Funding to support the utilisation of a GP/SMO management plan to avoid admission.
This service is part of the Primary Options for Acute Care (POAC) programme.
Your Pinnacle Services Contract applies to this service. By claiming for this service, you have indicated that you have read and agreed to the business rules set out here.
This is NOT a clinical guideline.
All Pinnacle practices in Waikato region can claim for this service.
Exclusion criteria to access POAC funding should not preclude emergency treatment of any medical conditions.
Patients not domiciled in Te Whatu Ora Waikato area.
The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient. If the claim is unable to be funded by POAC, the patient may be liable to the practice for the fees incurred.
Prices listed below are GST inclusive.
GP extended consultation: $81.37
This can be claimed once to cover an additional 15 minutes of GP time discussing the case with the SMO.
Acute declined follow up consult: $129.78
Up to two follow up consultations are funded to evaluate the plan of care. These consultations must be on separate days and cannot be claimed on the day of the initial presentation.
Claims must be accompanied by documentation of the discussion with the SMO and the management advice.
Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of POAC funding otherwise the referral may be declined.
It has been recommended that in addition to a good assessment and history, the full range of appropriate observations should be documented, especially where the diagnosis is undetermined. It is important to state the time of consultations and interactions with the patient.
Claims must be accompanied by documentation of the discussion with the SMO and the management advice.
The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient.
The service is funded by Te Whatu Ora Waikato.
Primary options team, Pinnacle Midlands Health Network
infoprimaryoptions@pinnacle.health.nz
027 687 7312
Business rules for the Primary Options Acute Care programme (Waikato), which supports primary care through funding specific clinical services.
Quick guides to assist practices with identifying eligibility criteria;invoices that can be claimed; managing claims and providing assistance with understanding remittance reports
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