Forum: HMR rejections


“I have just had 2 HMR’s rejected as the date I sent the report fell into the following month – ie I saw the patients on the 30th but did not send  the report until 2nd.

I have never had this issue and could not find in writing anything about the date of service being today the report was sent. I assumed and I can’t find anything in writing to refute it that the day I see the patient is the month it falls into the claim.

This really annoys me as I did not go over the cap for either month but because the 8 I saw at the end of May but sent in June has pushed me over the June cap by 2 even though I only saw 15 patients and even less the previous month.

If the date sent is the date to go by that is ridiculous and difficult to manage.  Oft patients are sick and you may end up seeing more at the end of one month which won’t be sent until the next day or two.

Anyone else had similar issues?”

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6 Comments

  1. PGA influence
    07/09/2016

    The PGA will find any way to refuse/delay payment. This is what they do. Their aim is to abolish this service all together so more diluted tick box in-house “professional service” can gain traction.

    Quite amusing when even on their HMR claim template the “day of report sent” cannot be the same as the “day of interview”…it has to be the day after which makes no sense. Deliberate red tape to influence the program and push its own agenda.

    • Drugby
      07/09/2016

      Are you sure this is correct. I almost always submit provide the GP report on the day of the interview. I haven’t had a claim rejected. I’ve just looked at the 6CPA website and the program specific rules and this is not specified.

      • PGA influence
        07/09/2016

        I too provide the report the same day as the interview. Nothing to do with the rules/rejections but the PGA claim template that doesn’t allow you to input a date the same day as the review…unless this has been rectified?

      • PGA influence
        07/09/2016

        Other ridiculous limitations: the inability to distinguish between family members when searching whether a patient has been reviewed within 2 years (not member # specific), the arduous task of completing the claim itself, the inability to get the claim amended purely for a type-o (as you said despite evidence provided it’s like pulling teeth) and let’s not forget the 20 patient cap itself which is the biggest insult of all. All pointing to a program phase out supported by the only professional body with any power.

  2. Drugby
    07/09/2016

    I have had a HMR claim rejected due to the system’s error. The Guild ‘system’ did not receive my claim for one HMR until after 30 days. I routinely submit my HMR claims on the day, after completing the report and discussion with the GP. On the day they claimed my HMR was submitted I was actually on a plane flying to Borneo. Despite providing travel evidence and a stat dec, my claim was rejected.

    Too many of the rules around HMR and RMMR claims are inconsistent or lack flexibility for different circumstances.

  3. Drugby
    07/09/2016

    I’ve just looked in the program specific guidelines on http://6cpa.com.au/medication-management-programmes/home-medicines-review/ and it is not specific about timeframes i.e. whether it is the date of interview, date of report or date of claim. I would ring the team at 6CPA for further consideration. Seems very unfair, when the service is provided in good faith, and yet the claim is rejected due to ‘silent’ rules.

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