Funding by Medicare and Occupational Therapy in Adelaide, SA

Mar 28, 2016

Medicare and OT

Clients on a Chronic Disease Management (CDM) Plan from their GP are eligible for a rebate on Allied Health treatment and services, including Occupational Therapy. In the past these have been known as an EPC and some GP practices may still use this term in their documentation.

The current Medicare funded program allows GPs to prescribe a maximum of five Allied Health consults per calendar year. The eligibility and specific mix of these services are determined by the General Practitioner.
 



If the medical condition is Chronic and/or Terminal the GP may place the patient on a GP Management Plan (GPMP). This entitles the patient to ongoing care by an allied health team (OT, Physio, Psychologist, Podiatrist. etc). These plans can roll over allowing up to 5 rebates per calendar year.

For complex conditions or for patients in an Age Care Facility, the GP may arrange a Team Care Arrangement (TCA) with a team of health professionals. An Occupational Therapist may be one of the health professionals in this team.

Our friendly client services team are pleased to address your queries and direct you to an Occupational Therapist for a discussion on your OT treatment needs.
 

What is the current OT Medicare Rebate?

The current Medicare rebate is $52.95 per service of Item 10958:Occupational Therapy (January 2016).
 

How do I access my OT Medicare Rebate?

Enhance OT can submit your claim to Medicare on your behalf. Your benefit will be paid by Medicare direct to your nominated bank account by the end of the next business day.

If you have not yet registered your bank account, Enhance OT can securely enter the account details for you.

Many people have a family member who assists them with their appointments and bill paying. If you are paying the account for a family member, Enhance OT can securely enter account details to process the claim on their behalf.

Many of our clients are managed by the Public Trustee or another person has Power of Attorney. Enhance OT can submit claims direct to Medicare for payment of benefit to the Trustee account.
 

What will my Occupational Therapist do in a Medicare OT session?

The OT will provide treatment as required by the GP request. This may include equipment or home modification prescription, training, health management and coordination with other health professionals where necessary. All Medicare funded programs require OTs to provide a written report to the referring General Practitioner after the first and the final appointment.

To find out more about what an Occupational Therapist does, read our information What is an OT?
 

What are the Enhance OT fees for OT home visits?

Enhance OT charge OT home visits at an hourly rate. For Medicare referrals, the Item number 10958 will allow the client to claim a benefit of $52.95 for each session.

Initial OT home visits for Medicare are one hour. Please contact our client services team for further information regarding rates.

Subsequent visits may only be 30 to 45 minutes. This will entirely depend on the OT treatment, the GP’s request and the patient’s condition. If the patient has only one OT Medicare item prescribed, Enhance OT can offer futher privately funded treatment on an account.

All OT home visit times are pre-quoted before treatment commences.

All Medicare referrals require a detailed report to the GP. Reports by the Occupational Therapist are charged at the hourly rate.
 

Do I have to pay on the day?

All Enhance OT home visits are charged on client account. We will post or email you an invoice. Terms are 14 days. Payments can be Direct Debit or Cheque. Credit card payments can be made over the phone or cash paid to our head office in Daw Park.  

We are pleased to assist you with submission of your Medicare Claim.
 

OT Bulk Billing

If any of the subsequent OT treatments are under 35 minutes, we are pleased to Bulk Bill the visit. Please discuss with the OT and client services team for more information on bulk billed services.
 

Need more information on Medicare, OT, Allied Health or Rebates?

Enhance Occupational Therapy are always pleased to direct our clients to the most up to date resources available. For further information on Medicare OT services, the guidelines for referrals and treatment, please refer to the Department of Health website.

For clients who are funded by Medicare, Occupational Therapy information can be found on the Department of Health website or from your GP practice. 
 

Resource: Medicare Chronic Disease Fact Sheet

Website: Department of Health – Chronic Disease Management (Formerly EPC)
 

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