Health Assessments

Primary Care Items - Health Assessment

There are four timed-based health assessment items. MBS items "Brief Assessment 701", "Standard Assessment 703", "Long Assessment 705" and "Prolonged Assessments 707" should be used for all categories of health assessments.  

• New health assessment item numbers and Definition
• Categories of Health Assessment
• Links and Resources  

Health Assessment Item Numbers and Definition 

Brief Health Assessment (MBS Item 701) $ 57.10

• A brief health assessment is used to undertake simple health assessments;
• The health assessment should take not more than 30 minutes to complete;
• Collection of relevant information, including taking a patient history;  
• A basic physical examination; Initiating interventions and referrals as indicated; and
• Providing the patient with preventive health care advice and information.

 Standard Health Assessment (MBS Item 703) $132.70

• A standard health assessment is used for straightforward assessments where the patient does not present with complex health issues but may require more attention than can be provided in a brief assessment;
• The assessment lasts more than 30 minutes but takes less than 45 minutes;
• Detailed information collection, including taking a patient history;
• An extensive physical examination;
• Initiating interventions and referrals as indicated; and
• Providing a preventive health care strategy for the patient.

 

Long Health Assessment (MBS Item 705) $183.05

• A long health assessment is used for an extensive assessment, where the patient has a range of health issues that require more in-depth consideration, and longer-term strategies for managing the patient’s health may be necessary;
• The assessment lasts at least 45 minutes but less than 60 minutes; Comprehensive information collection, including taking a patient history;
• An extensive examination of the patient’s medical condition and physical function;
• Initiating interventions and referrals as indicated; and
• Providing a basic preventive health care management plan for the patient.

 Prolonged Health Assessment (MBS Item 707) $258.65

• A prolonged health assessment is used for a complex assessment of a patient with significant, long-term health needs that need to be managed through a comprehensive preventive health care plan;
• The assessment takes 60 minutes or more to complete;
• Comprehensive information collection, including taking a patient history;
• An extensive examination of the patient’s medical condition, and physical, psychological and social function.

• Initiating interventions and referrals as indicated; and
• Providing a comprehensive preventive health care management plan for the patient.

 

Essential components of all categories of Health Assessment

• Before a health assessment is commenced, the patient (and/or his or her parent(s), carer or representative, as appropriate) must be given an explanation of the health assessment process and its likely benefits;
• The patient must be asked whether he or she consents to the health assessment being performed. In cases where the patient is not capable of giving consent, consent must be given by his or her parent(s), carer or representative. Consent to the health assessment must be noted in the patient’s records;
• All health assessments records must be kept offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
• Offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

 

Mandatory requirements for all categories of Health Assessment

 A health assessment must include the following elements:

• Information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;
• Making an overall assessment of the patient;
• Recommending appropriate interventions;
• Providing advice and information to the patient;
• Keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
• Offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

These health assessments could be undertaken either in consultation room or at patient’s home or a residential aged care facility.   

Health Assessments Categories 

1. An older persons health assessment
2. A type 2 diabetes risk evaluation
3. A 45-year old health assessment
4. A health assessment for a person with an intellectual disability
5. A health assessment  for refugee Health or humanitarian entrant
6. A comprehensive medical assessment for a permanent resident of an aged care facility
7. Healthy Kids Check

   

1. An older persons health assessment (75 years and over)

 Patient Eligibility

• An in-depth annual assessment for people at least over 75 years and over who live in the community;
• A structured way to identify problems and conditions that may be prevented; and
• An intervention to improve health and quality of life.

