ClaimLogic Live Q&A – Patient transfer from another facility, why are some items not paid?

By Máté Rudas

patient transfer

Q&A Session – 28 August 2025

Q: For a patient transfer from another facility, why was daily management and ventilation on the day of transfer rejected, but pressure monitoring paid?

This comes down to MBS rules governing ICU management and support items. TN.1.9 TN.1.10 TN.1.11

  • Scope: Daily management and support items
  • Details:
    • Most daily management and support items can only be claimed once per calendar day per patient, regardless of the number of doctors involved.
    • In a patient transfer situation, both the sending and receiving Intensivist may be eligible to claim, but there are no set rules — the consultants are expected to agree (ideally based on who was more involved), though in practice it often comes down to who bills first.
    • Pressure monitoring (item 13706) has different limits (up to 4 different pressures can be billed per day). Because Services Australia doesn’t always validate the type of pressure, claims for identical pressure monitoring from two hospitals on the same day may technically be paid.
  • 🔴 Important: Even if accepted, duplicate identical pressure monitoring item claims across two sites on the same day are not compliant and should be refunded.

👉 For a deeper dive, read our article in the Navigating the Maze series and watch the full Q&A video here:


Disclaimer

This blog is provided for educational and general informational purposes only and does not constitute legal, medical, or financial advice. While every effort has been made to ensure accuracy, billing requirements under the Medicare Benefits Schedule (MBS) are complex and subject to change. Clinicians should always consult the official MBS, relevant hospital policies, or seek independent professional advice before making billing decisions. While we use reasonable effort to ensure that our overview articles are accurate, current and complete, we do not represent, warrant, or guarantee (to the maximum extent permitted by law) their accuracy, currency, or completeness or imply that they are applicable to your individual situation. ClaimLogic accepts no liability arising from for actions taken based on the content of this article.

Máté Rudas

Dr Rudas is the Director and Founder of ClaimLogic. 

He is Senior Staff Specialist at Royal Prince Alfred Hospital in Sydney. His clinical interests include critical care ultrasound, advanced haemodynamic monitoring and mechanical cardiorespiratory support. He is a member of the CICM Ultrasound Special Interest Group, an examiner for the ASUM DDU (Crit Care) and works as part of the NSW ECMO Retrieval Service.

Other interests include medical billing, clinical informatics and health facility design. Roles include Clinical IT lead at NBH and ICU clinical co-lead for the RPA ICU redevelopment project. 

ClaimLogic Live Q&A – Can I bill for therapeutic procedures performed by trainees?

ClaimLogic Live Q&A – How is billing in public hospitals relevant to doctors?

Leave a comment