ALLIED HEALTH MEDICARE REFERRALS (AHMR)
Allan Donnelly is recognised as one of the most knowledgeable users of the Allied Health Medicare Referral system and his understanding of this document from both the perspective of the GP and the patient is unequalled. He was subject to a random Medicare audit in 2013, giving him the impetus to fully understand one of the most widespread medical documents used throughout Australia today. The breadth and depth of this knowledge is more comprehensive than most employees at Medicare. Allan has held presentations on AHMRs for both Allied Health Professionals as well as GPs, Practice Nurses and Managers and has run a webinar for Osteopathy Australia.
The Allied Health Medicare Referral (formerly called an EPC although this name hasn't been used for over fifteen years) can only be issued by a GP and are for patients with a chronic medical condition such as diabetes or those who have complex care needs.
A maximum of five rebates of $54.60 from Medicare can be given in a calendar year.
GPs can issue anywhere from one to five visits on the AHMR. These visits DO NOT expire. We prefer that they are used within a three year period, but essentially they will be valid until all visits showing on the AHMR have been used. Therefore, if five visits in the calendar year are used - three with podiatry and two with physiotherapy for example, and there are five visits listed on the podiatry AHMR with three used in one year, the other two visits will carry over to the next calendar year and can be used then. A new AHMR for podiatry for the new calendar year is not required.
A GP is required to do a GP Management Plan (GPMP) and Team Care Arrangement (TCA) which will take some time to complete. Many practice nurses are able to complete the details with the GP signing off on the referral.
A minimum of three practitioners are required to be listed on the TCA. These would include the GP and any allied health professionals such as a podiatrist, diabetes educator, dietitian, physiotherapist, exercise physiologist, osteopath, etc. The five visits can be spread across five different allied health services or given to just one or two services - whatever the GP thinks is required for good health management of the patient.
Specialists can be listed on the TCA as one of the three or more medical practitioners, but specialists do not require an AHMR. The AHMR is for Allied Health professionals only. Therefore, the five visits are only for Alllied Health practitioners, not specialists.
Practitioners based in hospitals can be listed on the TCA but do not require to be listed on the AHMR as one of the five visits as they are covered by government funding.
An AHMR can be issued at any time during the duration of the TCA. GPs do not need to issue another TCA or GPMP when another AHMR is required if the TCA is still valid. For example - if the TCA is valid for 12 months and there are two visits on the AHMR for podiatry and both are used within six months, another two or three visits can be issued on a new AHMR for podiatry without the GP having to do another TCA as podiatry is already listed on the TCA. If a new service is required on the TCA which wasn't listed originally, a TCA review must be undertaken as that service (such as physiotherapy) needs to be added to the TCA.
The GP needs to sign, date and note the number of visits allocated to each Allied Health service.
If the GP decides that two or more services from the same practice are required, the name of the practice can go in the section for Name (middle of the sheet) and no address needs to be included.
If only a particular service such as podiatry or physiotherapy are required and not a specific practitioner, then only "Podiatry" or "Physiotherapy" would be required in the Name section and again, the address section can be blank. This is beneficial if the patient travels and want to see practitioners in more than one practice or city but also if the preferred practice has more than one practitioner. That way, any of the practitioners at that practice could see the patient - especially beneficial if there is an emergency and the preferred practitioner is away. This way the patient is still able to see a practitioner and receive the rebate.
Most Allied Health practices are private practices but there are also bulk bill practices. If the preferred provider bulk bills, the patient will not be out of pocket. If the practice is a private practice such as Qcity Podiatry and Healthcare, the patient is charged the consult fee first and the rebate is claimed afterwards. Medicare usually deposits the rebates back into accounts the next or following business day.
Please note that Bunny Upathumpa no longer requires to be listed on the AHMR. As Bunny now has her Masters Degree as a Nurse Practitioner and is a specialist diabetes educator, she has her own Medicare item numbers. This means visits are not being used to see Bunny on an AHMR as she is able to give a Medicare rebate without an AHMR.
We publish two detailed and comprehensive booklets for both Allied Health Professionals and GPs, Practice Nurses and Practice Managers titled The 10 Minute Easy-Guide to AHMRs. These booklets are for sale and can be found by clicking on the image below.
The Allied Health Medicare Referral information is the same for Indigenous as Non-Indigenous Australians. However, for Indigenous Australians who require more visits to their allied health professional in the calendar year than the five, they can be allocated a further five visits by their GP under item number 81340 for podiatry (different AHMR form). The current Medicare rebate if you have an AHMR is $54.60.