 Contents

• Assessment of physical, psychological and social health
  • Activities of daily living, physical function, falls in last 3 months
  • Blood pressure, pulse rate and rhythm
  • Continence
  • Medication review (consider a Home Medicine Review)
  • Psychological function (mood, cognition)
  • Social function/isolation, support required, carer status
  • Vaccinations (fluvax, tetanus, pneumococcus)
• Fitness to drive
• Hearing and vision
• Oral health
• Diet and nutrition
• Foot care
• Sleep
• Exercise
• CVD risks (hypertension, alcohol, smoking)
• Home Safety

Billing and Claiming 

MBS Item fee for an older persons health assessment (75 years and over)

Description	Frequency	Item	Fee
An older persons health assessment (75 years and over)	Once a year	701	$57.10
		703	$132.70
		705	$183.05
		707	$258.65

 

2. A Type 2 Diabetes Risk Evaluation for individuals aged 40-49 years

Patient Eligibility 

• 40 to 49 years of age (inclusive)
• At high risk of developing type 2 Diabetes. ‘High risk’ is determined following the patient’s completion of the Australian type 2 diabetes risk assessment tool.

Contents

The Type 2 Diabetes Risk Evaluation must include: 

•  Evaluation of a ‘high risk’ score determined by the Australian Type 2 Diabetes risk assessment tool, which has been completed by the patient within a period of 3 months prior to undertaking the Type 2 Diabetes Risk Evaluation service;
• Updating a patient history and undertaking examinations and investigations in accordance with relevant guidelines (see Guidelines below);
• Making an overall assessment of the patient’s risk factors, relevant examinations and the results of any investigations;
• Initiating interventions where appropriate, including referrals and follow-up relating to the management of any risk factors identified;
• Providing advice and information (such as Lifescripts resources) to the patient including strategies to achieve lifestyle and behaviour changes where appropriate.

      

 Billing and Claiming 

MBS Item fee for A Type 2 Diabetes risk evaluation for 40-49 years

Description	Frequency	Item	Fee
A Type 2 Diabetes risk evaluation for 40 -49 years	Once in three years and not received a 45-year old health assessment  within 3 years	701	$57.10
		703	$132.70
		705	$183.05
		707	$258.65

 Note: If patient consents then referral to Life modification Program (SHAPE)http://www.wentwest.com.au/public/shape.asp

3. A 45-year old Health Assessment

 Patient Eligibility 

• 45 to 49 years of age (inclusive);
• Risk of chronic disease. Risk factors may include:
  • Lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol misuse;
  • Biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; and
  • Family history of a chronic disease;
• Chronic disease is likely to present for six months or terminal condition;
• Does not apply to admitted patients of a hospital or day-hospital facility.

 Contents 

• Information collection, including taking a patient history and undertaking relevant examinations and investigations as clinically required;
• Overall assessment of the patient, including history, results of any relevant examinations and investigations;
• Assessment could include readiness to make lifestyle changes (SNAP Guide);
• Interventions and follow up of any problems as indicated;
• Advice and information to the patient, including advice on strategies to achieve lifestyle and behaviour changes, utilising Lifescripts resources.

Billing and Claiming 

MBS Item fee for 45 – year old Health Assessment

Description	Frequency	Item	Fee
A 45 – year old health assessment	Once only	701	$57.10
		703	$132.70
		705	$183.05
		707	$258.65

 Note: If patient consents then referral into a Lifestyle Modification Program (SHAPE)

4. Intellectual Disability

 

Patient Eligibility 

• Patients in the community who have an IQ two standards deviations below the average IQ eg: have an IQ less than 70;
• Inpatients of a hospital or residents of an aged care facility do not qualify for an Intellectual Disability health assessment.

Contents

The assessment must include an overall assessment of the patient’s health, based on the history and the results of any relevant examinations and investigations:

• Assessing the physical, psychological, social and biomedical conditions of the patients;
• Keeping a record of the assessment;
• Recording a medical and family history;
• Reviewing and analysing the information collected during the health assessment;
• Making an overall assessment of the patient;
• Identify any medical intervention and preventative health care required;
• Arranging referrals and identifying appropriate follow-up;
• Providing advice and a written report to the patient and, if appropriate and the patient agrees, the patient’s carer and relevant disability professionals;
• Documenting the level of intellectual disability;
• Discussing assessment outcomes and providing advice to support the patient.

