This instrument rests on a set of recurring legal and operational concepts that determine whether a practitioner may lawfully claim the listed Medicare items. The main concepts, as used in the text, are:

• Patient at risk of COVID‑19: The instrument modifies the definition by adding that a person who “meets the current national triage protocol criteria for suspected COVID‑19 infection” is a patient at risk (Schedule 1, amendment 1). The phrase imports an external, time‑varying standard , the “current national triage protocol” , rather than creating a fixed test in the instrument.

• Bulk‑billing condition: Nearly every new or amended item contains the phrase “where the service is bulk‑billed.” In the item tables the fee column lists an amount that is payable for services that are bulk‑billed. The instrument therefore conditions the availability of the listed fee on the service being bulk‑billed; the item descriptions do not describe alternative fee arrangements for non‑bulk‑billed services (Schedule 1, amendments 3-5).

• Capacity to undertake attendance by telehealth: The instrument introduces and repeatedly uses a negative rule: a rendering practitioner “must not perform a service in [listed] subgroup[s] if the practitioner and the patient have the capacity to undertake an attendance by telehealth” (Schedule 1, amendments 2(5), 4(1) inserted and 5(3)). The concept of “capacity” is determinative of whether the in‑person or phone/telehealth item can be used. The instrument does not define “capacity” within its text; the operative rule is a prohibition on using particular items if telehealth is possible.

• Cross‑referencing of definitions and credentialing: The instrument refers to other legislative instruments for key terms and eligibility gates. For example:

  • “Eligible area” and “medical practitioner” meanings are taken from the 2018 Other Medical Practitioner Determination for certain items (Schedule 1, amendment 2(1)-(2));
  • Eligible allied health provider definitions are taken from the Health Insurance (Allied Health Services) Determination 2014 (Schedule 1, amendment 5(1));
  • Certain items are to be treated as specified in particular clauses of those Determinations (Schedule 1, amendments 2(3)-(4) and 5(2));
  • Some GP phone items require the practitioner to be “registered with the Chief Executive Medicare as meeting the credentialing requirements” for the service (Schedule 1, insertion of items 91842-91845).

• Minimum durations and reporting/referral conditions: For many allied health and psychology items the instrument specifies minimum session durations, the need for a referral from an appropriately authorised medical practitioner (or specialist), that services must be provided individually, a requirement that the referring medical practitioner review the need at the completion of a course of treatment, and a written report be provided to the referrer on completion (Schedule 1, amendment 5, items 91181-91188).

• Face‑to‑face antecedent for certain vulnerable patients: For patients “considered to be more susceptible to the COVID‑19,” the rendering practitioner must have had at least one face‑to‑face attendance with the patient in the preceding 12 months to qualify for certain telehealth items (Schedule 1, amendment 2(6)).

These concepts together create a payment architecture that privileges telehealth or phone delivery where telehealth capacity exists, mandates bulk‑billing for the listed items, ties item eligibility to external credentialing and referral structures, and sets recordkeeping reporting obligations. The instrument relies heavily on cross‑instrument references; the applicability of many items is therefore functionally dependent on other Determinations and external protocols.

The instrument affects several discrete groups of actors. The primary categories identifiable in the text are:

• Medical practitioners and GPs: The instrument inserts or varies items that medical practitioners and general practitioners may bill for. Several items are expressly limited to general practitioners (for example items 91842 and 91843 specify “by a general practitioner” and require registration with Chief Executive Medicare as meeting credentialing requirements). The amended paragraph 1.1.1 (Schedule 1, amendment 2) changes which items must give way to telehealth capacity (Subgroups 1 and 2) and introduces cross‑references to definitions of “medical practitioner” and “eligible area” in the 2018 Determination.

• Allied health professionals: Eligible clinical psychologists, eligible psychologists, eligible occupational therapists and eligible social workers are affected by the new Division 1.4 and its items 91181-91188. Their entitlement to claim is tied to the definitions in the Allied Health Services Determination 2014, referral pathways from medical practitioners or certain specialists, minimum durations, and reporting obligations.

