Maximising Medicare: Helping ACCHOs get the most from 715 health checks

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Ensuring that clients access their full entitlement of follow-up care after a 715-health check is a significant opportunity for ACCHOs to enhance patient health outcomes and secure Medicare funding. Sector Leader investigates.

The ACCHO sector plays a vital role in delivering culturally safe, comprehensive healthcare to Aboriginal and Torres Strait Islander communities in Queensland.

One key opportunity to further strengthen services, boost revenue streams and provide crucial free health care for Aboriginal and Torres Strait Islander patients lies in maximising follow-up care after 715 health checks.

The 715-health assessment plays an important role in the early identification of risk factors and early diagnosis of illness and chronic disease. It acts as a direct pathway to referral for essential preventive health and education.

On completion of the 715-health assessment, eligible Aboriginal and/or Torres Strait Islander clients can access a total of 10 follow-ups and/or allied health services per calendar year. This can be a combination of follow-ups and allied health services (as detailed below) or all 10 for a single service (e.g. physiotherapy).

For 715 follow-ups provided by an Aboriginal and/or Torres Strait Islander Health Practitioner (but not an Aboriginal Health Worker) or Practice Nurse on behalf of a General Practitioner, a formal referral letter is not required. However, follow-ups must be “consistent with the needs identified through the health assessment” — so it is important to document potential follow up actions during the health check.

As so many patients are on medications, using this follow-up service to check on the taking of medications can be a real help.

The doctor does not need to be present while the follow-up is being done. This means that distance supervision of the practice nurse/Aboriginal and Torres Strait Islander health practitioner by the GP is acceptable, so long as the GP can be contacted if required.

Upon completion of each episode of follow-up care provided by AHPs or nurses, any GP can claim MBS item 10987 on their behalf. Each 10987 item incurs a benefit of $27.30.

The telehealth items for these services can be claimed under 93200 (video) or 93202 (phone).

A formal referral is required to allied health services who will be providing a service of at least 20 minutes duration to claim their eligible MBS item benefit.

The allied health professional should claim the relevant MBS item for their service type (equal to a reimbursement of $70.90). Telehealth items for the above services can be claimed under 93048 (video) or 93061 (phone).

This Medicare-funded follow-up care and referral for allied health services not only promotes preventive health care and health education for the client, but also supports ACCHOs with steady incoming revenue from MBS item claims.

Between July 2023 and June 2024, Aboriginal Medical Services and bulk-billing clinics across Queensland conducted 90,213 health assessments.

If all clients were eligible and accessed their full entitlement to follow-up appointments and allied health care, this would have translated to 902,130 sessions, based on follow-up appointments alone, this would have generated more than $24 million in Medicare revenue.

However, only 13% of follow-ups (118,213 sessions) were completed during this period, Meaning that while ACCHOs successfully referred thousands of eligible clients for follow-up care, there is still significant opportunity for ensuring clients are accessing the full amount of care they are entitled to, and ACCHOs are maximising their opportunity for claiming Medicare revenue.

How can ACCHOs maximise this opportunity?

QAIHC Public Health Medical Director, Associate Professor Sophia Couzos, said taking advantage of 10987 follow-up sessions was what a health check was all about. The health check aims to identify early health risks so that disease can be prevented. This means a follow-up is essential to get things right.

“The patient benefits, first and foremost, and ACCHOs can grow their services, expand workforce capacity, and build financial sustainability,” she said.

Case study: Increasing follow-ups

Sam, the Quality Manager at health service X registered for and completed a module on the Medicare Benefits Schedule (MBS) Optimisation eLearning Course supported by NACCHO.

This inspired her to investigate how well the service was supporting Aboriginal and Torres Strait Islander clients to access MBS-funded follow-up services after a 715-health assessment.

In the course, Sam learned that Aboriginal and Torres Strait Islander clients are eligible to access up to 10 allied health services per calendar year, for preventive health care and education as follow-up care after a 715-health assessment. She reviewed the data from her health service to find out both how many clients were eligible to access and accessed the MBS follow-up items for eligible allied health services in the previous calendar year.

Sam found that 49% of regular clients (128 clients) had received a 715 health check and sixty-eight clients (53%) were eligible for follow-up appointments; however, only 2% (5 clients) had accessed eligible follow-up allied health services — far below the potential 680 services that could have been provided.

As Quality Manager, Sam understood the importance of a ‘whole of team approach’ to practice improvement and formed a multidisciplinary working group, including GPs, health workers, nurses, allied health, and admin staff, to review current referral processes and knowledge gaps.

The working group set a goal: to ensure all eligible clients were offered appropriate follow-up care. They worked together to develop a strategy which included introducing a streamlined referral process, displaying visual resources of eligible allied health services and associated MBS item numbers, and training staff through the free online course. Sam used the Plan-Do-Study-Act (PDSA) tool to guide the planning, implementation, monitoring and evaluation of the strategy.

Sam reviewed the data again three months later and found the number of eligible clients accessing MBS item 10987 for follow-up services had jumped from 2% to 62% (37 clients).

Sam documented the entire CQI process, which is now part of Health Service X’s policy and accreditation evidence. This quality improvement initiative is one example of how data, teamwork, and practical tools can support Medicare optimisation within services. There are lots of other ways too, and QAIHC welcomes Members sharing their stories.

For information on maximising followups for 715 health assessments please reach out to: PublicHealthRegistrar@qaihc.com.au.

Scan the QR code to visit the Medicare Benefits Schedule (MBS) Optimisation eLearning Course online.