- On July 2, 2018
- July / August 2018
A balanced resolution
AMA (NSW) successfully resolved potential billing headaches for VMOs, following recent changes to the CTP insurance scheme.
HISTORICALLY in NSW, the driver or rider at fault in a motor vehicle accident was not covered by Compulsory Third Party (CTP) insurance. What this meant for VMOs in an emergency setting was that the injured motorist was admitted as a public patient and the VMO was paid usual sessional or fee-for-service rates.
From 1 Dec 2017 the NSW State Insurance Regulatory Authority (SIRA) introduced a number of new reforms with the stated aim of:
- providing early access to income support and treatment expenses to all injured road users
- increasing the proportion of benefits provided to the most seriously injured road users
- reducing the cost of Green Slip premiums, and
- reducing opportunities for claims fraud and exaggeration
One of the consequences of the reforms is that the at-fault motorist in an accident is now covered under the CTP insurance scheme. This change requires the on-call VMO to treat an injured at-fault motorist as a private patient. The CTP scheme will cover the reasonable costs of treatment up to a maximum of AMA rates. However, the issue arises that if the at-fault driver declines to make a CTP claim, then the VMO must pursue the patient directly for payment. There would be no scope for payment by the hospital because the at-fault motorist is now a compensable patient under the CTP scheme.
VMOs were divided in terms of the advocacy that AMA (NSW) should be providing on this matter. Some were comfortable with the changes as they offered the potential for remuneration beyond ordinary sessional and fee-for-service rates. Others were concerned that a potentially large number of at-fault motorist patients would not submit a claim, and that the costs of the care would be difficult to recover, to the point that simply claiming ordinary VMO rates was more attractive.
With this in mind, AMA (NSW) entered into discussions with the Ministry of Health to find a practical solution to the issue. The Ministry has now agreed to create a new financial classification to cover at-fault motorist patients who decline to submit a CTP insurance claim. The new financial classification will have the same practical effect as the prior at-fault motorist classification in that the patient may elect to be treated either publicly or privately. If the patient claims on their CTP insurance then the VMO will be paid reasonable costs for treatment by the insurer (up to AMA rates). If the patient doesn’t claim on their insurance then the usual sessional or fee-for-service rates will be paid to the attending VMO by the hospital. The new classification will be rolled out shortly.
In the interim, we remind VMOs to continue to keep thorough patient records so that future VMoney claims may be easily facilitated.
For further information regarding at-fault motorist billing changes please contact Andrew Campbell at (02) 9439 8822 or firstname.lastname@example.org