• Nurse practitioners and participating nurse practitioners: The instrument replaces the nurse practitioner telehealth subgroup and inserts phone items (91178-91180 and 91189-91191). The nurse practitioner items are conditioned on the patient or practitioner being at risk and on the service being bulk‑billed.

• Patients at risk of COVID‑19: The instrument specifically targets services for persons defined as “patient at risk of COVID‑19” including those meeting the national triage criteria (Schedule 1, amendment 1). Those patients can be the subject of bulk‑billed telehealth, phone, or allied health phone services under the listed items, subject to referral and prior attendance rules.

• Referring medical practitioners and specialists: Allied mental health and focussed psychological items require referral from a medical practitioner (as part of a GP Mental Health Treatment Plan, shared care plan, or psychiatrist assessment and management plan) or from specified specialists (psychiatry or paediatrics). Referrers must review the need for further courses of treatment at completion and will receive written reports from allied providers (Schedule 1, amendment 5, items 91181-91188).

• Chief Executive Medicare and administrative bodies: The instrument requires certain practitioners to register with the Chief Executive Medicare as meeting credentialing requirements for some items (items 91842-91845). Payment, monitoring and enforcement of these item conditions will be administered through Medicare processes under the existing legislative framework (clause 3 authority under the Health Insurance Act 1973).

• Any bodies or agents maintaining or updating the “current national triage protocol”: Because the definition of patient at risk now depends on that “current national triage protocol”, any entity that sets or updates the national triage protocol will affect item eligibility.

In practical terms the instrument reshapes the incentives for providers to offer telephone or telehealth services, conditions Medicare remuneration on bulk‑billing for the inserted items, and embeds referral and reporting linkages between medical referrers and allied health providers. It therefore affects clinical workflows, billing practices, documentation and credentialling administrative efforts for the listed provider groups.

The instrument does not create freestanding statutory rights in the sense of property entitlements. Instead it imposes eligibility conditions, procedural duties and claim rules that determine whether a provider can claim the specified fee amounts for listed Medicare items. The key duties and entitlements derived from the instrument are:

• Duty not to use certain in‑person/subgroup items where telehealth is possible: For multiple subgroups the rendering practitioner has a duty not to perform the service if the practitioner and patient “have the capacity to undertake an attendance by telehealth” (Schedule 1, amendment 2(5); amendment 4(1) inserted; amendment 5(3)). This is a negative duty that conditions the availability of certain subgroup services on telehealth capacity being absent. The instrument does not define how “capacity” is to be evaluated within the text; therefore the duty requires a practitioner assessment or other record to show telehealth was not feasible for the item claimed.

• Duty to bulk‑bill when claiming the item fee: Each of the telehealth, phone and allied health items in the inserted tables states the fee with the qualifier “where the service is bulk‑billed.” Therefore the provider’s entitlement to the listed fee amount requires that the service be bulk‑billed. The instrument does not specify alternative item numbers or fee arrangements for non‑bulk‑billed services for those items. Practitioners must therefore bulk‑bill those services to claim the fees as described.

• Duty to obtain and rely on appropriate referrals: Allied mental health and focussed psychological items require referral by a medical practitioner under set arrangements (GP Mental Health Treatment Plan, shared care plan, psychiatrist assessment and management plan) or by specialist consultant physicians in psychiatry or paediatrics. The provider must ensure a valid referral pathway exists before delivering and claiming for the service (Schedule 1, amendment 5, item descriptions).

• Duty to provide written reports at completion of a course: Allied mental health items include a duty that the allied provider “gives a written report to the referring medical practitioner on assessments carried out, treatment provided and recommendations on future management” at completion of the course of treatment (Schedule 1, amendment 5, items 91181-91188). This creates a recordkeeping and reporting duty, and it ties claims to a coordinated care model with the referrer.

• Duty to review need for further course of treatment: At the completion of each course of treatment the referring medical practitioner is to review the need for further treatment (Schedule 1, amendment 5, items 91181-91188). That is a duty on the referrer which, while expressed as a clinical review, is also a precondition listed in the item descriptions.

