Research investigates medical billing literacy in Australia
Of all the things a trainee medical practitioner must learn, how to bill their patients is one of the most problematic.
can be the subject of more than 30 different payment rates, myriad rules and strict penalties, including custodial sentences, for non-compliance.
Yet 70% of Australian institutions that train medical practitioners do not offer, nor have ever offered, a course in medical billing, according to a study by lawyer, nurse and medical administration expert Margaret Faux.
Incorrect billing amounts to 10-15 per cent of the total of public funds assigned to Australia’s healthcare system. How much of that is deliberate and how much unintentional has proved impossible to quantify, says Faux, who is a PhD candidate in the UTS Faculty of Health.
The latest has revealed that the total cost of Medicare benefits in Australia was $23.2 billion for the financial year 2017-18, at an increase of 6.3% compared to 2016-17.
“We don’t know the impact of alternative factors for incorrect billing beyond rorting, such as medical practitioners struggling to navigate the complex requirements of the Medicare system or inefficiencies that exist within the system itself,” Faux explains.
We do know, however, that there is no formal medical billing curriculum in Australia. Where medical billing education does exist in Australia, it is provided largely by medical practitioners, who themselves have never been formally taught to bill correctly, rather than educators with qualifications or expertise in the administrative and legal aspects of Medicare.
The Medical Board of Australia recognises the importance of medical billing compliance by requiring medical practitioners to sign a legally binding declaration assuming prior learning of the Medicare system, but how, when or where this learning occurs remains unknown.
“Our study suggests that very little proactive education aimed at improving medical billing compliance by medical practitioners is currently occurring or has ever occurred in Australia,” says Faux.
“Available medical billing education may be highly variable and may not deliver the level of expected legal and administrative literacy required to effectively and competently use the national insurance scheme and ensure programme integrity.”
The majority of medical education stakeholders in the study expressed the view that medical billing should be taught, and that Australia’s national universal insurer—Medicare—had sole responsibility for developing a standardised course and teaching correct medical billing to medical practitioners.
However, like the Australian Tax Office, Medicare would be fundamentally conflicted acting as regulator, educator and prosecutor simultaneously. Further, this approach is not supported by the relevant legislation.
Faux suggests that “rather than reliance on ad hoc training and education, development of a formal national medical billing curriculum for medical practitioners should be encouraged to improve billing compliance, expedite judicial processes, enhance programme integrity and reduce wasted resources in the health system.
“Further research is required to determine the most effective design and delivery of any such curriculum.”