Billing and Claiming 

MBS Item fee for a Health Assessments for a Person with an Intellectual Disability

Description	Frequency  Item	Item	Fee
A Health Assessments for a person with an intellectual disability	Once in 12 moths	701	$57.10
		703	$132.70
		705	$183.05
		707	$258.65

 

5. A Health Assessment for Refugee or Humanitarian Entrant

 Patient Eligibility 

• Be a resident of Australia;
• Have access to Medicare;
• Be granted a visa category of refugee, special humanitarian programme, permanent protection visa, temporary humanitarian visa or temporary protection visa: a) 200 Refugee; b) 201 In Country special Humanitarian; c) 203 Emergency Rescue; d) 204 Women at Risk; e) 202 Global Special Humanitarian; f) 447 Secondary Movement Offshore Entry Temporary; g) 451 Secondary Movement Relocation Temporary; h) 786 Temporary Humanitarian Visa; i) 866 Permanent Protection Visa;  j)785 Temporary Protection Visa

Patient should be asked to provide proof of their visa status and date of arrival in Australia. Alternately, medical practitioners may telephone Medicare Australia on 132011, with the patient, to check eligibility.

Contents 

a) Medical history

• Includes family history, perceived health status, medications, allergies, habits and chronic conditions;
• Refugee history, country of origin, language, trauma;
• Immunisation history (for children contemplate full course and ACIR, for adolescents consider measles, mumps and rubella, Hep B and Meningococcal C, for adults consider serology and booster vaccines);
• Nutritional assessment including malnutrition, anemia and vitamin deficiencies;
• Psychological history including PTSD, depression, torture and family separation;

b) Physical examination

• Height, weight, BMI, BP, temperature, percentile chart for children; and
• Cardiac, respiratory and abdominal examination;
• Dental: caries, gum disease, decreased dentition;
• Vision and hearing;
• Scars or injuries;

c) Undertaking/arranging investigations as required

• Tests for anemia, lipids, glucose, hepatitis and rubella serology;
• Urine: urinary tract infection, Chlamydia with pregnancy;
• Others: faecal examination for parasites, serum Vit D, HIV, chest x-ray and Mantoux skin test for TB

d) Assessment of patient using evidence from the above examination

e) Management plan

• Planned follow-up of issues / conditions found from above examination, including initiating intervention activity to meet the identified patients needs;
• Initial recommendation of immunisation, diet, vitamins and medications;
• Referrals to allied health professionals.

Consideration of contraception advice and review of Pap smear, STIs.

Billing and Claiming 

MBS Item Fee for Refugee and Humanitarian Entrant Health Assessments

Description	Frequency	Item	Fee
Refugee and Humanitarian Entrant Health assessment  At Consulting rooms or another place other than a Hospital or Aged Care Facility.	Once only	701	$57.10
		703	$132.70
		705	$183.05
		707	$258.65

 

6. Comprehensive Medical Health Assessment for a Permanent Resident of an Aged Care Facility

 A residential aged care facility is a facility in which residential care services, as defined in the Aged Care Act 1997, are provided. This includes facilities that were formerly known as nursing homes and hostels. A person is a resident of a residential aged care facility if the person has been admitted as a permanent resident of that facility.  

Patient Eligibility 

• A new residents on admission into a residential aged care facility as soon as possible after admission, preferably within six weeks following admission into a residential aged care facility; and
• Provided that a comprehensive medical assessment has not already been provided in another residential aged care facility within the previous 12 months.

Contents

Must include resident’s health and physical and psychological function, and must include: a) Making a written summary of the comprehensive medical assessment;

b) Developing a list of diagnoses and medical problems based on the medical history and examination;

c) Providing a copy of the summary to the residential aged care facility; and

d) Offering the resident a copy of the summary.  

