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.
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.
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.
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.
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.
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.
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
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
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.
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.
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.
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
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.
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.
Congratulations, you have now completed this Module.
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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