• Duty to meet credentialing requirements and registration: Some GP phone items require that the practitioner be “registered with the Chief Executive Medicare as meeting the credentialing requirements” for provision of that service (Schedule 1, inserted items 91842-91843). This places an administrative duty on providers to complete any registration process administered by Medicare.

• Duty respecting prior face‑to‑face attendance for more susceptible patients: For certain items the rendering practitioner must have had at least one face‑to‑face attendance with patients considered “more susceptible to the COVID‑19” in the preceding 12 months (Schedule 1, amendment 2(6)). This is an eligibility duty that may constrain access to telehealth items for newly referred vulnerable patients.

• Right to claim the specified fee when conditions are met: Where the item descriptions’ conditions are satisfied (patient at risk or practitioner at risk, referral rules, durations, bulk‑billing, credentialing, reporting) the listed fee becomes the relevant Medicare fee for the service. The instrument sets the fee figure in each item table (for example 91843 $158.60; 91181 $101.35, etc.) and thereby creates the entitlement to that fee under the section 3C Determination mechanism as applied to the listed items.

• Reliance on external, evolving standards: Two features confer a continuing right or disqualification depending on external standards. First, the “current national triage protocol” is external and time varying; second, many definitions and credential conditions are located in other Determinations and can change over time. The instrument itself acknowledges that references to other Acts and Determinations are to be read “as in force from time to time” (clause 4(2)). That means a practitioner’s duties and rights under these items will shift as those other instruments or the national triage protocol are updated.

The instrument therefore creates a matrix of eligibility duties and entitlements that are operationalised at the item‑claiming level: practitioners must ensure telehealth capacity was absent to use some in‑person items, must bulk‑bill the listed items, must meet referral and credential requirements, and must produce reports where required. The instrument leaves the mechanics of enforcement and the detailed procedures for registration and claims to existing Medicare administration frameworks and to the other Determinations it cross‑references.

The instrument itself contains no bespoke penalties, sanctions or enforcement mechanisms. It is an amendment determination made under subsection 3C(1) of the Health Insurance Act 1973 (clause 3), and its effect is to define or alter the conditions under which Medicare items may be claimed and fees paid. Enforcement and penalties for incorrect claims or non‑compliance are thus not set out in the instrument; they fall to the enforcement regime and compliance processes established in the Health Insurance Act 1973 and the general Medicare payment administration framework, including any relevant regulations, the Chief Executive Medicare’s administrative processes, and Medicare compliance/audit action.

Specific enforcement‑relevant features to note from the instrument are:

• Conditional fees tied to bulk‑billing: Items repeatedly state “where the service is bulk‑billed.” If a provider claims the item but does not bulk‑bill, or incorrectly claims the item when the conditions are not met, that would put the provider into the general Medicare compliance framework for incorrect claims. The instrument does not itself specify civil or criminal penalties,those are provided for elsewhere in the Health Insurance Act 1973 and related law.

• Credentialling registration gate: Items that require the practitioner to be “registered with the Chief Executive Medicare as meeting the credentialing requirements” create an administrative gate. If a practitioner is not properly registered and claims the item, that will trigger denial of payment and potential further compliance action under Medicare rules. The instrument does not specify administrative appeal or review processes; those are managed via Medicare.

• Record and reporting obligations: The requirement that allied providers provide written reports to referring medical practitioners and that referring medical practitioners review the need for further treatment at completion of a course creates documentary obligations. Failure to maintain or provide required documentation could affect claims and attract Medicare audit scrutiny.

• Discretion tied to external documents: Because item eligibility relies on external, evolving standards (for example, the “current national triage protocol” and other Determinations), providers must ensure they are complying with the current versions. Non‑compliance due to reliance on an outdated protocol would be a matter for Medicare audit and administrative processes rather than a penalty described in this instrument.

In short, enforcement will be by existing Medicare claims compliance mechanisms, using the instrument’s item eligibility rules as the benchmark. The instrument itself does not add or describe new criminal penalties or enforcement procedures.