Billing and Claiming 

MBS Item Fee for a Health Assessments provided as a Comprehensive Medical Assessment for Residential Facilities

Description	Frequency  Item	Item	Fee
A health assessments  provided as a comprehensive medical assessment for residential facilities	Once in 12 moths	701	$57.10
		703	$132.70
		705	$183.05
		707	$258.65

 

7. Healthy Kids Check

 

Patient Eligibility 

• All children between the ages of three and five  who are permanent residents in Australia or who are covered by a Reciprocal Health Care Agreement are eligible (once only) for either item 701, or 703 or 705 or 707 or 10986;
• The Healthy Kids Check is to be delivered in conjunction with the four year old immunisation. If a practice completes the healthy kids check prior to completion of the four year old immunisation, then they are required to recall the child to complete the four year old immunisation. The practice can bill the items either item 701, or 703 or 705 0r 707 or 10986 only after completion of the 4 year old immunisation.

Contents

Healthy Kids Check must include mandatory requirements and patient’s physical health, general well being and development, with the purpose of initiating medical interventions as appropriate.

Physical examination and assessment will include:

• Height and weight (plot and interpret growth curve/calculate BMI)
• Eyesight
• Hearing
• Oral health (teeth and gums)
• Toileting
• Allergies
• Social and emotional well being
• Eating habits
• Speech and language development
• Fine and gross motor skills

 Billing and Claiming

MBS Item Fee for Healthy Kids Check

Description	Frequency	Item	Fee
Healthy Kids Check by GP	Once only	701	$57.10
		703	$132.70
		705	$183.05
		707	$258.65
Healthy Kids Check by practice nurse or registered Aboriginal health worker on behalf of medical practitioner	Once only	10986	$57.10

Aboriginal and Torres Strait Islander Health Assessment (MBS Item 715)

 Overview 

• Patient to be identified as Aboriginal and/or Torres Strait Islander in the patient records;
• An in-depth Health Assessment for people who identify as being from either Aboriginal or Torres Strait Islander descent or both;
• A structured way to identify problems and conditions that may be prevented;
• An intervention to improve health and quality of life.

 Health Assessment Requirements 

• Patient background information;
• Personal Medical History/Family Medical History/Social History
• Assessment of physical, psychological and social health
• Activities of daily living, physical function, Blood pressure, pulse rate and rhythm
• Continence
• Medication review (consider a Home Medicine Review)
• Psychological function (mood, cognition)
• Social function/isolation, support required, carer status
• Vaccinations
• Hearing and vision
• Oral health
• Diet and nutrition
• Foot care
• Sleep
• Exercise
• CVD risks (hypertension, alcohol, smoking)
• Home Safety

How to Make Health Assessments Work for Your Practice:

Take a systematic approach to healthcare in your practice - designate the task of setting up health assessment processes in the practice:

• Obtain a list of patients who identify as being of Aboriginal and/or Torres Strait Islander descent (database search);
• Ensure all patients are eligible for a Health Assessment;
• Set up a process for contacting patients (phone or mail);
• Ensure adequate time is allowed for each assessment, approximately 45-90 minutes;
• Identify and discuss the benefits of a Health Assessment with each patient;
• Obtain patient consent;
• Findings and outcomes must be discussed with the patient (and carer where appropriate);
• The GP prepares a written summary which the patient signs. This includes any outcomes and recommendations. A copy should be offered to the patient.
• Keep a copy of each assessment in the patient’s records;
• Practice Nurse or Aboriginal Health Worker may help to conduct the assessments if available;

Who is eligible for this evaluation?

Eligible patients must be of Aboriginal and/or Torres Strait Islander descent and may be of any age.

 

Is use of the Australian type 2 diabetes risk assessment tool mandatory in conjunction with MBS item 715?

After receiving the Health Assessment, the Type 2 Diabetes Risk Assessment Tool may be undertaken with those patients aged between 15 and 55 years if identified as having a high risk of developing Type 2 Diabetes.

