‘I think you dropped out’ - Maintaining telehealth service compliance

Image of Alison Rowe 31 Aug 2022

Alison Rowe Manager – Legal Services

Healthcare providers, in particular General Practitioners, have continued to serve their communities by embracing telehealth as a way of delivering quality and timely healthcare to the community as the COVID-19 pandemic persists, and communities are impacted by natural disasters.
Health practitioners and patients alike have embraced this use of technology and, as it becomes more apparent that telehealth is here to stay, it is timely to remind members of some key issues to keep in mind when considering whether to provide, or continue to provide, telehealth services.
What is Telehealth?
Telehealth involves patients consulting their healthcare provider by phone or video call, without the need to attend the practitioner in person.
Telehealth is not a new concept. In fact, the Medical Board of Australia published Guidelines for “Technology-based patient consultations” as far back as 2012. A more recent document was published in 2020. (See Resources below).
The COVID-19 pandemic, as well as recent natural disasters, have resulted in telehealth becoming a fundamental feature of healthcare rather than a little-used exception to the rule. This is evidenced by the recent announcement of the continuation of patient eligibility for certain MBS telehealth services which were initially introduced as temporary measures as part of the Government’s response to the COVID-19 pandemic.
Compliance matters
Practitioners providing telehealth services are expected to comply with the “The Medical Board of Australia Good Medical Practice: A Code of Conduct for Doctors in Australia”, for all consultations.
The Code of Conduct states that the standard of care expected is the same, irrespective of whether the practitioner is providing a face-to-face or telehealth consult. This also extends to the standard of clinical records. That is, a practitioner must maintain adequate and contemporaneous records whether the consultation is face-to-face or via telehealth.
Telehealth will not be appropriate for all situations. It is a matter for the practitioner to decide whether a telehealth consultation is clinically appropriate in the circumstances. While a patient’s preference may be taken into account, the practitioner is the final arbiter on what type of consultation is appropriate in the circumstances. There will be circumstances where a face-to-face consultation is the only appropriate option.
There are some additional requirements attached to the provision of rebated telehealth services.
Requirements for Medicare telehealth items include:
  • The Practitioner and patient must be in Australia to use Medicare telehealth items (as is the case for Medicare items generally)
  • The Practitioner does not need to be within their regular practice location to provide telehealth.  It can be provided from home
  • The Practitioner should use their provider number for their primary practice location
  • The Practitioner’s Medicare provider number should only be used for telehealth consultations undertaken by them. It cannot be used by other practitioners within the practice for their consultations
  • For each service / consultation, the full requirements of a telehealth item must be met
  • Subject to some exceptions, General Practitioners and other doctors working in general practice can only claim COVID-19 telehealth items if they have an established clinical relationship with the patient.  See MBS Factsheet - Continuing MBS Telehealth Services listed below:
    • This involves the patient having seen the same doctor or another medical or health practitioner (including a practice nurse) at the same practice face-to-face in the last 12 months. 
    • New patients of a practice and regular patients who have not attended the practice face to face in the preceding 12 months must have a face-to-face attendance if they do not satisfy the exemptions.
  • Telehealth can still be used if it does not qualify for a Medicare rebate where clinically appropriate to do so. All fees should be disclosed to the patient prior to the consultation.
The Government has recently announced that they would “pause” the proposed new prescribed pattern of service (a ”30/20 rule” i.e. 30 consultations in a day for more than 20 days in a calendar year) for telephone attendances provided by consultant physicians and General Practitioners. It is expected that this will be recommenced on 1 October 2022.
Practitioners need to be aware that the existing “80/20 rule” now applies to all consultation types (face-to-face, video and telephone). According to the “80/20 rule”, a medical practitioner engages in inappropriate practice if they have rendered or initiated 80 or more relevant professional attendance services on each of 20 or more days in a 12-month period.
Tips for effective telehealth consultations
If a practitioner plans to provide telehealth consultations outside of the practice location, for example, from home, consideration must be given to the appropriateness of the environment. For example, care must be taken to ensure that the location is private and the discussion is not able to be overheard.
At the time of booking a telehealth consultation, the patient should be asked to confirm the phone number they would like the practitioner to call. In addition, before commencing a telehealth consultation, the practitioner should verify the identity of the patient, by verifying their full name and date of birth. This also applies to any follow up calls, for example to discuss test results.

The Practitioner must also ensure that they have access to the complete clinical file from their location to ensure contemporaneous record keeping and consideration of past medical history and test results.
The Practitioner must also ensure that the telehealth consult is provided via reliable and secure technology.
We’re here to support you
Please be assured that MIGA is here to assist you with any queries or concerns you may have regarding the provision of telehealth services.
MIGA’s Medical Indemnity Insurance Policy provides specific cover related to the provision of telehealth services.  If you have any queries regarding the provision of telehealth, please contact our Legal Services Team on 1800 839 280.
Our Risk Education Team have also developed a new hypothetical for our risk management conferences, “Medicine online – right click for care”, which will be presented at Conferences around the country over the next 12 months.  The hypothetical explores the tips and traps associated with the delivery of Telehealth services. Book your place at a Conference here.