G P Management Plans, also known as G P M P

 

Module code M B S M 1 2

Date February 20 20

 

This module provides an overview designed to enable you to understand your obligations to comply with standard work practices and maintain a sound working knowledge of the requirement of the M B S relating to G P Management Plans.

 

Table of Contents

Learning objectives

What is a G P Management Plan, G P M P

Which patients are eligible for a G P M P?

Who can provide a G P M P?

What to do before preparing or reviewing a G P M P

G P M P requirements, item 229 or 721

G P M P review, Item 233 or 732

General assistance in preparing or reviewing a G P M P

Claiming frequency for G P M P and G P M P review items

Access to M B S allied health services

Individual and group allied health services

Summary

References

Education Feedback

Acronyms

 

Learning objectives

At the end of this module you will be able to

         understand what a G P Management Plan, also known as G P M P, is

         identify which patients are eligible for a G P M P

         know who can provide a G P M P

         prepare a G P M P

         have an understanding of G P M P requirements

         know the claiming frequency for G P M P and G P M P review items

         understand who can assist to prepare or review a G P M P

         understand who can access M B S allied health services and the services available.

 

What is a G P Management Plan, G P M P

G P M Ps are comprehensive documents that allows you to provide an organised approach to the management of your patientís health and care needs.

 

The care and treatment provided to your patient when implementing a G P M P would be provided through normal consultation items.

 

A G P M P isnít a substitute for normal patient medical care and treatment.

 

Which patients are eligible for a G P M P?

G P M Ps are available for patients with a chronic or terminal medical condition who will benefit from a structured approach to the management of their care needs.

 

A G P M P is available to

         patients in the community

         private in patients, including private in patients who are residents of aged care facilities, who are being discharged from hospital.

 

A G P M P isnít available to

         public in patients being discharged from hospital

         care recipients in a residential aged care facility.

 

Chronic Medical condition

A chronic medical condition is one that has been, or is likely to be, present for 6 months or longer, including but not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions and stroke.

 

Who can provide a G P M P?

G P M Ps can be claimed by vocationally and non vocationally registered medical practitioners, but not by a specialist or consultant physician.

The term G Pí in G P Management Planí is used as a generic reference to medical practitioners able to claim these items.

 

G P M Ps should be provided by the patientís usual medical practitioner.

 

Usual Medical Practitioner

The patientís Ďusual medical practitionerí means the medical practitioner, or a medical practitioner working in the medical practice, who has provided the majority of care to the patient over the previous 12 months and, or will be providing the majority of medical practitioner services to the patient over the next 12 months.

 

The term Ďusual medical practitionerí wouldnít generally apply to a practice that provides only 1 specific chronic disease management service.

 

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What to do before preparing or reviewing a G P M P

Before proceeding with a G P M P or G P M P review, you must make sure that

         the steps involved in providing the service have been explained to the patient and to the patientís carer, if appropriate and with the patientís permission

         the patientís agreement to proceed is recorded.

 

G P M P requirements, item 229 or 721

The following steps are all requirements for claiming M B S Item 229 or 721.

 

Assess the patient

Assess your patient to identify and, or confirm their health care needs, health problems and conditions

 

Agree on goals

Agree on the management goals with your patient

 

Patient actions

Identify actions to be taken by your patient

 

Identify and arrange treatment and services

Identify treatment and services for your patient and make arrangements for the provision of same

 

Prepare written plan

The plan should comprehensively outline each of the previous steps and specify a date to review the plan, recommended every 6 months

 

Offer copy of G P M P to patient

A copy must be offered to your patient and, or with the permission from your patient to your patientís carer, if appropriate. A copy should be attached to your patientís records

 

G P M P review, Item 233 or 732

Items 233 or 732 are for patients who have a current G P M P, Item 229 or 721, in place and whoíll benefit from a review of their G P M P.

 

A review is the principal mechanism for making sure that the G P M P and the management of your patients chronic condition is still appropriate.

 

The steps in reviewing a G P M P must include

         explaining the steps involved in reviewing the G P M P with your patient and, or your patientís carer, where appropriate and with your patientís permission, and recording your patientís agreement to proceed

         reviewing all matters set out in the plan and making required amendments

         adding a new review date

         offering a copy of the reviewed G P M P to your patient and, or your patientís carer, where appropriate and with your patientís permission

         attaching a copy of the amended document to your patientís records.

 

A benefit isnít claimable, and an account shouldnít be rendered until all components of the G P M P review service have been provided.

 

General assistance in preparing or reviewing a G P M P

A practice nurse, Aboriginal and Torres Strait Islander health practitioner, Aboriginal health worker or other health professional may assist you to prepare or review a G P M P including patient assessment, identification of patient needs or making arrangements for services.

 

You must personally attend the patient and confirm all elements of assistance provided on their behalf in the development of the G P M P.

 

Patients already managed under a G P M P may receive ongoing support and monitoring services from practice nurses and Aboriginal and Torres Strait Islander health practitioners under Item 10997, consistent with the management goals of the plan, for and on behalf of the medical practitioner managing the patientís chronic condition.

