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No payments, copayments and faux payments: are medical practitioners adequately equipped to manage M edicare claiming and compliance?
Author(s) -
Faux M. A.,
Wardle J. L.,
Adams J.
Publication year - 2015
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12665
Subject(s) - copayment , medicine , compliance (psychology) , payment , health care , government (linguistics) , actuarial science , public relations , business , law , finance , political science , health insurance , psychology , social psychology , linguistics , philosophy
The complexity of M edicare claiming means it is often beyond the comprehension of many, including medical practitioners who are required to interpret and apply M edicare every day. A single M edicare service can be the subject of 30 different payment rates, multiple claiming methods and a myriad of rules, with severe penalties for non‐compliance, yet the administrative infrastructure and specialised human resourcing of M edicare may have decreased over time. As a result, medical practitioners experience difficulties accessing reliable information and support concerning their claiming and compliance obligations. Some commentators overlook the complexity of M edicare and suggest that deliberate misuse of the system by medical practitioners is a significant contributor to rising healthcare costs, although there is currently no empirical evidence to support this view. Quantifying the precise amount of leakage caused by inappropriate claiming has proven an impossible task, although current estimates are $1–3 billion annually. The current government's proposed copayment plan may cause increases in non‐compliance and incorrect M edicare claiming, and a causal link has been demonstrated between medical practitioner access to M edicare education and significant costs savings. M edicare claiming is a component of almost every medical interaction in A ustralia, yet most education in this area currently occurs on an ad hoc basis. Research examining medical practitioner experiences and understanding regarding M edicare claiming and compliance is urgently required to adapt Medicare responsibly to our rapidly changing healthcare environment.