How to use Cubiko to handle your 10997 billings

Chronic Disease Management (CDM) is rapidly growing in Australia and General Practice. Data suggests that 34-50% of GP consultations involve the active management of one or more chronic conditions.

Typically, when patients are diagnosed with a chronic disease, they are booked in for a GP Management Plan (GPMP), a Team Care Arrangement (TCA) or a Multidisciplinary Care Plan. If used correctly, these items, along with the continued monitoring and support, can drastically improve the care and quality of life for a patient with chronic disease.

CDM billings have always played a large part in a practice’s billings, often making up 20-40% of a practice’s total billings and ultimately helping a practice be more financially viable. While billing CDM item numbers play a large part in helping to keep a practice financially sustainable. We have seen a shift in Practitioners attitudes when completing GPMP’s, TCA’s or Multidisciplinary Care Plans as they move towards practising more preventative medicine.

In my previous blog post, I discussed Chronic Disease Management and the role of GPMP’s and TCA’s in a patient’s care journey. In this article, I will discuss how you can handle billing 10997’s in your practice and how you can facilitate the ongoing care of patients who have been diagnosed with a chronic disease.

What is a 10997?

Medical Practitioners can claim MBS Item 10997, where a monitoring and support service for a patient with a chronic disease care plan is delivered by a practice nurse or Aboriginal and Torres Strait Islander Health Practitioner on behalf of that medical practitioner.  

MBS Item number 10997 assists patients who require access to ongoing care, routine treatments and ongoing monitoring and support. This ongoing support is offered between the more structured reviews of the patient’s care plans by their usual GP. This includes:

  • checks on clinical progress;
  • monitoring medication compliance;
  • self-management advice, and;
  • collection of information to support the GP’s reviews of Care Plans.

It is important to note that the services provided by the practice nurse or Aboriginal and Torres Strait Islander health practitioner should be consistent with the scope of care outlined in the patient’s care plan.

How many 10997's can I bill?

Patients are eligible to be billed for a total of 5x 10997’s per calendar year (i.e. 1 January to 31 December) if they have a current GPMP, TCA or Multidisciplinary Care Plan in place.

Interested in learning more about how you can use Cubiko to opportunistically book patients in for appointments?

How do I target patients from my appointment book?

Patients need to have a current GPMP, TCA or Multidisciplinary Care Plan in place to be eligible for an item 10997. Without the proper tools and technologies, identifying patients who may be eligible can be quite a manual and time-consuming process, from downloading reports from your practice management system to writing custom queries.

Cubiko’s Item Optimisation cabinet looks at your billing history to identify patients who have had a GPMP, TCA or Multidisciplinary Care Plan billed in the last 12 months but have not had 5x 10997’s billed in the current calendar year in your practice. The item 10997 metric outlines the possible billings your practice could make from patients who may be eligible. Lastly, Cubiko provides you with a breakdown of these potentially eligible patients to identify who has an upcoming appointment and does not have a future appointment booked. 

Providing your nursing team with access to this cabinet can allow the nursing team to opportunistically book these patients into their appointment book for a 10997 service. We recommend creating a specific appointment type for your nursing team so that you can easily see and track it in the appointment book.

How do I identify patients who have a GPMP, TCA or Multidisciplinary Care Plan?

Once diagnosed with a chronic disease, patients are booked in for a GPMP, TCA or Multidisciplinary Care Plan. Check out our blog post “What is a GP Management Plan (GPMP)?” to learn how you can use Cubiko to identify patients who have care plans currently in place.

Next Steps

Interested in learning more about how you can use Cubiko to help you with your practice’s Chronic Disease Program? Book in for a demo today.

Trusted, reliable, loved by practices

Hear what your colleagues in the industry have to say