Changes to optometry services under Medicare expected 1 January 2015 Preparation checklist Expected changes – in brief It is expected that from 1 January 2015:    the cap on fees optometrists can charge under Medicare will be removed and optometrists/optometry practices can determine what fee they charge patients for their clinical services fees for all optometry items on the Medicare schedule will reduce by around 5% (such that the patient rebate of 85% is equivalent to 80% of the current scheduled fee) item 10900 will be replaced by two new items that support, respectively, patients 65 years or over to access a rebate for an initial comprehensive examination annually, and patients under 65 years to access a rebate for an initial comprehensive exam every 36 months. Will the changes go ahead? Advice from Government is that processes are on track for these changes to be in place by 1 January 2015. Once tabled in Parliament (expected in mid-December 2014) these changes will come into effect from the listed date of effectiveness (expected to be 1 January 2015.) What is optometry Australia doing about the reduction in Schedule fees and the increase to frequency in access to a comprehensive eye health examination for under 65 year olds under Medicare? Optometry Australia have made our concerns about the flow-on effects of the rebate reduction very clear to the Health Minister and Government decision-makers. It is ultimately patients, communities and population health that lose out. We have been most disappointed by the Minister’s insistence on not re-considering until there is evidence of negative effects for patient health. We want to minimise the risk of negative effects on health, so we have been gathering the evidence of where the cuts are likely to hit hardest and will soon launch a campaign directed at obtaining Government, opposition and minor party commitment to do more to ensure optometry services in these areas are sustainable. We have also been focused on advocating for a reversal of the decision to reduce access to an initial comprehensive assessment for those under 65 years, particularly those in the 40 – 65 years age group where there is strong evidence of increasing risk of eye disease and vision loss. What you need to do to get prepared If you’re a practice owner/manager… Make sure you understand the changes. The rebate reductions will affect the amount your patients can access as a rebate and the fee you receive if you bulk-bill. The frequency changes for comprehensive eye health examinations will change how you can bill under Medicare; you will no longer be able to bill an 10900. The removal of the fee cap enables optometrists to determine the fees they charge for the services they provide. Find out more at Optometry Australia’s Federal Budget measures and impact on optometry webpage Decide if you will change your billing practices from 1 January 2015. The impact of a reduced Medicare benefit may mean it is unsustainable for you to bulk-bill as many patients as you have been, or at all. With the removal of the cap you may wish to introduce fees that you feel are fairer for the services you provide. There are practical resources to help you in thinking through billing practices on Optometry Australia’s Federal Budget measures and impact on optometry webpage, including a fee calculator and Practice Notes on setting fees, changing billing practices and electronic Medicare claiming approaches. If you’re changing billing practices, plan an approach to support a smooth transition, including a clear communications strategy to explain any changes to patients. For practical tips and advice from members who have reduced bulk-billing, see Optometry Australia’s Federal Budget measures and impact on optometry webpage Inform practice staff of changes. This is necessary to ensure no inappropriate Medicare billing, limit misinformation to patients and ensure patient queries are smoothly dealt with. Update your practice management software or records and billing systems This is necessary so that item number changes and any changes to your fees are established on your first day of practice after 1 January 2015. It is likely that some software providers will establish automatic updates. If you are an employee optometrist… Make sure you understand the changes. Find out more at Optometry Australia’s Federal Budget measures and impact on optometry webpage Make sure you understand any billing practice changes your practice may be making, how there are being communicated to patients and the plan to support a smooth transition. Prepare how you will explain or discuss any changes with patients Check-in to ensure that other staff have been informed of changes and that record and billing systems will be updated