Important Medicare Audit Information
Medicare Provider Status Audit 2011 
Medicare is currently conducting an audit of Medicare Provider Status for speech pathologists with a Medicare provider number. To be eligible to use a Medicare provider number the speech pathologist must be a financial practicing member of SPA and have paid their membership by the due date (1 January) each year. In 2011 SPA negotiated a grace period with Medicare
between 1 January and 28 February. As a result anyone who paid their membership between 1 January and 28 February did not have a gap in their Medicare provider status. Anyone who paid after 28 February will have a gap in their Medicare eligibility for the period they were unfinancial up until the day they renew their membership. As a result clients will not be able to claim a Medicare rebate for services received during the period the speech pathologist was unfinancial or if the rebate has already been paid the speech pathologist may be required to refund the amount paid to Medicare.
Medicare Compliance Program 2011-2012
Each year Medicare conducts a Compliance Program. The key focus and priorities of the Compliance Program for 2010-2011 are:
· research and monitoring,
· education, information and support, and
· audits and enforcement.
In 2011 Medicare will conduct compliance audits of speech pathologists whose clients have received a rebate from Medicare. Speech Pathology Australia has not been informed as to how many speech pathologists will be audited.
A compliance audit is designed to check that both the provider and patient were eligible for Medicare benefits and that the service was provided, meeting all item requirements. Compliance audits are usually conducted by telephone, letter or face-to-face and Medicare provide health professionals with the opportunity to respond before they take action. This audit is based on questions of fact - it does not question either the clinical appropriateness or adequacy of the MBS service, or the clinical decision-making of the provider.
Audits conducted in 2009-2010 identified the following areas of concern:
· first and final reports were not provided to the referring practitioner
· referrals were backdated
· referrals were incomplete, unsigned or expired.
Additional information and a template for the written report is provided in the Private Practice Resource section of SPA’s website.
Where an incorrect payment is identified, Medicare may seek to recover the incorrectly paid amount. Medicare may also provide advice and education material to the provider where this will support voluntary compliance.
Medicare do not use compliance audits to investigate suspected fraud or criminal behaviour – or the clinical decision making, or quality of care provided by providers.
For more detailed information regarding Medicare audits please follow this link:
