Medicare compliance - our questions answered
2 July 2025
Questions from February’s webinar on compliance with Medicare sleep study item numbers have been answered.
The Department of Health and Aged Care has worked closely with ASA leadership to clarify a range of topics raised by members before, during and after the webinar.
Read the Q&A document
As mentioned in the April update on 2025 compliance activities, there is an emphasis for this year on auditing compliance with MBS items 132 and 133, as well as claims for MBS services carried out while the provider was overseas.
The Q&A document contains important information about these two key compliance priorities.
In particular, Part F relates to sleep study requirements that both reporting and supervising physicians must be in Australia when the service is undertaken:
In relation to sleep study items, the reporting practitioner who claims the service must be present in Australia when preparing the report and while supervising the service (if they are the practitioner responsible for supervision). Medicare claims may be submitted while the claiming practitioner is overseas but only if the date of the MBS service is consistent with the presence of that provider in Australia.
The Department has clarified that the supervising physician does not need to be the same person as the reporting physician, but that each must be in Australia on the relevant date.
In the context of sleep study items, the overnight investigation of sleep must be performed under the supervision of a qualified adult sleep medicine practitioner. This individual may be the same or a different individual to the practitioner who interprets the data and prepares a report (see DN.1.17 – Billing requirements for level 1 and 2 sleep studies).
As per GN.12.31, a supervising medical practitioner need not be present for the entire service but must have a direct involvement in at least part of the service. Although the supervision requirements will vary according to the service in question, they will, as a general rule, be satisfied where the medical practitioner has:
(a) established consistent quality assurance procedures for the data acquisition; and
(b) personally analysed the data and written the report,
noting again that, for sleep study items, (a) and (b) may be undertaken by a different individual.
As stated in GN.12.31, the qualified adult sleep medicine practitioner(s) responsible for each component of the sleep study service must be present in Australia at the time they fulfil their role.
Questions
If you have any general questions about these topics, please read the Q&A document again to ensure the answers aren’t covered.
If you still have questions, please contact AskMBS to seek answers relevant to your specific situation.
If you feel you’re not getting the answer you need, please contact the ASA CEO, Marcia Balzer, and your question will be referred back to the Department for clarification. (Please note that it is likely to take some time to get a response.)