ALLIED HEALTH MEDICARE REFERRALS (AHMR) - FREQUENTLY ASKED QUESTIONS
What are the chronic conditions that meet the criteria for an AHMR?
There is no prescriptive list of conditions. It is essentially up to the GP to decide if the patient’s needs meet the parameters listed on the MBS. The GP can get in serious trouble with Medicare if their patient does not meet these requirements. You can’t just have an AHMR because you want the rebate. You must have a chronic condition or health issue that meets the MBS requirements.
Can all five visits be given to one Allied Health Provider (AHP)?
Yes all five visits can be given to one AHP. There is no requirement to split the visits.
Can I have more than five rebates in a calendar year?
The limit is five unless you are an Aboriginal or a Torres Strait Islander. If you are, you can have a total of ten rebates in the calendar year.
How long does the referral last for?
The AHMR lasts until the stated number of visits have been used. It does not expire in relation to the date on the form. Unused visits can be carried into the following calendar years. However, to reflect good clinical practice, Qcity Podiatry and Heathcare will not carry unused visits past the third calendar year.
I have used all the visits on my current AHMR. When can a new one be issued?
As long as the Team Care Arrangement identifies the need for the service, then a new AHMR can be issued at any time. The GP does not have to wait until twelve months has elapsed before a new AHMR can be issued.
My mother is a resident of a Residential Aged Care Facility. She is on the Low Care schedule. Can she have an AHMR for podiatry?
Yes. The process to get one is different but the AHMR is the same. The RAFC needs to give her GP a copy of her RACF Care Plan. The Care Plan should identify the need for the podiatry. Her GP will then review the Care Plan under Medicare Item 731 and if it is appropriate, will issue an AHMR for podiatry. Residents of RACFs who are High Care are not likely to be eligible for a Medicare referral.
My GP has given me an AHMR for podiatry but not the practitioner of my choice. Can I use this referral for another podiatrist?
No. The referral has to have either the podiatrist’s name, business name or address of the podiatrist on the AHMR form that you want to see. If it has a different name, business name or address to your preferred podiatrist, they cannot use this AHMR.
I need a new AHMR. Can the GP just send one to me without me having to go and see them?
No. The GP is bound by legislation to see you in person and discuss the issue with you. The GP can face serious charges for breaching these conditions.
The GP has listed several other providers on my TCA. Can’t I just have podiatry listed?
No. Under the legislation, your GP must be able to identify two other providers other than the GP who can contribute to your TCA. If your health needs do not enable you to have two other providers other than the GP, then the Medicare legislation precludes you from having an AHMR. The GP has no control over this requirement. The minimum requirement is a team of three, the GP and at least two other providers.
My podiatrist told me that they would bulk bill me for the service but they then charged a $25 administration fee. Can they do this?
No. Bulk billing means that there are ‘no out of pocket expenses’ and the podiatrist accepts the rebate as their total fee. Claiming that you are bulk billing and then adding an extra charge is in breach of the legislation.