The Private Practice Summer 2013/14 Page 35

The Private Practice

Summer 2013/14

The name and practice address or name and provider number of the practitioner who actually rendered the service
(where the practitioner has more than one practice location recorded with Medicare Australia, the provider number used
should be that which is applicable to the practice location at or from which the service was given).
For Medicare claiming purposes, the Health Insurance Regulations provide that a valid account or receipt must contain
the medical practitioner's name and either:
· The address of the place of practice from which the service was provided; or
· The provider number for the place of practice where the service was provided.

A provider number uniquely identifies the medical practitioner and the location from which a service is rendered.
You cannot transfer a provider number for one address to another address, as this has an adverse impact on Medicare
claims and prescriptions issued from the previous address.

Practitioners eligible to have Medicare benefits payable for their services and/or who for Medicare purposes wish to raise
referrals for specialist services and requests for pathology or diagnostic imaging services, may apply in writing to Medicare
Australia for a Medicare provider number for the locations where these services/referrals/requests will be provided.

When a practitioner ceases to practice at a given location they must inform Medicare promptly. Failure to do so can lead to
the misdirection of Medicare cheques and Medicare information.

Practitioners at practices participating in the Practice Incentives Program (PIP) should use a provider number linked
to that practice. Under PIP, only services rendered by a practitioner whose provider number is linked to the PIP will be
considered for PIP payments.
Where a locum tenens will be in a practice for more than two weeks or in a practice for less than two weeks but on a
regular basis, the locum should apply for a provider number for the relevant location. If the locum will be in a practice for
less than two weeks and will not be returning there, they should contact Medicare Australia (provider liaison 132 150) to
discuss their options (for example, use one of the locum's other provider numbers).

LOCATION, LOCATION

It is apparent that much of Medicare's
broad interpretation of the legislation
on this topic is not contained,
or at least not with any clarity,
in the legislation.

Specifically, neither the Act nor

the regulations contain Medicare's
statement, being that: `A provider
number uniquely identifies the medical
practitioner and the location from which
a service is rendered'.

The legislation says a provider

number identifies the person and the
places where that person practices.
The scheme clearly refers to the person
(being the medical practitioner)
not the place where the service was
rendered, and nowhere is there a
clause indicating that a medical

practitioner is prohibited from using
a different provider number than that
attached to the service location.

Of course, much of this is a non-

issue for many practitioners and
specifically for many GPs, who will
usually practice in one location. For
them it is simple enough, as they will
obtain a provider number for that
location and it will often be the only
provider number they will ever need.

But I've even had GPs ask similar

questions to those above when they
have started providing inpatient
services as CMOs, or are moving
around for other reasons. And with
Telehealth services now being on the
increase, more and more provider
numbers will be attached to home
addresses or even corporate offices,

where the clinician physically sits to
undertake the Telehealth consultation.

Many specialists are simply

choosing to use one of their existing
provider numbers for Telehealth
consultations, just as GPs do when
they conduct home visits. Still, some
practitioners, mostly those providing
inpatient services, are not sure which
provider number to use when.

SITE SPECIFIC

General practice is almost exclusively
made up of outpatient services and,
as I have mentioned, it's usually fairly
straightforward in that environment.
The practitioner should have a
provider number linked to that
location. Nowhere in the scheme
is there any indication that you