There was an error in my Medicare billings where there was an incorrect item claimed which gave a higher benefit than what should have been paid. My practice manager has told me that I am responsible for the full 100% of the repayment to Medicare for this billing error. This seems unfair since the practice retains 50.95% of my MBS earnings; is this correct?
Primary responsibility for correct Medicare billing rests with the practitioner (NTCER cl. 14.7). So, it is important to regularly check the services you provided against the services that have billed to your MBS provider number. The NTCER requires the employer to provide the registrar with their billing information. Your employer should provide ready access to lists of patient billings and associated documentation and records for you to review for any inadvertent breaches. If you become aware of an incorrect payment it is recommended that you immediately let Medicare know, voluntarily, so that any administrative penalty may be avoided.
However, it is not solely your responsibility. Under the Shared Debt Recovery Scheme*, the responsibility for billing accurately under Medicare is shared between the practitioner (the primary debtor) and the organisation employing the practitioner (the secondary debtor). So the employer also has an obligation to ensure that MBS claims are not false or misleading.
The Department of Health recommends that practitioners make use of the AskMBS advice service for providers seeking advice on interpretation of the Medicare Benefits Schedule items and rules and the Health Insurance Act 1973 and associated regulations. Providers can contact AskMBS via email at AskMBS@health.gov.au.
*Please note, the Shared Debt Recovery Scheme came into effect on 1 July 2019. Previously, the responsibility for billing accurately under Medicare rested solely on the practitioner.