The instrument functions within a web of cross‑references to the Health Insurance Act 1973, the National Health Act 1953, other Determinations and a “current national triage protocol.” The instrument explicitly states that references to provisions of the Act, the National Health Act 1953 or regulations are to be read “as in force from time to time” (clause 4(2)). Practical interactions include:

• Reliance on the Health Insurance Act 1973: The instrument is made under subsection 3C(1) of that Act (clause 3). The instrument therefore operates as a section 3C Determination amending the General Medical Services table under the Act. The instrument does not restate enforcement or appeals provisions; those procedural and sanctioning rules remain located in the Health Insurance Act 1973 and its regulations.

• Cross‑references to the Health Insurance (Section 3C General Medical Services - Other Medical Practitioner) Determination 2018: Several definitions and operational clauses are pulled in by reference. For example, the meaning of “eligible area” for items 91806-91808 and the definition of “medical practitioner” for Division 1.1 items are tied to the 2018 Determination (Schedule 1, amendment 2(1)-(2)). Clause 2.22.7 and clause 1.9.4 of that Determination are to apply as if specific items were included. Practitioners must consult the 2018 Determination to understand area, provider and other eligibility rules that affect these items.

• Cross‑references to the Health Insurance (Allied Health Services) Determination 2014: Eligible allied health provider definitions and the application of sections 7 and 9 are drawn from that Determination for Division 1.4 items (Schedule 1, amendment 5(1)-(2)). The instrument therefore inherits the eligibility structure, credentialling and perhaps other constraints from that Determination. Practitioners must check the 2014 Determination for precise definitions of “eligible clinical psychologist”, “eligible psychologist”, “eligible occupational therapist” and “eligible social worker”.

• Interaction with Medicare administrative processes: Items require registration with the Chief Executive Medicare for credentialing for some GP phone services (items 91842-91843). That injects an administrative interaction between practitioners and Medicare in order to secure entitlement to particular items.

• Dependence upon the “current national triage protocol”: The inclusion of paragraph (d) in the definition of “patient at risk of COVID‑19” (Schedule 1, amendment 1) imports the content and updates of an external, presumably clinical, protocol into the legal test for item eligibility. That means changes to the national triage protocol will change who qualifies as a “patient at risk” for the purposes of these items without amendment of this instrument.

• Referral and shared care pathways: The allied health items require referrals that interact with the GP Mental Health Treatment Plan, shared care plans, and psychiatrist assessment and management plans. Those referral mechanisms exist in the Medicare allied mental health framework and are governed by other Determinations and administrative policies; the instrument presumes those pathways and references them.

• Dynamic updating: Clause 4(2) expressly makes references to Acts and regulations dynamic (“as in force from time to time”). This means changes to the Health Insurance Act, the National Health Act, or the referenced Determinations will affect the operation of these items without formal amendment to this instrument.

The instrument therefore does not sit alone. To determine precise eligibility, provider duties, credential requirements and claim processes a practitioner must consult the 2018 Other Medical Practitioner Determination, the 2014 Allied Health Services Determination, any applicable Medicare administrative guidance on credentialling and claims, and the current national triage protocol. Those interdependencies are central to operational compliance.

The instrument itself identifies as an amendment determination No.1 2020 and indicates the date and signing delegate. The parts amended and introduced are contained in Schedule 1. The instrument’s internal record of amendment steps is as follows:

• Title and administrative metadata: The instrument carries the name Health Insurance (Section 3C General Medical Services - GP and Allied Health COVID‑19 Services) Amendment Determination No.1 2020 (clause 1).

• Commencement: Clause 2 sets out commencement mechanics. The table in clause 2(1) states that “the whole of this instrument” commences immediately after registration of the Health Insurance (Section 3C General Medical Services - GP and Allied Health COVID‑19 Services) Determination 2020. The instrument includes the standard note that this table relates only to original provisions and will not be amended to deal with later amendments (clause 2 notes).

• Authority: Clause 3 records the legal power: made under subsection 3C(1) of the Health Insurance Act 1973.

