Our client, a leading private provider of fertility services in Australia, approached us for advice on a nuanced Medicare billing issue involving a returning doctor. The clinician in question was an Australian-trained medical graduate who had spent over a decade overseas completing postgraduate training. The question was whether he could begin billing Medicare immediately upon his return – despite not yet holding formal specialist recognition in Australia.
The client also needed clarity on a related issue: if the doctor was not eligible to bill in his own name, could Medicare services he provided instead be billed by a supervising clinician?
This was a legally and administratively complex matter that required a detailed review of Medicare law, specialist recognition requirements, and supervision rules. We conducted a thorough analysis of relevant legislative instruments and MBS rules, particularly those governing registrar training and billing under supervision.
We delivered clear, practical advice tailored to the client’s specific clinical setting, outlining:
- When and how the doctor could lawfully begin billing under Medicare
- The conditions under which services could be billed by a supervising specialist
- Relevant MBS items that may be claimed during the transitional period
- Risks and safeguards to ensure ongoing compliance
Our guidance helped the client navigate this challenging scenario with confidence and certainty.