AMA acts to protect integrity of Medicare Safety Net

Dr Glasson said the Safety Net is there for patients, not doctors.

"The Safety Net is an arrangement between patients and the Federal Government to minimise patients' out-of-pocket expenses for essential health services," Dr Glasson said.

"It is a good system that looks after the poorest and the sickest in the community.

"It is a system that benefits the aged with their complex health needs in the same way it benefits families with young kids.

"The AMA wants to ensure that the intent and the integrity of the Medicare Safety Net are protected.

"We have produced a set of guidelines to help doctors operate the provisions of the Safety Net to ensure their patients have access to the benefits to which they are entitled," Dr Glasson said.

The AMA Guide To Understanding the Medicare Safety Net for doctors is detailed below.

23 August 2004

CONTACT: John Flannery (02) 6270 5477/(0419) 494 761

AMA Guide to Understanding the Medicare Safety Net

Medicare Safety Net:

The Medicare Safety Net is an additional rebate scheme introduced by the Federal Government for the benefit of patients and represents an arrangement between patients and the Federal Government
The newly introduced Medicare safety net provides for reimbursement of 80% of the gap between the rebate and the charge for non inpatient services once the relevant threshold has been met
It is a significant benefit to patients and there is an interest in ensuring that the safety net remains as an aspect of Medicare into the future
It is reasonable for doctors to do what they can to assist patients to understand the safety net
Safety net entitlements should be based on existing fee structures, not vice versa.

Fees:

Longstanding AMA policy is that doctors provide their services in a competitive market and they are free to set their own fees without interference from third parties
The AMA produces a List of Medical Services and Fees, which it considers are fair and reasonable 
The AMA strongly supports open discussion and disclosure of fees between the doctor and the patient
The doctor should attempt to ensure that patients are aware of the existence of safety net benefits.

The AMA recommends:

Doctors should document their fees and fee charging policies and provide these to patients.
The charge for any medical service should be set having regard to the physical, technical and intellectual resources applied by the doctor to the service, including background practice costs.  It should not include the cost of any consumables (other than background practice costs) not related to the service or the cost of any item for which separate reimbursement is available to the patient.
The account for the service should indicate whether the service was rendered in an inpatient or outpatient setting.
Doctors should not alter the actual location of the service to financially benefit the patient, nor to shift an inpatient gap to an associated outpatient consultation.
Patients should expect that the billing practice of a doctor will not alter once the patient has reached the safety net eligibility point.
The introduction of the safety net is not an opportunity to lift medical charges. 
Charges should be reviewed regularly in the light of movements in practice costs and earnings and should not vary from patient to patient without good reason. 

AUGUST 2004