Short window for expressions of interest in Medicare outsourcing

The federal government has allocated two weeks for the private sector to submit an expression of interest to provide a claims and payment solution for Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) transactions.

Fairfax newspapers revealed last week that the government was going ahead with its plan to explore a “commercially integrated health payment system”, as briefly outlined in the May budget. Half a million dollars was allocated to the Department of Health (DoH) to develop a proposal in conjunction with the Department of Human Services (DHS) to market test the delivery of a new system.

The budget papers state that expressions of interest “will be sought from commercial providers to gauge interest in the proposal and to identify potential alternative approaches to the delivery of health payments”.

DoH currently contracts DHS to handle MBS and PBS claims and payments on its behalf, with hundreds of millions of transactions being processed each year.

DHS has had an automatic payment system for bulk-billed transactions for almost a decade and is increasingly encouraging online transactions, both from healthcare providers and patients.

Between 2007 and 2009, the government provided financial incentives to GPs, specialists, pathologists and medical software vendors to transition to online services under the Transitional Support Package (TSP). Online services now account for the vast bulk of transactions handled by DHS.

It runs the Medicare Easyclaim system for bulk-billed general practice consultations, which allows practices to swipe the patient's Medicare card through an EFTPOS terminal to have the rebate paid to the practice on the patient's behalf.

Non bulk-billing practices can also use Easyclaim to have the Medicare rebate paid into the patient's bank account, and patients themselves can make online claims through Medicare Online – now linked to MyGov, which also handles Centrelink and child support payments as well as acting as a gateway to the PCEHR – or through an express app, which allows patients to take a photo of the receipt and send it to Medicare.

PBS claims at the pharmacy work similarly, with Online Claiming for PBS allowing pharmacies to submit PBS claims automatically. That system has been in use since 2004. Both Easyclaim and PBS Online are integrated into general practice and pharmacy software.

DHS also runs ECLIPSE, which is used for hospital inpatient Medicare and PBS claims and is linked to all of the private health insurers.

In a statement, Health Minister Peter Dutton said the current IT systems that manage the claims and payments processes “are dated and in need of a substantial upgrade”.

He did not specify what those IT systems were, but said the government it was “good process to review and test existing and alternative systems”.

Mr Dutton hinted that he might have a preferred solution in mind when he addressed the HIMSS conference in Sydney a week after the budget was released.

“I’d like to draw people’s attention to ... the government’s desire to go to market and call for expressions of interest about the the way in which the payments model works, the transfer system in particular, between government and general practice across the country,” he told the conference.

“It’s an area we want to see streamlined and to provide greater support outside of the current regime that will deliver a cutting-edge technology and efficiency gain that we think we can deliver fairly promptly to general practice.”

The EOI, which does not include face-to-face services provided by Medicare, will close on August 22.

Posted in Australian eHealth

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