Telehealth Reimbursement for Allied Health in Australia

There have been a number of changes to telehealth billing and reimbursement in the last few years. With new regulations and standards, combined with differing rules from governmental departments and private health insurance providers, staying up-to-date can be challenging.

We’re here to turn that around for you.

This updated guide aims to simplify the billing and reimbursement process for telehealth services, ensuring you can continue providing essential care while maintaining a financially healthy practice.

Government Support for Permanent Telehealth Services

The Australian government has made significant investments to ensure the continuation and growth of telehealth services. They’ve invested $512 million to support GPs, specialists, and allied health professionals in delivering telehealth services across Australia. This commitment reflects the recognition of telehealth’s importance in providing accessible and flexible healthcare.

MBS Telehealth Services from 1 July 2024

The updated MBS factsheets for telehealth services provide the latest information, outlining the eligibility criteria, service conditions, and updated item numbers for telehealth consultations.
They include details on how the funding is allocated to support different types of telehealth services, ensuring that healthcare providers have the resources to deliver quality care remotely.

Requirements for Telehealth Providers

To provide telehealth services effectively and in compliance with regulations, allied health professionals must adhere to specific technology and privacy requirements, ensure valid referrals, and follow a comprehensive compliance checklist.

The Medicare Benefits Schedule website specifies that:

A service may only be provided by telehealth where it is safe and clinically appropriate to do so.
The MBS telehealth items are for out-of-hospital patients.
Providers are expected to obtain informed financial consent from patients prior to providing the service; providing details regarding their fees, including any out-of-pocket costs.

Necessary Technology and Privacy Requirements

The technology used for telehealth services must meet clinical needs and comply with privacy laws. This includes secure platforms for video and audio consultations to protect patient confidentiality.

While there are no specific equipment mandates (the MBS website provides a high-level checklist), the chosen technology should facilitate clear communication and be user-friendly for both providers and patients.

Need for Valid Referrals and Eligible Medical Practitioner Involvement

Patients require a valid referral from an eligible medical practitioner to access telehealth services. This referral can be part of various care plans, including chronic disease management, shared care, team care, multidisciplinary care, and eating disorder management.
Maintaining proper documentation and ensuring that referrals are up-to-date is crucial for compliance and reimbursement.

Medicare & Telehealth Reimbursements

Medicare provides a range of telehealth items specifically for allied health professionals. Understanding these items and how to claim them is essential for reimbursement.

Telehealth Items for Allied Health Professionals:

According to the MBS factsheet, Telehealth services available for allied health professionals include:

Chronic disease management
Follow-ups for patients of Aboriginal and Torres Strait Islander descent
Pregnancy support counselling
Early intervention services for children
Eating disorder services
Group dietetics services
For detailed information on these services, download the MBS Telehealth Services Factsheet for Allied Health Providers.

Telehealth Items for Mental Health Professionals:

Telehealth services available for mental health professionals include:

4 Psychological therapy items for clinical psychologist services
20 Focused Psychological Strategies items for services provided by psychologists, GPs, non-specialist medical practitioners, occupational therapists, or social workers.

For more information, download the MBS Telehealth Services Factsheet for Mental Health Professionals. Psychologists looking to grow their online caseload can find further guidance in our guide on telehealth for psychologists in Australia.

Department of Veteran Affairs (DVA) & Telehealth Reimbursement

Telehealth is designed to supplement, not replace, in-person services.

Allied health services, except for dental, optical, and neuropsychology, can continue to be delivered to DVA patients under permanent telehealth arrangements.

Eligible allied health professionals can claim telehealth services as outlined in the updated Notes for Allied Health Providers – Section One – General. Updated fee schedules are available on the Dental and Allied Health Fee Schedules page (updated for 2024).

Allied Health Services

Telehealth services are only for patients with an established clinical relationship with the provider.
Initial and extended consultations should be conducted in person, except for certain mental health services.
Telehealth services must be delivered safely and in accordance with professional standards and guidelines.
Telephone consultations are allowed only if videoconferencing is unavailable. Initial mental health consultations must use videoconferencing.
Group therapy, services requiring specialised equipment, and home assessment services cannot be delivered by telehealth.
Telehealth services can be claimed for patients in hospitals or residential aged care facilities if the services do not require prior approval.

Mental Health Services

Going forward, allied health providers can offer mental health services via telehealth without needing an initial in-person consultation, provided that video conferencing technology is used.
Initial mental health consultations cannot be delivered by telephone; they require video conferencing.

National Disability Insurance Scheme (NDIS) & Telehealth Reimbursement

The National Disability Insurance Scheme (NDIS) supports the delivery of allied health services through telehealth, ensuring participants have access to necessary care regardless of their location.

The NDIS allows for support activities to be delivered via telehealth, using the line items provided in the NDIS Pricing Arrangements and Price Limits.

These services are designed for participants who cannot be in the same location as the healthcare provider, ensuring continuity of care through remote consultations.

To claim telehealth services, providers must use the new ‘Telehealth’ claim field added to the myplace provider portal. This field helps streamline the billing process and ensures accurate reimbursement for telehealth services.

My Aged Care & Telehealth Reimbursement

The Commonwealth Home Support Programme (CHSP) and Home Care Packages Programme (HCP) under My Aged Care have been funding allied health services through telehealth, providing essential support to older Australians. Providers can refer to the CHSP Programme Manual for complete details on the telehealth services covered and the reimbursement process.

Private Health Insurance & Telehealth Reimbursement

Private health insurance coverage for telehealth services varies widely among insurers, making it essential for allied health professionals to understand the specific reimbursement policies of each provider. By doing so, practitioners can ensure they receive appropriate compensation and streamline the claims process for their patients.

HICAPS has partnered with all Australian private health insurers to facilitate easier processing of telehealth claims. This partnership helps streamline the claims process for both patients and healthcare providers.

HICAPS covers a range of allied health services offered via telehealth, including:

With over 70% of Australia’s healthcare funding provided by the government, it’s encouraging to know that Medicare is on board with the shift to permanent telehealth solutions for allied health practitioners.

Telehealth allows practitioners to provide accessible, flexible, and high-quality care to patients across various settings, including remote areas, aged care facilities, and the homes of those with disabilities. This makes telehealth an ideal growth opportunity for allied health practices, whether you’re already offering telehealth, or just getting started.

This article was originally published in 2020 and has been updated for comprehensiveness and accuracy.

Telehealth Reimbursement for Allied Health Professionals in Australia (Updated for 2024!)