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Physiotherapy and Medicare

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Thursday, July 27, 2017

Physiotherapy and Medicare

Whilst most physiotherapy services provided in the private sector must be paid for by the individual accessing that service (or their insurer), Medicare does allow patients with a chronic medical condition to access funding for up to 5 visits per calendar year to an approved Allied Health practitioner. 

This scheme is known as the Chronic Disease Management Program (previously called the Enhanced Primary Care Program), and up to date information is always best sought from the Australian Department of Health website. However, the information below (current as at July 2017) should provide some useful information. 


Does Everyone Qualify for the Chronic Disease Management Scheme?

The short answer here is no. Whilst many people will qualify for the program, the scheme is specifically targeted at people with chronic or complex medical problems, or terminal illnesses.


The team at Empower Physiotherapy are committed to providing the very best health care options to those clients who most need them, and as such bulk bill all of our clients referred under a CDM Plan.



What is a Chronic Medical Condition?


A chronic medical condition is one that has been (or is likely to be) present for six months or longer. There is no specific list of eligible conditions, but the CDM scheme is particularly beneficial for those patients who require ongoing care from a multidisciplinary team.

Empower Physiotherapy has provided treatment to patients under this scheme who have required assistance in optimising their health whilst dealing with:

  • Asthma
  • Cancer
  • Osteoporosis
  • Osteoarthritis
  • Orthopaedic Trauma
  • Diabetes
  • Chronic Pain
  • Stroke
  • Lung Disease
  • Cardiovascular Disease
  • Neurological Disorders
  • Paediatric Conditions


Are There Additional Eligibility Requirements?

In order for you to be eligible to access this funding, you must discuss your suitability with your General Practitioner.  If your GP has determined that your chronic medical condition would benefit from Allied Health services, and you agree, then the GP must complete some specific paperwork – a GP Management Plan (GPMP) and Team Care Arrangements (TCA).


Your GP will then discuss with you and determine which services are appropriate, and provide written referrals to each service provider.



What Services Can I Access Under the CDM Scheme?

The scheme provides funding for those Allied Health services deemed appropriate in your management by your GP.  As physiotherapists, we often work with the same clients as dieticians, occupational therapists, podiatrists, or psychologists, but it is your GP - in consultation with you - that will determine which professionals would best be able to assist you.


The Physiotherapists at Empower Physiotherapy will recommend appropriate physiotherapy services based on your specific condition and requirements.  These could include any of the broad range of services we have available to all of our clients, including:

  • Education and Advice
  • Hydrotherapy
  • Exercise Rehabilitation
  • Clinical Pilates
  • Joint Mobilisation
  • Massage
  • Exercise Prescription
  • Chest Physiotherapy
  • Real Time Ultrasound Pelvic Floor Training


How many treatments can I have?

Under the CDM scheme, you are eligible for a total of 5 visits to allied health providers in one calendar year.  Those 5 consultations may be with one provider or be spread between several providers.


It is important that the client receiving these services is aware that only 5 services are available across ALL Allied Health services, and keeps in mind how many services they have already received within a year.  If services are provided and it is later discovered that Medicare has already funded 5 consultations for that client in the calendar year, then the client will become responsible for payment for the services provided.  

The most common error we see in processing these claims is that clients believe they are eligible to receive 5 funded consultations per plan, and as a result attend for more than 5 services in a calendar year.  Medicare will always reject any claimed service over a total of 5 in any calendar year, regardless of unused services from a prior year.



Does Empower Physiotherapy Bulk Bill?

Yes.  At the time of writing, Empower Physiotherapy continues its commitment to providing affordable health care to our clients, and in particular for those clients who as a result of long term illness or injury spend a much greater proportion of their income on servicing their healthcare needs.


As such, if you present to us with a CDM Plan, we will simply obtain your Medicare details at the time we receive the appropriate documentation from your GP, and will process service payment online through our Medicare portal.


Further Queries?

If you would like any further information, visit http://www.health.gov.au/ and search for the CDM Plan.  Alternatively, speak to any of our friendly staff.


If you think this is something you should discuss with your GP, ensure that you advise the medical centre when you are booking your appointment; because of the large paperwork requirements, most Medical Centres have specific processes and staff members who deal with this program.


Until then, keep moving!

Jase




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