Can doctors make claims without my knowledge?

[anney]

Nurse stuff they should be able to bulk bill for but I wouldn't think they could bill for the call from emergency where they looked up your records. Does the online medicare thingo have an item number against it?

[Floweryfields]

Yep the hospital one where I had the tetanus needle was item number 05020 level B surgery after hours at consulting rooms. As for having to present my medicare card, nope. Not even when I saw doctor today and definitely not at hosptial. I actually asked if they needed it and was told no, it was on file already.


From MBS site:

5020 CONSULTATION AT CONSULTING ROOMS

Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:

a) taking a patient history;

b) performing a clinical examination;

c) arranging any necessary investigation;

d) implementing a management plan;

e) providing appropriate preventive health care;

in relation to 1 or more health-related issues, with appropriate documentation.

I would say looking up a medical history from home would be a stretch?

[Phteven]

I think that looking up your file and calling it a 1 hour consult is a bit rich. He would be within his rights to claim for after hours but IMO 30 minutes is a reasonable charge not an hour.

[anney]

Are you saying he was at home and you were in the ED? I read that excerpt from the schedule as you both being in the consulting rooms which clearly you weren't. A loooooooooong stretch.
Eta i get that it is difficult to run a practice with costs rising and Medicare reimbursement not rising but I think it would be more appropriate if he billed you a longer consultation next time he saw you rather than using an item number incorrectly.

[Floweryfields]

I never saw him. I rang the hospital to ask whether I should come in for a tetanus shot. The said they'd look it up and call me back. They rang back and said they couldn't find anything in my records there and Doctor couldn't find anything either, so come in and have one just in case. I went and the nurse gave me the shot and looked at my foot where I had stood on the nail.
Would've been there 10 mins tops. Definitely never saw the doctor.

[Mother Goose]

If you saw the hospital and not the clinic then no, the clinic can not bill you. A healthcare provider has a right to ask for relevant medical history and there should never be a charge for that (different if you're asking for it). In this instance, only the hospital has the right to bill you (or Medicare).

Out of curiosity, was the Dr who put through the claim on duty at the hospital? Either in person or in an on-call manner?

You won't ever be asked to sign a medicare form in hospital - although I think you sign something on admission and they use that for everything. But hospital billing is different to a clinic.

In a clinic setting you should be asked to sign for it before you leave but if you don't (for whatever reason) they can sign it on your behalf (citing the reason). We did this often when the system crashed and we had to do retrospective claims.

[Floweryfields]

Yes he was the on-call doctor however I thought hospital was seperate to surgery. He owns the practice and has other doctors that work for him and he also has the contract for the hospital as a seperate thing.

If he's billing medicare for it, shouldn't it be billed as attendance in hospital? Perhaps he was at the practice doing files when they rang him?