Diabetes Risk Assessment Tool - please refer to page 28 of CDM Manual

The Role of the GP

The patient’s usual GP is responsible for conducting the ATSI Health Assessment and the Type 2 Diabetes Risk Evaluation. The GP is expected to take a primary role in the following activities:

• Reviewing and analysing the information collected;
• Making an overall assessment of the risk factors that contributed to the ‘high’ risk score of the patient and their readiness to make lifestyle changes to address the identified factors;
• Undertaking and arranging relevant investigations;
• Making relevant referrals and identifying appropriate follow-up; and
• Providing information and advice to the patient, for example, to undertake lifestyle modifications, and/or the use of “Life Script” resources.

 

The Role of Other Health Professionals

Practice nurses and Aboriginal Health Workers may assist GPs in performing components of the ATSI Health Assessment under the supervision of the GP. This may include activities which:

• Identify eligible patients through examination of patient records, patient information systems, and risk assessment tools used within the practice;
• Collect information such as measuring height and weight (body mass index), waist circumference and blood pressure; and
• Provide patients with information about recommended interventions, and actions the patient could take (at the direction of the GP) to encourage good health.

 

MBS Item Fees for Aboriginal and Torres Strait Islander Health Assessment

ATSI Health Assessment	Item	Fee
At Consulting rooms or another place other than a Hospital or Aged Care Facility. Children aged between 0 -14 years Adult aged between 15 – 54 years Older people over the age of 55 years	715	$204.20

*Note: If a third person is undertaking the information collection component, the GP must ensure that this person has suitable skills, experience and qualifications.

 

Guidelines and Resources

In considering and addressing risk factors, GPs are encouraged to utilise relevant guidelines and resources, such as:

• WentWest's Prevention in Primary Health Care Program (PIPHCP): www.wentwest.com.au/public/PIPHCP.asp

• The Department of Health and Ageing website www.health.gov.au;
• ‘SNAP’– a population health guide to behavioural risk factors in general practice www.racgp.org.au/guidelines/snap;
• ‘Guidelines for Preventive Activities in General Practice’. www.racgp.org.au/redbook;
• ‘Putting Prevention into Practice’. Guidelines for the implementation of prevention in the general practice setting. www.racgp.org.au/guidelines/greenbook;
• Measure up campaign http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Measure-Up

• Medicare Australia enquiry line 132 011 or Medicare Australia’s Aboriginal and Torres Strait Islanders Employment Access Line 1800 556 955.

 

Links and Resources

• The Department of Health and Ageing website: http://www.health.gov.au/mbsprimarycareitems

• Fact Sheet on Primary Care Items: http://www.health.gov.au/internet/main/publishing.nsf/Content/63655B6F92B2927ACA25768B007EC1D7/$File/GPfactsheet.pdf

• AUSDRISK Fact Sheet: http://www.health.gov.au/internet/main/publishing.nsf/Content/C73A9D4A2E9C684ACA2574730002A31B/$File/Risk_Assessment_Tool.pdf

• "SNAP" – a population health guide to behavioural risk factors in General Practice: www.racgp.org.au/guidelines/snap
• WentWest's Prevention in Primary Health Care Program (PIPHCP): www.wentwest.com.au/public/PIPHCP.asp

• 'Guidelines for Preventive Activities in General Practice': www.racgp.org.au/redbook

• ‘Putting Prevention into Practice’. Guidelines for the implementation of prevention in the general practice setting": www.racgp.org.au/guidelines/greenbook

• ‘The Department of Health and Ageing’s Lifescripts order form
• Lifescripts order form - standard resources (Word 887 KB large file)

• Medicare Australia enquiry line: 132 011
• Chronic Disease Management Resource Manual - October 2011

 

Case Conference Items 735, 739, 743, 747,750, 758

A case conference is a discussion, at one time, between the GP and two other care providers (but not including a specialist or consultant physician), of a patient with complex chronic medical conditions, usually involving immediate management plans, such as to develop short term or urgent solutions.

A case conference should be initiated by the GP or the GP participates in a case conference arranged by other parties.

Patient Eligibility

To be eligible for a Case Conference, a patient may be of any age with at least one chronic complex condition that requires the multidisciplinary care needs of at least two other health or community care providers.

