The Private Practice Summer 2013/14 Page 36

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could not use a provider number attached
to a different location while you were, for
example, waiting for a new one to be issued.

Sometimes the issuing of provider

numbers can take much longer than the
stated timeframes on Medicare's website.
Earlier this year there was a significant
backlog, causing even the simplest
applications to take over a month.

So, if you look at the contents of a

standard GP invoice, you will find that only
one provider number will usually be included,
being that of the servicing GP. In contrast,
with the exception of anaesthetists (who don't
need referrals to claim most of their services),
specialist invoices will always include a
minimum of two provider numbers, and three
if an inpatient service has been provided.

In the outpatient context, a specialist

invoice will include the servicing doctor's
provider number and the referring doctor's
provider number. Inpatient specialist
invoices will include a third provider number,
being that of the hospital or registered
healthcare facility.

As to whether this last invoice containing

three provider numbers complies with the
legislation or not, it would be difficult to
suggest that it doesn't even if the provider
number used by the specialist was not the
provider number linked to the service location.

The two clear requirements of the scheme

are met by providing the servicing providers
name and address. However, it is also
standard practice and most software requires
that, in addition, the provider number of the
location at which the service was provided is
included on the claim.

After all of that, all you need is your name

and address. But, according to Medicare, `the
fiction that we have to have' includes a provider
number linked to the service location.

If you think about it from the department's

point of view for a moment, Medicare does
need to keep its legislative drafting style
broad to allow doctors to exercise their clinical
discretion. To do otherwise would result in
lawyers and bureaucrats determining how
doctors should practice medicine, something

clearly not in the best interests of the health of
the nation. But this is cold comfort for doctors
who want and deserve certainty and freedom
from fear of a Medicare audit.

ROLL WITH IT

In stark contrast to Medicare's interpretation
of the Act, Adams J in Sood's case adopted
a narrow view and basically said it (the Act)
means what it says, and to suggest otherwise
would create "...considerable uncertainty
in a context where precision of scope is of
considerable importance...

Although the Regulations comprise a

distinct statutory instrument, it forms part
of a detailed, comprehensive scheme. In my
respectful opinion, the acceptance of the Crown
submission would, in effect, surround each item
with a penumbra of indeterminate meaning
inconsistent with the structure of the legislative
scheme and unfair to the medical practitioners
attempting to work within its boundaries."

Medicare will need to adapt to modern

medical practice, where providers have
changing needs as they become more mobile
and the traditional model of medical practice
becomes a thing of the past. Virtual medical
practices are here to stay, and this will impact
the way provider numbers are used.

But because no-one wants to end up

facing criminal prosecution, the best advice
is to obtain a provider number at each place
where you intend to practice and always use
the provider number attached to the location
where the service is provided, if you can.
But if you simply can't, use another provider
number and include additional information
on your invoices to inform Medicare of the
location at which the service was provided.

Always ensure you can tick off the

legislative requirements, of which there are
only two, and if you have specific limitations
or restrictions on your provider number, speak
with Medicare and follow its instructions on
exactly what you can and can't do.

It's one of those situations where it's

better to just roll with the Flat Earth Society
don't fall off the horizon and accept that
this is a fiction we just have to have.