Module 5: Financial models and the MBS


Learning Objectives

At the completion of this module participants will have:

  • Increased ability to navigate MBS Online
  • Increased understanding  of how nurses contribute to the business model of general practice
  • Awareness of the Medicare item numbers practices can claim for employed nurses activity

Nursing services can be claimed by practices

Nurses in General Practice can provide a number of services for patients independently or in collaboration with the GP for which the practice can claim a Medicare Benefit Schedule (MBS) Item.

MBS Online

The MBS used to be a large cumbersome document and with the increasing introduction of medicare items, the format was changed to an online version. 
You might find it useful to go online with the following link and spend sometime to familiarise yourself with the format and searching for MBS service items

MBS service Item provided by a practice nurse




16400
              		 Antenatal care (RRMA 3-7 only)                                        $19.50
10993
Immunisation                                                                                                                                                                        		$10.85

10994
 Pap smear and preventive check $21.70
10995
Pap smear and preventive check not completed in last 4  years
- Ages 20-69 years             		$21.70

10996
 Wound Management $10.85
10997 Person with a chronic disease on GP Management Plan x 5 per year $10.85

10998
 Pap smear $10.85

10987
 Follow up services post Aboriginal health check x 5 per year $22.20

711
 Healthy Kids Check after 4 year old immunisation $46.05



In some instances more than one medicare item can be claimed. Nursing in General Practice demonstrate a number of financial models for Medicare Item No.s and can be accessed by the following link to GPNSW NiGP Programs


Reflection:

While studying the activity statement highlight the activities you can attend now and note the areas requiring further CPD to improve competency.  The more activity you provide will improve service provision for patients, improve job satisfaction and contribute to the practice business model.

Practice Incentive Program

What is the Practice Incentives Program (PIP)?

The PIP delivers financial incentives with the aim of recognising general practices that provide comprehensive, quality care, who are either accredited or working towards accreditation for the Royal Australain College of General Practitioner (RACGP) Standards for General Practices.

Payments made through the program are in addition to other income.  The PIP aims to compensate for the limitations of 'fee for service' arrangements.

PIP Payments  focus  on aspects of general practice that contribute to quality care including:

  • The use of Information Management /Information Technology (eHealth)
  • Provision of after hours care
  • Student teaching and better prescribing
  • paying a rural loading to practices in rural and remote locations
There are eleven broad elements to the payments.  
The elements can be accessed by the following Medicare link

For further information on PIP

Quick Quiz

Write a short response to each question in the provided answer sheet.
  1. What are the common medicare item number's, a practice can claim for practice nurses activity?
  2. Summarise your days direct patient activity and make a quick calculation of your financial benefit to the practice.  The amount sometimes surprises practice nurses.
  3. How does PIP improve care?