The recent changes to NiB Medigap carry significant implications not only for anaesthetists but also for Intensivists in private practice. These updates, which affect how medical services are billed and reimbursed, make it crucial for both anaesthetists and intensivists to adjust their practice management strategies to maintain financial stability and compliance.
Key Updates to NiB Medigap for Anaesthetists and Intensivists
- Introduction of a Discretionary Known Gap
Starting 1 October 2024, NiB Medigap will allow a discretionary Known Gap of up to $500 per episode. This shift transforms Medigap into a network offering both No Gap and Known Gap options. Even if you’re not currently registered with Medigap, it’s important to note that it remains one of two medical networks available to both anaesthetists and intensivists. - Continued Benefits Under GapSure Anaesthetics
For those registered under the GapSure Anaesthetics network, no immediate action is required. This network, known for its competitive rate schedule, continues to provide certainty for both anaesthetists, intensivists, and their patients. The GapSure Anaesthetics Schedule of Benefits offers a standard value of $43 per unit on all MBS Item numbers with ASA RVG unitisation, with a review pending soon. - Comparison: GapSure Anaesthetics vs Medigap
- GapSure Anaesthetics: Registered providers must charge through the network for each treatment, adhering to a non-discretionary policy with a single, uniform value per unit.
- Medigap: Allows providers to participate on a case-by-case basis with a discretionary Known Gap option up to $500 per episode.
- Registration Restrictions
Anaesthetists and intensivists cannot be registered with both Medigap and the GapSure Anaesthetics network simultaneously. If you choose to register for Medigap, Honeysuckle Health will automatically deregister you from GapSure Anaesthetics. However, you can re-register for GapSure Anaesthetics at any time. To deregister from GapSure, you must provide Honeysuckle Health with 30 days’ written notice.
How These Changes Affect Your Practice
- Impact on Patient Billing
The choice between staying with GapSure or moving to Medigap should be made with careful consideration of how each network’s billing policies align with your practice’s financial goals and patient expectations. - Legal and Regulatory Compliance
Remaining informed and compliant with NiB’s network changes ensures your practice avoids legal pitfalls while optimising revenue collection. - Communicating Changes to Patients
Clear communication about any potential out-of-pocket expenses due to the introduction of the Known Gap is essential. Transparency will help maintain trust and patient satisfaction.
Conclusion: Staying Ahead with Informed Decisions
The NiB Medigap changes highlight the importance of staying informed and proactive in private practice management. Anaesthetists and intensivists should carefully evaluate the benefits of both the GapSure and Medigap networks, considering the impact on their practice’s revenue and patient care.
By understanding these changes and adjusting your practice management strategies accordingly, you can continue to provide excellent care while ensuring the financial health of your practice.
For more details and personalised advice, reach out to the team at Honeysuckle Health, who manage these networks on behalf of NiB.
If you would like to switch schemes, the team at Solo Practice Management can help you. Reach out to our billing experts today.