Contents

Case conference contents:

• Preparation and co-ordination of the conference with patient permission;
• GP’s participation in the case discussion, with all parties that have agreed to have a case conference. Patient may or may not be present at this meeting;
• Copy of the case conference in patient’s file, give copies to relevant parties with patient consent .

Billing and Claiming

Case Conferences

	GP Prepares and Coordinates					GP Participates
	15–<20 mins $67.95	20–<40 mins $116.40			40 mins and over $194.00	15 –<20 mins $49.95	20–<40 mins $85.60	40 mins $142.60
Community Case Conference	735	739			743	747	750	758
Discharge Case Conference (At the invitation of the hospital)	for private patients					for public and private patients
	735		739	743		747	750	758
RACF Case Conference	735		739	743		747	750	758

 

Department of Health and Aging – Fact Sheet

Correct Medicare Billing for a Complete Medical Service

What is a complete medical service?

A long standing general principle in the Medicare Benefits Schedule (MBS) is that each professional service listed is a complete medical service in itself. To bill an item you must be confident you have fulfilled the service requirements as specified in the item descriptor. The full description of the service is important as it ensures correct identification of the service and thereby avoids the possibility of error in the processing and claiming of Medicare benefits.

Where a service is covered by more than one item it is important to understand the requirements of each item. Some comprehensive items will specify that other services should be provided in conjunction with that item and other items will describe only the specific service provided. In such cases the item representing the comprehensive or ‘complete’ service is the item that should be claimed, not the items representing the individual services.

Where a comprehensive item is used, separate items should not be claimed for any of the individual services included in the comprehensive service. For example, benefit is not payable for item 49809 (a foot tenotomy – cutting of the tendon) or item 50112 (correction of contracted joint) when claimed in association with item 49848 (correction of claw or hammer toe) since the cutting of the tendon and correction of contracted joint is an integral part of the operation for correcting claw or hammer toe.

Does this mean practitioners can only bill one item?

Where only one service is rendered, only one item should be billed. Where more than one service is rendered on one occasion of service, the appropriate item for each discrete service may be billed, provided that each service fully meets the item descriptor. Where an operation comprises a combination of procedures which are commonly performed together and for which there is an MBS item that specifically describes the combination of procedures then only that item should be billed.

The incorrect use of MBS items can result in penalties, including the health care provider being asked to repay monies that have been incorrectly received. Therefore, it is extremely important to understand the full requirements of each medical service, and the complete medical service principle, prior to billing a MBS item.

Will compliance of this be a key focus of the increased Medicare audits to be conducted by Medicare Australia?

Medicare Australia’s current risk assessment processes will continue to apply to all items claimed under Medicare. Practitioners are identified using a combination of the following techniques:

• Artificial intelligence (predictive computer programs)

• Claiming data analyses

• Intelligence analysis (analysis of information specific to a case or person)

• Top providers data analysis

• Tip-offs from the public and referrals.

Medicare Australia’s National Compliance Program is developed in consultation with stakeholders including the medical profession. The document is published every year and outlines where Medicare Australia will focus its efforts, identifying the key compliance risks and specifying the actions which will be taken to address these risks. The 2008-09 program was launched by the Minister for Human Services on 4 September 2008.

Practitioners should claim the most appropriate Medicare item for the service they provide to the patient. When billing for a service the practitioner should ask two questions:

• Does the service rendered comply with the time and content requirements of the MBS item descriptor?; and
• Would the majority of my peers accept that the treatment provided during the service is clinically appropriate for this patient?

A practitioner who can confidently answer yes to both questions and who has adequately documented the service should be able to address any concerns raised in the event of an audit by Medicare Australia or an investigation by the Professional Services Review.

Is the Department of Health and Ageing planning other changes to assist practitioners to be confident they are claiming only items they are entitled to?

Medical practitioners who are unsure of the interpretation of the Schedule can contact Medicare Australia. The following telephone numbers have been reserved by Medicare Australia exclusively for enquiries relating to the Schedule: NSW – 02 9895 3346

 

Latest News

Western Sydney Medicare Local progress update, click here to read