Questions and Answers - Medicare-eligible midwife starting up private practice

Hello dear reader,
I am preparing a series of posts on general questions asked by women and midwives about private midwifery practice. If you have questions, please add them in the comments section, or send me an email joy@aitex.com.au

In preparing questions and (attempting) answers, please note that questions on clinical conditions can only be addressed in a general way, and cannot replace the face-to-face discussion and decision-making between a woman and her midwife or other care provider.  Also readers are welcome to provide additional information or discussion via the 'comments' section, or to write guest posts.

Frequently asked questions can be grouped, and colour-coded to help organise:

1. about midwives who have (or plan to obtain) Medicare provider numbers
2. about planned homebirth
3. about planned hospital birth
4. about vaginal birth after caesarean surgery (VBAC)
5. about women who have certain 'risk' factors
6. about ...

Today's question, to get the ball rolling, is:

Q. I wish to practise as an eligible midwife providing antenatal education and postnatal care.  How do I go about getting started?

A.  The short answer is that there is a great deal of scope for Medicare participating midwives to offer private midwifery services, including antenatal care and postnatal care.

When commencing private practice, a midwife is advised to find an experienced mentor, who is willing to support the midwife's entry into private practice. You may avoid a few headaches!



The longer answer ...

Women who receive midwifery care from a chosen midwife in private practice who is Medicare-eligible, and who has fulfilled the requirements such as collaborative arrangements and indemnity insurance (these have been written about previously on this blog. Use the search function if you want to check out previous posts) will receive rebate on the midwife's fees for services that have a Medicare item number.  The amounts of rebate are set out in legislative tables that are available for anyone interested.


The following brief summary is quoted from the government's ComLaw website.

Health Insurance (Midwife and Nurse Practitioner) Determination 2011 - F2011L02162

Schedule 1 Midwifery services and fees

Part 1 Midwifery services and fees

Part 1 of Schedule 1 of the Determination sets out the relevant general midwifery services, assigns applicable item numbers, item descriptors and fees for the services. These items enable the payment of Medicare benefits to patients of participating midwives for antenatal, birthing and postnatal care: ·

• an initial antenatal attendance of at least 40 minutes duration (item 82100); · 
• a short antenatal attendance of up to 40 minutes duration (item 82105); · 
• a long antenatal attendance of more than 40 minutes duration (item 82110); · 
• development of a maternity care plan for a pregnant woman, where the pregnancy has progressed beyond 20 weeks (item 82115); · 
• management of a confinement for up to 12 hours (item 82120); · 
• management of a confinement in excess of 12 hours, where care of the patient is transferred from one midwife to a second midwife (item 82125); · 
• short postnatal attendance of up to 40 minutes duration (item 82130); · 
• long postnatal attendance of at least 40 minutes duration (item 82135); and · 
• six week postnatal attendance (item 82140), after which the woman would see her general practitioner. 

Antenatal and postnatal services may be provided in a range of settings including in consulting rooms, community clinics and the woman’s home. Medicare benefits for the management of labour and delivery are only payable where the service is provided to an admitted patient of a hospital, including a hospital birthing centre.

Please note that there is no Medicare item number for antenatal education.  However, midwives provide education for each woman in their care, relating the science and art of midwifery to that woman's personal situation, and guiding the woman in her preparation for birth and mothering.

A midwife who intends to provide Medicare-rebated prenatal (items 82100, 82105, 82110, 82115) and postnatal services (items 82130, 82135, 82140) is able to charge a fee, or bulk bill.  The amount of rebate the woman receives will depend on her status with the Extended Medicare Safety Net (EMSN) capping system.

For example, if the midwife's charge for a 1-hour postnatal visit (Item 82135) in the woman's home is $120, the scheduled fee for that item is $75.05, and the EMSN (if applicable) is $20.65

The rebate a woman who has passed the Safety Net threshold is $75.05+$20.65=$95.70.
Out-of-pocket expenses for that consultation are $24.30.

On the other hand, if the midwife chooses to do so, she may 'Bulk Bill' for that item.  The midwife receives the 'Benefit 85%' (of the scheduled fee) payment of $65.60 into her nominated bank account, from the public purse.  The midwife may consider the ease of bulk billing, and the opportunity to provide a greater number of postnatal visits without increased cost to the woman, to outweigh the lesser unit payment.

Midwives participating in Medicare are able to obtain portable EFTPOS machines from their bank, which enable easy and quick credit card payments (swipe the credit card), Medicare rebates into the client's debit card account, and bulk bill payments (swipe the Medicare card). 


Where to go for more information:
Midwives Australia
has a wealth of information and links at its website. Midwives Australia is a not-for-profit organisation supporting midwives through these changes with practical hands on initiatives, programs and resources.

Your comments are very welcome.
Please note that any opinions expressed in this blog are the opinions of the writer, Joy Johnston, and may not necessarily be shared by other members of MiPP.