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DECEMBER HEALTH FUNDS UPDATE

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The latest items file includes the following schedule updates:

 

•         QldWC

•         SAWC

•         VicWC

•         WAG

 

We are still waiting on a November update for ADF_BUPA.

 

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ASA RVG SCHEDULE

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The ASA RVG schedule has been updated according to changes published by the AMA effective November 2019. These changes largely follow the changes made in the Medicare schedule and have not yet been confirmed by the ASA.

 

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AGE MODIFIER 25015

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There has been some confusion over the use of the age modifier for patients between the ages of 3 and 4. Initially this was to be applicable to all patients less than 4 years of age, but the description in the Medicare schedule was modified to state ‘not more than 3 years’. Because of this, Medicare and some funds have been rejecting the modifier for patients between 3 and 4. We have followed this up with the ASA, and yesterday we received the following communication from Medicare. We interpret this as meaning that the modifier will continue to be applicable to patients between 3 and 4, and that rejected claims will be adjusted. It may be wise to hold off on sending claims using the modifier until the situation is resolved.

 

The Australian Government Department of Human Services would like to advise that there is an issue with the age restriction for children on anaesthetic item 25015.

The Department of Health is working towards resolving the issue and the outcome will be published on MBS online. In addition, we will email you with instructions on what you will need to do to resubmit rejected claims.