• Definitions and interpretative saving: Clause 4(1) defines “Act” as the Health Insurance Act 1973 and “Schedule” as a Schedule to this instrument. It also notes that certain terms appear in subsection 3(1) of the Act (clinically relevant service; general medical services table; item), and clause 4(2) contains the saving that references to provisions are to be read as in force from time to time.

• Schedule 1 amendments: The Schedule contains five numbered amendment blocks:

  1. Insert after (c)(v) in the definition of Patient at risk of COVID‑19 a new paragraph (d) regarding the national triage protocol criteria.
  2. Omit and substitute paragraph 1.1.1 - a substantive reworking of the application of COVID‑19 medical practitioner telehealth services including cross‑references, item inclusions and rules on telehealth capacity and prior face‑to‑face attendance.
  3. Repeal and substitute Subgroup 5 - COVID‑19 nurse practitioner telehealth services table with three telehealth items (91178-91180) including clinical content and fees.
  4. Insert Division 1.3 - Services and fees - COVID‑19 medical practitioner attendances: adds Group A40, Subgroup 10 focussed psychological strategies phone services (items 91842-91845) and a rule that prohibits subgroup 10 services where practitioner and patient can undertake telehealth.
  5. Insert Division 1.4 - Services and fees - COVID‑19 allied health phone services: sets definitions, makes sections of the 2014 Determination apply, places telehealth capacity limits on some subgroups, and lists items 91181-91191 covering psychology, occupational therapy, social work and nurse practitioner phone service items.

The instrument contains a commencement note that the table details relate only to the original provisions as made. The instrument does not contain its own subsequent amendment history within the text; it is Amendment No.1 2020 to the parent Determination. The instrument does not recite any previous amendments to itself or the parent Determination beyond what it is changing in Schedule 1.

The instrument contains no litigation history, and the text does not mention any judicial or administrative decisions, challenges, or litigation outcomes. There are no cases named in the instrument. The instrument itself is an administrative instrument made under the Health Insurance Act 1973 and sets out item eligibility conditions. Any disputes about entitlement to Medicare payments, incorrect claims, or the interpretation of items would proceed under the Health Insurance Act 1973 administrative and judicial review processes; none are detailed here. Therefore, based on the text provided, there is no litigation history recorded within this instrument.

The instrument creates a number of practical traps for practitioners, administrators and referrers. These are concrete operational and legal risks grounded in the text:

• Bulk‑billing is a condition of payment: The items in the tables repeatedly specify fees only “where the service is bulk‑billed.” The instrument does not provide alternative item numbers or standing for non‑bulk‑billed services for these items. Practitioners who provide the service but charge a private gap, or who do not properly bulk‑bill, risk rejection of claims and possible Medicare compliance action. To claim the fees listed, the provider must bulk‑bill.

• “Capacity to undertake an attendance by telehealth” is pivotal but undefined: Several provisions impose a prohibition on using certain subgroup items if the practitioner and patient “have the capacity” to do telehealth (Schedule 1, amendment 2(5); amendment 4(1); amendment 5(3)). The instrument does not define “capacity.” Practitioners must therefore form and document an assessment of capacity whenever deciding to use a non‑telehealth item. Absent a clear standard in the instrument, this is an evidential risk in audits: practitioners will need contemporaneous documentation showing why telehealth capacity was absent.

• External, dynamic triage protocol determines patient‑at‑risk status: By importing the “current national triage protocol criteria for suspected COVID‑19 infection” into the definition of patient at risk (Schedule 1, amendment 1), the instrument creates a moving target. Changes to that protocol by its maintaining authority will change who is eligible. There is no text in this instrument telling providers where to find the protocol or how updates will be communicated; practitioners must actively monitor the relevant national protocol.

• Cross‑instrument dependence obliges checking other Determinations: Key definitions and credential requirements are not contained in the instrument but in other Determinations (2018 Other Medical Practitioner Determination; 2014 Allied Health Services Determination). Practitioners need to consult those instruments to determine whether they are an “eligible clinical psychologist” or an “eligible area” applies to a given item. Failure to do so may lead to incorrect claims.

