EMDR and Medicare

An application has been drafted to the Australian Government Department of Health to propose that EMDR Therapy be listed as an additional, individual Focused Psychological Strategy under the Medicare Better Access to Mental Healthcare Scheme. Much time and care have gone into describing the detailed information required by the department, in order for them to determine whether a proposed medical service is suitable or appropriate for addition. Dr Chris Lee’s research assistant, Sarah Dominguez has done a very comprehensive and thorough job of attaching a summary of research evidence to demonstrate the effectiveness of EMDR therapy. The board is in the process of refining this application and ensuring that all allied health practitioners who provide services under the Better Access Scheme are included in the proposal. This will likely be a long process as once this draft is submitted to the department it will then be sent to a committee who will determine if the application is worth further investigation. Further requests for information might be made or other refinements or amendments necessary. From there EMDR will be judged on its treatment and cost effectiveness before being added as a Focused Psychological Strategy. So it might be a long road in the end, but this is definitely a worthwhile goals; to give EMDR the recognition it deserves and increase clients’ accessibility to this treatment under Medicare.  Zineta Dedovic

– This information is taken from EMDRAA’s April 2017 newsletter, which can be found here

 

Will I be audited by Medicare Australia and, if so, what will it involve?

Psychologists who are providing services under the Medicare Benefits Scheme (MBS) may be subject to a compliance audit by Medicare Australia. These audits may be ‘random compliance audits’ or may be conducted on the basis of an analysis of Medicare data and the identification of practitioners whose billing patterns differ from those of their peers (e.g., high billing patterns). These audits are conducted to check that the services that have been claimed under Medicare have actually been provided. The audit for psychological services may be conducted either by phone and letter or as part of a face-to-face interview. Medicare audits do not involve disclosure of any personal client information regarding the nature of the referral or the treatment that was provided. Nor are they linked to the clinical relevance of the service. They simply address any concerns regarding billing for the service. Compliance audits are conducted across all service provider groups in the entire MBS program as part of Australian Government requirements. Approximately 2,000 random compliance audits are conducted every year. Although in auditing some professional groups clients may be contacted to verify that the services were received, Medicare has a policy that clients of psychologists who have received services for a mental health problem are not contacted.

Medicare Australia also conducts more detailed ‘research audits’ to determine compliance with the requirements of various MBS programs. The Better Access initiative is not currently subject to a research audit and this will not occur without the APS being consulted and notified. However, for Medicare Australia auditing purposes, a requirement of providing services under Medicare is that for each client seen under the MBS, psychologists are required to retain documentation of the medical practitioner’s referral for each set of sessions and to ensure that all reporting requirements are met. Medicare requires that documentation be kept for 24 months from the date the first service under that referral was provided.

– This information is taken from the Australian Psychological Society (APS) Website