare. We keep track of their visits on an attachment in their file, but if they exceed their approvals it does not leave us out of pocket.

We do use online claiming for DVA, but not for EPC. Works for us.