 

Item 1 0 9 9 7

Group M 12, Services Provided By A Practice Nurse Or Aboriginal And Torres Strait Islander Health Practitioner On Behalf Of A Medical Practitioner

Subgroup 3, Services Provided By A Practice Nurse Or Aboriginal And Torres Strait Islander Health Practitioner On Behalf Of A Medical Practitioner

 

Service provided to a person with a chronic disease by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner if

a.    the service is provided on behalf of and under the supervision of a medical practitioner, and

b.    the person is not an admitted patient of a hospital, and

c.    the person has a G P Management Plan, Team Care Arrangements or Multidisciplinary Care Plan in place, and

d.    the service is consistent with the G P Management Plan, Team Care Arrangements or Multidisciplinary Care Plan to a maximum of 5 services per patient in a calendar year

 

Item 1 0 9 9 7 may not be claimed for assistance by a practice nurse, Aboriginal and Torres Strait Islander health practitioner or Aboriginal health worker in the development of a G P M P, Item 229 or 721. The assistance is provided on behalf of the medical practitioner and not as a separate Medicare service. Item 1 0 9 9 7 can only be claimed where your patient already has an existing G P M P in place.

 

Claiming frequency for G P M P and G P M P review items

G P M P, Item 229 or 721

The recommended frequency for a G P M P is once every 2 years, however, there is a minimum claiming interval of 12 months to allow for the completion of a new G P M P where required.

 

A rebate wonít be paid within 3 months of items 231, 232, 233, 729, 731 or 732 other than in exceptional circumstances, such as repeated discharges from hospital.

 

G P M P review, Item 233 or 732

The recommended frequency for a G P M P review is once every 6 months. A rebate wonít be paid within 3 months of a previous claim for a G P M P, other than in exceptional circumstances.

 

M B S definition of exceptional circumstances

Provision for claims to be made earlier than these minimum intervals are in place for exceptional circumstances.

 

Exceptional circumstances apply where there has been a significant change in the patientís clinical condition or care circumstances that require a new G P M P or G P M P review service to be developed rather than amending the existing G P M P.

 

Where a service is provided in exceptional circumstances, your patientís account or Medicare voucher, assignment of benefit form, should be annotated or a text included for online claims, to indicate the reason why the service was required earlier than the minimum time interval for the relevant item. The annotation or a text included for online claims should be Ďclinically indicatedí, hospital discharge, exceptional circumstances or significant change.

 

Adequate and contemporaneous clinical notes should be recorded in your patientís file at the time of consultation outlining the need for the G P M P or G P M P review service to be provided with the minimum time interval.

 

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Access to M B S allied health services

Medicare benefits are available for certain services provided by eligible allied health professionals to people with chronic conditions and complex care needs who are being managed by a medical practitioner using certain Chronic Disease Management, also known as C D M, Medicare items.

 

The allied health services must be recommended in your patientís plan as part of the management of their chronic condition.

 

Patients being managed under the necessary prerequisite C D M items may be eligible for

         individual allied health services, Items 1 0 9 5 0 to 1 0 9 7 0, and

         group allied health services for people with Type 2 diabetes, Items 8 1 1 0 0 to 8 1 1 2 5.

 

Follow this link for a printable C D M, G P M P referred allied health services infographic

 

Individual and group allied health services

To be eligible for these individual allied health services, the patient must have 1 of the following in place

         a G P Management Plan, M B S Item 229 or 721, or review Item 233 or 732 for a review of a G P M P, and Team Care Arrangements, M B S Item 230 or 723, or review Item 233 or 732 for a review of T C A s, or

         alternatively, for patients who are permanent residents of an aged care facility, their medical practitioner must have contributed to, or contributed to a review of, a multidisciplinary care plan prepared for them by the aged care facility, M B S Item 232 or 731

 

Group allied health services for people with Type 2 Diabetes

To be eligible for these group allied health services, the patient must have 1 of the following in place

         a G P Management Plan, M B S Item 229 or 721, or review Item 233 or 732 for a review of a G P M P, or

         for a resident of a residential aged care facility, the medical practitioner must have contributed to, or contributed to a review of, a care plan for the patient by the facility, Item 232 or 731

 

Generally, patients of an aged care facility rely on the facility for assistance to manage their Type 2 diabetes. Therefore, the resident may not need to be referred for group allied health services under these items, as the self management approach offered in group services may not be appropriate.

 

Unlike the individual allied health services under items 1 0 9 5 0 to 1 0 9 7 0, there is no additional requirement for a Team Care Arrangement, Item 230 or 723, in order for your patient to be referred for group allied health services.

 

Summary

In this module you have covered the following

         which patients are eligible for a G P M P

         what is involved in preparing a G P M P

         when to bill a G P M P, including how often and when you can develop a new G P M P in exceptional circumstances

         what tasks a practice nurse, Aboriginal and Torres Strait Islander health practitioner, Aboriginal health worker or other health professional can assist with in the provision of a G P M P

         how a G P M P is part of the process required, except for care recipients in a R A C F, refer item 232 or 731, to allow patient access to Medicare subsidised allied health services under M B S Items 1 0 9 5 0 to 1 0 9 7 0.

 

References

M B S Online

Department of Health

National Asthma Council Australia

National Diabetes Services Scheme

 

Education Feedback

Congratulations, you have now completed this Module.

 

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To contact us regarding this eLearning program, send an email to

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Acronyms

Medicare Benefits Schedule, also known as M B S

Chronic disease Management, also known as C D M

G P Management Plan, also known as G P M P

Team Care Arrangements, also known as T C A s

Residential Aged Care Facility, also known as R A CF

 

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