• Prior face‑to‑face attendance requirement for “more susceptible” patients: The substituted paragraph 1.1.1 requires a rendering practitioner to have had “at least one face to face attendance with the patient in the preceding 12 months” if the patient is considered to be “more susceptible to the COVID‑19” (Schedule 1, amendment 2(6)). The instrument does not identify who determines “considered to be more susceptible.” That uncertainty needs to be resolved in practice and documented. The requirement can limit access to telehealth for newly referred vulnerable patients who have had no recent face‑to‑face contact.

• Referral and reporting mechanics impose administrative load: Allied health phone items require a specified referral pathway and a written report to the referring medical practitioner at the completion of a course (Schedule 1, amendment 5, items 91181-91188). Providers must track referrals, course completions, and produce reports that meet the item description. Systems and staff will need to be arranged to meet these documentation requirements.

• Credentialling registration burden for GPs on some items: Some GP items require registration with the Chief Executive Medicare as meeting credentialing requirements. That creates an administrative step before a GP can lawfully claim the items. GPs must ensure registration is completed and evidence maintained.

• Fees and durations are prescriptive: Many items set minimum time thresholds and link the fee to a duration band. Practitioners must record session start/finish times or otherwise document duration to support a claim for a particular item fee band.

• Potential substitution effects left to clinical discretion: The negative duty not to perform in‑person subgroups where telehealth is possible will in many instances push clinicians toward telehealth or phone modalities. Practitioners will have to make clinical judgments and document them, especially where in‑person care is nonetheless clinically indicated.

• No enforcement detail in the instrument: The instrument specifies eligibility conditions but not inspection, audit, suspension or penalty pathways. Practitioners should assume that normal Medicare claims compliance processes apply and that failure to meet item conditions exposes the claim to retrospective audit, recovery and other administrative consequences under the Health Insurance Act 1973.

• Where the instrument references other instruments “as in force from time to time” there is a continuous legal update risk: Definitions and eligibility may change because of amendments elsewhere. Practitioners must adopt a process to monitor the 2018 and 2014 Determinations, any changes to the Health Insurance Act or National Health Act and updates to the national triage protocol.

Each of these “gotchas” stems from the instrument’s structure: conditional, cross‑referenced item rules; dynamic external references; and heavy reliance on bulk‑billing and documentation. Practitioners and administrators must treat these features as operational risks requiring explicit systems and records to manage.

Compliance with the amended Determination requires operational, clinical and administrative steps tailored to the item conditions set by the instrument. Below is a practical checklist tied to specific instrument features, with actions that flow from the text.

1. Confirm item applicability and definitions

   • Consult the parent Determination and the amended Schedule 1 to identify the correct item codes for the service you intend to provide (see Schedule 1 amendments 2-5).
   • Where the instrument refers to external Determinations for definitions (for example the 2018 Other Medical Practitioner Determination for “eligible area” and “medical practitioner” (Schedule 1, amendment 2(1)-(2)) and the 2014 Allied Health Services Determination for “eligible” allied providers (Schedule 1, amendment 5(1))), obtain and read those Determinations to confirm eligibility and any geographic or provider constraints. The instrument explicitly imports those cross‑referenced meanings.

2. Establish patient risk status using the national triage protocol

   • For services that require the patient to be a “patient at risk of COVID‑19,” verify whether the patient meets the definition in the parent Determination as amended by insertion of paragraph (d): “meets the current national triage protocol criteria for suspected COVID‑19 infection” (Schedule 1, amendment 1).
   • Identify the current national triage protocol relevant to this instrument and retain contemporaneous evidence that the triage criteria were applied to the patient at the time of the attendance. The instrument makes eligibility dependent on that external, time‑varying protocol.

3. Implement bulk‑billing procedures for eligible items

   • All the telehealth, phone and allied health items added or amended in the schedule state the fee payable “where the service is bulk‑billed.” Organise billing workflows so that these items are bulk‑billed (no patient gap) and that Medicare claims are submitted accordingly.
   • Ensure practice software and billing staff are configured to mark and claim these items as bulk‑billed in accordance with Medicare procedures.

