Claiming Telehealth

The Department of Health intends to send targeted letters to a very small number of GPs who have potentially claimed a very large number of non-compliant services. After discussions with the AMA, and other stakeholder organisations, the Department has further refined and reduced the number of GPs that will receive a letter.  

The Department of Health has indicated that there will be a focus on educating practitioners around telehealth requirements.  

Before claiming any of the COVID-19 Telehealth items, GPs are reminded that it is a legislative requirement that GPs and Other Medical Practitioners (OMPs) working in general practice can only perform a telehealth or telephone service where they have an established clinical relationship with the patient. There are limited exemptions to this requirement.  

Patients are eligible for GP and OMP telehealth services if they have an established clinical relationship with a GP, OMP, or a medical practice. This requirement supports longitudinal and person-centred primary health care that is associated with better health outcomes. An established relationship means the medical practitioner performing the service:  

• has provided a face-to-face service to the patient in the last 12 months; or  

• is located at a medical practice where the patient has had a face-to-face service arranged by that practice in the last 12 months (including services performed by another doctor located at the practice, or a service performed by another health professional located at the practice, such as a practice nurse or Aboriginal and Torres Strait Islander health worker); or   

• is a participant in the Approved Medical Deputising Service program, and the Approved Medical Deputising Service provider employing the medical practitioner has a formal agreement with a medical practice that has provided at least one face-to-face service to the patient in the last 12 months.  

The existing relationship requirement does not apply to:  

• children under the age of 12 months;   

• people who are homeless;   

• patients living in a COVID-19 impacted area;   

• patients receiving an urgent after-hours (unsociable hours) service; or   

• patients of medical practitioners at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service.   

A COVID-19 impacted area is one where a person’s movement is restricted by a state or territory public health requirement that applies to the person’s location. This includes patients subject to quarantine, and other restrictions intended to support infection control.