Medicare provider liabilities

The Medicare provider number is a unique identifier which enables psychologists to bill for Medicare-funded services provided under the Medicare Benefits Schedule (MBS). Provider numbers are issued by the Department of Human Services (DHS) on application. A Medicare provider number identifies:

• The psychologist and his or her eligibility to have Medicare benefits paid for eligible services provided
• The location from which services are rendered, with a provider number required for every location at which the psychologist provides Medicare-funded services.

Holding a Medicare provider number comes with certain liabilities including legal responsibility for services billed to Medicare under that provider number. In practice, this means that as the holder of a provider number you are responsible for incorrect claims made under your provider number (or in your name) regardless of who does the billing or receives the benefit. Moreover, if a service has been billed incorrectly under your provider number (or in your name) you will be responsible for the repayment of benefits. Some possible consequences of this are:

• If you, your administrative assistant or practice manager makes a billing error, you are liable for repayment.
• If you fail to immediately close down your provider number when you cease delivering services at your practice, you will be liable for the repayment of benefits as a result of someone misusing your provider number.
• You are responsible for repayment of benefits if there is fraudulent use of your Medicare number by another party. This includes psychologists or students within your practice who may be making claims against your provider number.

How to protect your liability as a Medicare provider

• Ensure that any administrative staff managing billing on your behalf are well trained and know the requirements of Medicare, and implement regular billing audits. (For further information see www.humanservices.gov.au/sites/default/files/documents/8765-record-keeping-booklet.rtf)
• Immediately contact DHS to close down your provider number if you are no longer providing services at a location.
• Instigate regular checks of items claimed under your provider number. This can be done at the Health Professional Online Service (www.medicareaustralia.gov.au/hpos/). To access this you need a DHS Public Key Infrastructure (PKI) certificate (see www.medicareaustralia.gov.au/provider/business/online/register/apply.jsp).

If you have particular queries that you would like addressed in this column, please contact [email protected].