Primary healthcare news, information & resources

POAC for the assessment of suspect COVID-19 cases

In response to the COVID-19 pandemic there is now funding available via POAC for the assessment of suspect cases. 

Following the release of the Ministry of Health's revised case definition on 24 June 2020, the assessment framework has been updated in conjunction with PHO clinical leads and CEOs.

This means the funding available for assessments is changing, effective Monday 6 July.

  • You can only claim one type of claim per patient, per day, per practice. 
  • This service needs to be at no cost to the patient.
  • Please continue to claim through primary options.
  • Any care delivered prior to 6 July 2020 can be claimed under the previous funding model provided the claim is submitted in July. (Details of the previous claiming model can be found below.)

There are now four funding categories, tiers 1-3 are further explained in this PDF.

COVID - Virtual -$60 (excl GST)

  • Tier 1 COVID-19 triage or telehealth assessment.

COVID - F2F no swab $60 (excl GST)       

  • Tier 2 COVID-19 symptoms alone.

COVID - F2F swab $120 (excl GST)  

  • Tier 2 COVID-19 symptoms alone.

COVID - F2F high index of suspicion $250 (excl GST)

  • Tier 3 COVID-19 symptoms plus a high index of suspicion.

For more information

If you have any questions or concerns please contact Sally Newell, clinical services manager, phone 021 150 8788.

Claiming prior to 6 July 2020

Prior to 6 July 2020 practices could claim funding for the assessment of a suspected COVID-19 case as detailed below. 

  • The patient(s) must meet the Ministry of Health's case definition (as it stands at any given point in time).
  • There is to be no co-payment or GMS clawback.
  • Patients must be advised of test results.
  • These are funded for any patient who meets the Ministry case definition, irrespective of where the patient is enrolled or whether they are eligible for publicly funded healthcare. This enables you to claim for domestic and international visitors to your regions.
  • If you assess a patient, then send them to a CBAC or swabbing centre for a swab then you can claim either a virtual assessment, or if you have seen the patient in your practice, you can claim the simple assessment.

Please claim by selecting the COVID-19 assessments pathway and then the appropriate service, as detailed below. 

The Ministry of Health has also confirmed during COVID-19, a virtual consultation counts as a consultation for the purposes of the 12 visits necessary for High User Health Card eligibility. 

Virtual COVID-19 assessment ($60 excl GST)

  • A virtual consultation does not need to be a video consultation, it can be a telephone call.
  • The virtual payment can be for the initial virtual consultation and advice to go to a CBAC (in the Waikato an e-referral process has just gone online).
  • You can claim a virtual consultation for any consultation of about 15 minutes or more, i.e. any consultation you would have charged a co-payment for.
  • If you telephone triage a patient then bring them into the practice you can claim a simple or complex assessment, but not an additional virtual consultation for the telephone call.
  • Please ensure your notes reflect your assessment. Please create one referral per patient and then add each individual invoice to that.

Simple COVID-19 Assessment ($120 excl GST)

  • Patient has mild symptoms.
  • Visual check and basic observations.
  • Swab undertaken if indicated.
  • Patient is notified of their result (if a swab was taken). 

Complex COVID-19 Assessment ($250 excl GST) 

  • Patient has moderate or severe symptoms. 
  • Chest exam in the practice.
  • Swab undertaken and patient notified of their result.
  • Patient may require a follow-up check (included in this funding package).

Follow up consultations

  • Follow ups can be claimed irrespective of where the swab was done. 
  • These are funded if clinically indicated and evidenced in the notes e.g. a positive result or a symptomatic patient after a negative result.
  • For a face to face follow up please claim for a simple assessment.
  • For a virtual follow up please claim for a virtual assessment.
  • NOTE: A complex assessment claim already includes a follow up.

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