4. Document telehealth capacity and the negative duty

   • Where the instrument prohibits providing a subgroup service “if the practitioner and the patient have the capacity to undertake an attendance by telehealth” (Schedule 1, amendment 2(5), amendment 4(1), amendment 5(3)), document an assessment whenever choosing to provide an in‑person service or a phone service instead of telehealth. Record technological, clinical or other barriers to telehealth that justify using the chosen item.
   • Use a standard checklist or template note capturing whether both parties had telehealth capability, reasons why telehealth was not used, and any patient consent regarding modality.

5. Capture and retain duration evidence

   • Many items have minimum duration bands (for example phone sessions of at least 30 but less than 40 minutes or at least 40 minutes). Capture start and finish times or otherwise record the basis for duration claims in clinical notes to support the particular item code chosen.

6. Manage referral and reporting obligations for allied mental health items

   • Allied psychology, occupational therapy and social work items require specific referral pathways. Ensure the patient has a valid referral from an eligible referring medical practitioner as described in each item (GP Mental Health Treatment Plan, shared care plan, psychiatrist assessment and management plan, or specialist in psychiatry/paediatrics).
   • Keep records of the referral and, at the end of a course of treatment, prepare and send the required written report to the referring medical practitioner documenting assessments, treatment provided and recommendations (Schedule 1, amendment 5, items 91181-91188).
   • Ensure the referring medical practitioner performs the required review at the end of a course to determine further need.

7. Maintain evidence of prior face‑to‑face attendance where required

   • For patients “considered to be more susceptible to the COVID‑19,” the rendering practitioner must have had a face‑to‑face attendance with the patient in the preceding 12 months to use certain telehealth items (Schedule 1, amendment 2(6)). Make a record of any such prior face‑to‑face attendance, or if none exists, do not claim the telehealth item that requires it.

8. Ensure credentialling and Medicare registration where required

   • For GP items that require the practitioner to be “registered with the Chief Executive Medicare as meeting the credentialing requirements,” confirm registration is completed and maintain evidence of the registration status before claiming those items (e.g., items 91842, 91843).
   • Check the relevant Medicare processes for credentialling registration and follow their application and renewal procedures.

9. Create an audit trail and internal compliance checks

   • Because claims will be subject to Medicare audit and the instrument creates various conditional eligibility criteria, implement routine internal audit checks that review a sample of claims for compliance with patient risk status, telehealth capacity documentation, bulk‑billing status, credentialling evidence, referral validity, duration and reporting.
   • Maintain a compliance folder with copies of the national triage protocol as it applied on relevant dates, registration evidence, referral templates and report templates.

10. Update policies and staff training

    • Update clinic/health service billing policies and staff procedures to reflect the new items, bulk‑billing requirement, telehealth capacity assessment process and referral/reporting steps.
    • Train clinicians and administrative staff on the new documentation expectations, how to identify applicable items, and how to record the required evidence.

11. Monitor the referenced external instruments and protocols

    • Because clause 4(2) makes references to Acts, regulations and other Determinations “as in force from time to time,” allocate responsibility to monitor updates to:
      • The national triage protocol;
      • The Health Insurance (Section 3C General Medical Services - Other Medical Practitioner) Determination 2018; and
      • The Health Insurance (Allied Health Services) Determination 2014.
    • When updates occur, re‑assess whether changes affect eligibility, definitions, or credentialling.

12. Seek administrative clarification where ambiguity arises

    • For ambiguous phrases in the instrument (for example “considered to be more susceptible” and “capacity to undertake an attendance by telehealth”), consider seeking written Medicare guidance or documented advice from the relevant administrative unit if a consistent internal interpretation is needed for practice policy.

Following these steps aligns practice operations with the item conditions laid out by the instrument and reduces the risk of rejected claims or Medicare compliance action. The central operational themes are: document triage status, ensure bulk‑billing, demonstrate why telehealth was or was not feasible, secure required referrals and registrations, and maintain complete records of durations and reports.