HEALTH FUND NEWS
PROVIDER TERMS AND CONDITIONS ARE LOCATED ON THE ATMS WEBSITE UNDER THE HEALTH FUNDS TAB .
The Four Pillars to remain current with Health Fund Registration
1 . Maintain ATMS Membership
2 . Maintain current First Aid
3 . Maintain current Professional Indemnity Insurance ( Chinese Medicine practitioners require a minimum of $ 5 million and Remedial Massage practitioners require a minimum of $ 2 million )
4 . CPE ( continuing professional education ) ( ATMS accepts completed CPE that enhances clinical practice however Health Funds require CPE to be modality specific )
Acupuncture and Chinese Herbal Medicine practitioners must hold current AHPRA registration
Working With Children
Practitioners working with under 18 ’ s MUST hold a current WWC ( Working With Children Check ) in their practising state . Please send ATMS a copy to info @ atms . com . au
Additionally to holding a current WWC , ATMS require that the parent of the child or guardian MUST be present during the consultation .
Current renewal certification is essential
Please forward all renewals ASAP to prevent disruption of your health fund provider registration : renewals of your insurance , first aid , AHPRA registration and WWC to info @ atms . com . au as ATMS must hold a current copy at all times for health fund compliance .
* Lapsed membership , insurance or first aid , or non-compliance with CPE , will result in a member being removed from the health funds list . As health funds change their provider eligibility requirements at any given time , upgrading qualifications may be necessary to be re-instated with some health funds .
Clinical Records
Please note that whilst there is no law or regulation requiring patient clinical notes to be taken in English , many of the major health funds do require patient clinical notes to be taken in English . Failure to do this will be a breach of the Health Funds Terms and Conditions and may result in the practitioner being removed as a provider for that health fund .
Receipting Information
• Medibank / AHM do not accept handwritten receipts ( As of April 2021 ), they must be electronic .
• Sample receipt can be found on our website in the Health Fund tab
• Receipts must be numbered .
• Only one modality per day can be claimed by a client .
Treating Family , Partners and Business Partners of the Clinic
Health Funds do not permit the payment of benefits if the treated member is a partner , dependent , parent , sibling , or business partner of the servicing provider .
By definition , a provider can only perform one initial consultation with a member . Initial consultations attract a higher benefit than a subsequent consult . Only one ‘ initial consult ’ is allowed for any patient per condition .
Health Fund Clinic address requirements
It is MANDATORY that you provide the full clinic address with the street number , street name , suburb , state , and post code , phone number and email address . No PO Boxes acceptable . All updates are forwarded to the health funds by ATMS .
* Note Medibank have a limit of 3 clinic addresses for Remedial Massage practitioners and Bupa have a limit of 4 clinic addresses regardless of the modality .
Sharing provider numbers is fraud and against the law
An Accredited member must never allow anyone to use their provider details , as this constitutes health fund fraud . Health fund fraud is a criminal offence which may involve a police investigation and expulsion from the ATMS Register of Members .
No health funds rebate on mobile services
Mobile Services are services at Hotels , Markets , Retreats or Corporate .
Home visits
Health Funds that do accept home visit services for rebates are : Aust Unity , CBHS , GU Health and NIB . Home Visit must be Stamped or pre-printed on the receipt .
Gift vouchers
Most Health Funds do not accept Gift Vouchers as the person receiving the treatment did not pay for the service . It is up to the Health Fund should they recognise it .
Being a provider implies acceptance of the terms and conditions for the health funds
It is of note that the health funds require practitioners to be in private practice . Some health funds will not recognise claims where accommodation , facilities or services are provided or subsidised by another party such as a public hospital or publicly funded facility . Rebates are only claimable for the face-to-face consultation ( not the medicines or remedies ); however , this does not extend to mobile work including markets , corporate or hotels .
Online or phone consultations are not recognised for health fund rebates
Please be aware that whilst a health fund may indicate that they provide a rebate for specific modalities , this rebate may only be claimable if the client has the appropriate level of health cover with that fund and has not exceeded any limits on how much they are eligible to claim back over a certain period of time .
52 | vol30 | no1 | JATMS