Find appointments with your nurses where a 10997 may have been performed but not billed
This metric can assist in finding appointments that were booked with your nurse team where a 10997 may have been performed but not billed.
Eligibility for item 10997 is based on historical billings of items 721, 723, 731, 732 and also their Telehealth, Telephone and non-VR equivalents. Patients who received 5 (five) item 10997s in a calendar year are not considered eligible for further billing opportunities of item 10997s in that calendar year. Always consult your Providers about billing decisions and ensure the relevant service or appointment meets MBS/DVA guidelines.
To navigate to this metric, go to Clinic Optimisation > Billing Optimisation > Historical opportunities tab > Historical 10997 opportunities
NOTE: Please ensure to review these appointments to check if the service was performed, documented, and therefore eligible for billing as per MBS/DVA guidelines for item 10997. Not all appointments listed in this metric will be able to be billed an item 10997.
NOTE: A time limit of two years currently applies to the lodgement of claims with Medicare under the direct billing (assignment of benefit) arrangements. This means that currently, Medicare benefits are not payable for any service where the service was rendered more than two years earlier than the date the claim was lodged with Medicare.
Click here and here to find further information about it.
It has recently been announced that this claiming period will be reduced to 12 months from November 2025. Read more about it here."
Item 10997 will assist patients who require access to ongoing care, routine treatment and ongoing monitoring and support between the more structured reviews of the care plan by the patient's usual GP.
The services provided by the practice nurse or Aboriginal and Torres Strait Islander health practitioner should be consistent with the scope of the GP Management Plan, Team Care Arrangements, or Multidisciplinary Care Plan.
The sections included in this article relating to Potential 10997 opportunities are:
- Historical potential 10997 opportunities by Nurse
- Trend of historical potential 10997 opportunities
- List of historical potential 10997 opportunities
Historical 10997 opportunities by Nurse
This is the number of nurse appointments that were with patients who were potentially eligible for item 10997 but no item 10997 was billed with the same service date. Opportunity is broken down by each Nurse appointment book as per your setup in your Practice Management Software.
Trend of historical potential 10997 opportunities
This graph shows the trend of nurse appointments that were with patients who were potentially eligible for an item 10997 but no item 10997 was billed with the same service date.
Use this graph to identify if there are certain days where more potential 10997 opportunities are missed and whether different nurse clinics running on those days have an impact.
List of historical potential 10997 opportunities
This table shows a list of patients who had a nurse appointment who were potentially eligible for item 10997 but no item 10997 was billed with the same service date.
This list allows you to see the appointment date and time, patient details, appointment type, Nurse seen, how many 10997s billed that calendar year, item numbers billed for that patient on that service date, which doctor they were seeing that day and the patient's Usual Doctor.
TOP TIP! Create an appointment type specifically for 10997, so nurses can book patients into their appointment book using this appointment type. This will make it easy to search and find any potential missed billings by using the filter 'Select Appt Type' at the top of the page to refine the list to those appointments booked as '10997' only.