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MEDICARE AUDITS

Do you require help with complying for a Medicare audit? Then you have come to the right place.

 

IS THIS YOU?

Are you one of many Allied Health Professionals who spends more time on your patients than doing your paperwork?
Are you one of many Allied Health Professionals who are involved with the Medicare Allied Health Medicare Referral (AHMR) Program?


Are you overwhelmed with the paperwork associated with the AHMR Program and have just been hoping it will all work out?


Have you been audited by Medicare yet or know someone who has?


Do you need assistance in getting your paperwork in order so that you are able to keep it in order?


Do you work out of a number of medical centres or aged care facilities and do all your paperwork yourself?


Get organised and be prepared for a spot or full audit by Medicare now.


WE CAN HELP YOU GET SORTED BEFORE YOU GET AUDITED.

 

 

OUR STORY

Jane Bloomfield was literally thrown in at the deep end of a Medicare spot audit. Jane's husband Allan, like many Allied Health Professionals, felt that the important area of his work were his patients. His self-professed lack of paperwork skills did not deter him from his main objective — an ongoing high degree of professional podiatry care for his patients. Then came the letter from Medicare that changed our attitude to paperwork and threw us into a spin about a Medicare audit.

If you have not been audited as yet, the chances are good that you will be at some stage of your professional career. The Medicare AHMR Program is convoluted and difficult to understand as it is open to interpretation. When we started trying to understand exactly what was required, a number of professionals in the field had different views on various aspects of the AHMR Program. What Medicare actually requires for an Allied Health Professional to comply with the AHMR Program is difficult to work out from the Medicare website and seems, at times, contradictory.

For example, do you know how long an AHMR extends for? We were told by those in the industry the following:
a) one year from the date of the referral
b) two years from the date of the referral 
c) until 31 December of the following year from the date of referral
d) until all the visits have been utilised

How can there be so many answers to the one question? The answer is until 31 December of the following year from the date of referral but many people are unaware of this. This means that some referrals can go almost two years (if dated 1 January and others can go just on one year if dated 31 December). Most people do not know who to contact at Medicare until they have been selected for a spot audit. After contacting Medicare, quite often they are unable to get the answers they require. The Medicare website is useful but like many websites by large government departments, it is not crystal clear and certainly open to interpretation.

To help Allan sort out his paperwork, Jane devised a simple Excel spreadsheet which lists current AHMRs and columns including referral expiry date, referring doctor, provider number, doctor's practice, whether or not the referral is signed, dated and numbered and when letters to referring doctors are due. Also included are expired referrals which have to be kept under Medicare legislation for two years. The spreadsheet shows how many visits the patient has had during the referral and how many visits they have had during the current calendar year.

Although not complicated, the spreadsheet went through a number of drafts with both Allan and Jane until they were satisfied that everything relating to AHMRs that was required in a practice and for a Medicare Audit was listed and able to be found quickly and easily.

 

 

SERVICES

Medicare Audits are able to provide you with an organised, ready to use Excel file listing all your AHMRs alphabetically. We provide a fast turn-around time from your bundle of AHMRs (just like a bundle of receipts in a shoe box only larger!) into an organised, manageable, functional file that you are able to keep updated yourself. Once your AHMRs are in order and you have finished inputting the visits of each of your AHMR patients, you will be able to keep on top of your referrals, know when an AHMR has expired and when letters to doctors are required, etc. You will never be floundering in the dark again wondering if you are handling the AHMR Program correctly or if your referrals are drowning you in paperwork.

After your receive your file, you will need to enter all the visits for the current year you are in plus the previous year for all your AHMR patients. Talk to Jane about your requirements and what you need to do. Be prepared before you need to be and be in control.

 

 

FEES

Medicare Audits have a fee structure of $88.00 for the Excel file plus $35/hour for sorting your AHMRs and database entry. You will receive an Excel file with all your AHMRs listed which are given to us, organised into a manageable, functional file which also lists applicable expired AHMRs.

You will be taken through the management of the Excel spreadsheet (it's very easy so don't panic if you are not an Excel whiz) so that you will be able to keep your file up to date and be ready when Medicare calls.

Also available is a three month troubleshooting service (by email) from the date of delivery of your Excel file to work out any issues you may be experiencing. This service is at no cost but we do not profess to know the answer to every question about the Medicare AHMR Program nor Excel. However, we will try our hardest to answer your query to the best of our ability.

If you would like to go ahead with Medicare Audits in sorting your AHMRs, what you need to do is:
In the first instance, contact us to determine if you would like us to organise your paperwork (email is best).
If so, you will then need to send us all your AHMRs so we can start the ball rolling.
The only software requirement is that you have Excel on your computer (we use Excel 2010).
Your AHMRs will be returned to you alphabetically listed or whichever way suits you best. They can then be housed in either folders or in filing drawers. Allan has approximately six hundred AHMR patients and I currently file these in four folders sorted alphabetically by Medical Centre. This works best for us but you can file your AHMRs the best way that works for you.

Please remember that Medicare Audits are not able to list your consultations with your AHMR patients. That is a process you or your secretary/receptionist will need to organise. In the first instance, patients with a current AHMR in place will need all their 2015 and 2016 visits listed. This will be a major task for any practice, however once done, it is an easy process to keep updated on a daily or weekly basis.

 

 

ALLIED HEALTH PROFESSIONALS

If you are any of the following Allied Health Professionals and give receipts with the applicable item number listed next to your profession, then you will, quite probably, be audited by Medicare in the course of your professional career.

Aboriginal Health Worker - 10950
Audiologist - 10952
Chiropractor - 10964
Diabetes Educator - 10951
Dietitian - 10954
Exercise Physiologists - 19053
Mental Health Worker - 10956
Occupational Therapist - 10958
Osteopath - 10966
Physiotherapist - 10960
Podiatrist - 10962
Psychologist - 10968
Speech Pathologist - 10970

 

The current AHMR can be found here: www.health.gov.au

This form can easily be found on the Australian Government's Department of Health website by typing AHMR REFERRAL FORM into the search box on the home page. You should then see a section for Referral Form for Chronic Disease and if you open this file, it should be the referral form which can be downloaded as a PDF document and printed.

Jane Bloomfield

PO Box 721

Queanbeyan  NSW  2620

02 6147 1616     0423 220 205

Email Jane