We’re often asked about Medicare Rebates when accessing our physiotherapy and exercise physiology services. It can be confusing, so we’ve compiled all the answers right here to explain everything you need to know about Medicare rebates at Transcend Health.
Medicare rebates can be accessed under the Medicare Chronic Disease Management (formerly Enhanced Primary Care or EPC). Chronic Disease Managament plans are a government incentive which allows individuals with a chronic medical illness/condition to receive Medicare rebates for allied health services, such as physiotherapy and exercise physiology.
So, what exactly is a chronic medical illness/condition?
A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions. However, these items are designed for patients who require a structured approach to their care and to enable GPs to plan and coordinate the care of patients with complex conditions requiring ongoing care from a multidisciplinary team (Health.gov.au, 2018).
You need to consult your GP who will perform a health assessment to determine whether you would benefit from a Medicare Chronic Disease Management plan.
How do Chronic Disease Management plans help?
A Medicare CDM plan is put in place to assist you and your GP manage your chronic medical illness/condition by identifying and managing your needs and planning the best method of treatment. Your GP will prepare Team Care arrangements with you and other allied health professionals such as Transcend Health. This provides an organised approach to your care and allows for collaboration of your treatment plan with at least two other health care providers.
You’ve visited your GP and are eligible, what’s next?
For Medicare benefits to be payable, the patient must be referred to an eligible allied health professional by their GP using a referral form. GPs and medical practitioners may use one referral form to refer patients for single or multiple services of the same service type (e.g. five physiotherapy services). If referring a patient for single or multiple services of different service types (e.g. two physiotherapy services and three exercise physiology services), a separate referral form will be needed for each service type.
The patient will need to present the referral form to the allied health professional at the first consultation, unless the GP has previously provided it directly to the allied health professional.
A Medicare rebate is available for up to five services per patient each calendar year. This is renewed each calendar year.
At Transcend Health we do allow bulk billing ONLY for those people with a valid, government-issued pension card. We can’t bulk bill Medicare for physiotherapy and exercise physiology at our practice if you don’t hold a valid pension card, so there will be a small gap payment for those people (the difference between the fee charged and the Medicare rebate).
How does the payment process work?
You need to pay the full fee upfront, then we process the Medicare rebate and refund the difference on the spot. Here it is step by step:
- You need to pay the full fee upfront on a DEBIT card
- We swipe your Medicare card and access the $52.95 rebate for you
- We swipe your DEBIT card again and put the $52.95 back onto that card on the spot.
If you need reminding, here’s a summary of what we’ve talked about:
- You can get a Medicare rebate for physiotherapy and exercise physiology, using the Medicare CDM plan
- You need a specific doctor’s referral, and the right type of physical condition
- You can get $52.95 rebate for up to 5 visits per year (this can be a mix of physiotherapy and exercise physiology)
- There will always be a small gap fee (unless you hold a valid, government-issued pension card)
- We can process the rebate on the spot, straight back onto your debit card
- If you have any questions at all regarding the CDM process – get in touch and we’ll talk you through it and happily answer any questions.
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Health.gov.au. (2018). Department of Health | Chronic Disease Management – Provider Information. [online] Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-factsheet-chronicdisease.htm [Accessed 4 Jul. 2018].