Mastering Medical Administration

A Comprehensive Guide to Australian Medical Billing

Presented by

Admin-Assist

Today's Training Modules

  • Module 1: The Foundations (Medicare & PHI)
  • Module 2: Informed Financial Consent (IFC)
  • Module 3: Private Health Fund Billing (No Gap, Known Gap & HBF)
  • Module 4: Third-Party Billing (DVA & Worker's Comp)
  • Module 5: Specialist Billing (Surgical Assistants)
  • Module 6: The Importance of Accuracy

Common Terminology

Account Holder

The person financially responsible for the account (e.g., a parent for a child).

OSHC/OVHC

Overseas Student/Visitors Health Cover. These require special handling.

Fee Schedule

The list of fees a doctor charges for their services, which can differ from Medicare or Health Fund rates.

Op Record

The official report from the surgeon detailing what occurred during a procedure. This is required by insurers for payment.

Ex-Gratia Request

A request to an insurer for a discretionary, one-off payment for something not normally covered.

The Rules of a Valid Referral

  • GP to Specialist: Valid for 12 months.
  • Specialist to Specialist: Valid for only 3 months.
  • Hospital Inpatient: Valid for 3 months or the duration of admission, whichever is longer.
  • Invalid Source: Referrals cannot be written by nurses or allied health professionals.

Common MBS Item Codes

Surgeon

  • 104: initial consultation
  • 105: subsequent consultation

Physician

  • 110: initial consultation
  • 116: subsequent consultation

Outpatient Billing: Standard & Bulk Bill

Standard Self-Funded (Private Billing)

  • The patient pays the full consultation fee directly to the clinic on the day.
  • We issue a paid invoice to the patient.
  • The patient uses this invoice to claim their rebate back from Medicare.

Bulk Billing

  • The doctor accepts the Medicare rebate as full payment for the service.
  • The patient has no out-of-pocket cost.
  • We must obtain the patient's signature and submit the claim directly to Medicare.

Outpatient Billing: DVA & Worker's Comp

DVA (Department of Veterans' Affairs)

  • Verify the patient's card type (Gold or White).
  • For White Card holders, confirm the consultation is for an approved condition.
  • Bill DVA directly using the correct MBS item codes. There is no cost to the patient.

Worker's Compensation

  • You must obtain prior approval from the insurance company before the consultation.
  • Bill the insurer directly, not the patient or Medicare.
  • Attach the approval and clinical notes to the invoice when sending.

Custom Billing: Cancellations & Reports

Cancellation / DNA (Did Not Attend) Fees

  • These fees are set by the individual practice and cannot be claimed from Medicare.
  • Check the practice policy for the specific fee and the required notice period (e.g., 24 hours).
  • Issue a private invoice directly to the patient for the fee.

Medical Reports / Record Release

  • This is for work requested by third parties like lawyers or insurance companies.
  • The fee is based on the time taken to prepare the report.
  • Issue a private invoice to the requesting third party.

Advanced Workflows: DVA & Worker's Comp

Requesting Additional DVA Funding

  • For fees above the standard DVA rate, you must request approval using the D1328 form.
  • Submit the form with a clinical justification letter from the doctor.
  • You must wait for written approval before proceeding.

Worker's Compensation Email Templates

  • When requesting approval, use a clear subject line: Approval Request for [Patient Name] - Claim #[Claim Number].
  • Always attach the clinical notes and the formal quote.
  • Follow up by phone if no response is received within 3-5 business days.

Advanced Workflows: Special Cases & OSHC

Hospital Funding Programs (\\"Public as Private\\")

  • This is when a public hospital pays our doctor to treat a public patient to reduce wait times.
  • The Hospital is the payor. Create an account for the hospital in the address book.
  • Bill the hospital directly; do not bill Medicare or the patient.

OSHC/OVHC (Overseas Patients)

  • These patients are not eligible for Medicare. They must be billed as self-funded.
  • The patient pays the full fee upfront.
  • We provide the patient with a paid invoice, which they use to claim back from their overseas insurer. Do not bill the insurer directly.

Patient Payments & Methods

Available Payment Methods:

  • NAB Transact: For secure credit card payments taken over the phone.
  • Bank Transfer (EFT): Patients can transfer funds directly to the practice bank account.

Tracking Payments (TPP Register):

  • All payments received must be meticulously recorded in the "TPP Register 3.0" spreadsheet.
  • This register is our source of truth for tracking incoming funds and reconciling accounts.

Managing Surgical Deposits

Purpose of a Deposit

To secure a booking and cover the patient's out-of-pocket costs before a procedure.

Standard Workflow

  • The deposit amount is specified on the signed Informed Financial Consent (IFC).
  • Record the payment in the TPP Register and apply it as a deposit against the patient's account in Gentu.

Handling Variances

  • If Deposit < Final Invoice: The remaining balance must be invoiced to the patient post-procedure.
  • If Deposit > Final Invoice: The excess amount must be promptly refunded to the patient.

Receipting Third-Party Payers

The Trigger

You receive a Remittance Advice from a third party (e.g., an insurer).

The Tool

Use the "Organisation Remittance" tool in Gentu for this process.

The Workflow

  • Open the tool and select the correct third-party payer.
  • Enter the total payment amount and date from the remittance advice.
  • Gentu will display outstanding invoices for that payer.
  • Match and apply the payment to the corresponding invoices listed on the remittance.

The Foundation: Medicare

Medicare is Australia's universal health insurance scheme. It gives all Australians access to healthcare at low or no cost.

What does it cover?

  • Hospital services as a public patient.
  • Consultations with doctors and specialists.
  • Diagnostic tests and imaging.

What is Bulk Billing?

When a doctor accepts the Medicare rebate as full payment for a service. The patient has no out-of-pocket cost.

Going Private: PHI

Private Health Insurance (PHI) gives patients more choice, such as their own doctor, shorter wait times, and access to private hospitals.

No Gap

The doctor accepts the fund's fee as full payment. The patient pays nothing out-of-pocket.

Known Gap

The fund covers most of the fee, and the patient pays a defined out-of-pocket amount (the 'gap').

What is an IFC?

An IFC is a formal agreement outlining a patient's out-of-pocket costs before a procedure. It's about total transparency.

Legal & Ethical Duty

Protects the patient and the practice from disputes.

Prevents Bad Debt

Ensures financial agreement before services are rendered.

Builds Patient Trust

No surprise bills means happier, more informed patients.

A Step-by-Step Guide

  1. Generate the Quote based on the doctor's item numbers.
  2. Issue the Quote as an IFC to the patient for review and signature.
  3. Receive the SIGNED IFC back from the patient. This is non-negotiable.
  4. Save the signed document to the patient's file.
  5. Collect any out-of-pocket Gap Payment prior to admission.
  6. Record the payment as a Deposit in the billing system.

The HBF 'Provider Choice' Rule

This is one of the most common and costly mistakes. The rule is simple but counter-intuitive.

You Can't Have Both!

A doctor can either accept HBF's higher fee schedule (No Gap to the patient) OR charge a gap. The moment a gap is charged, HBF pays the LOWER MBS rate, not their higher schedule.

Getting this wrong causes a Shortfall: a direct loss of income for the doctor.

How to Invoice an HBF Gap Correctly

  1. In Gentu, click Add > Quote.
  2. Select PRIVATE as the Account Type. This is the most critical step.
  3. Change the Fee Schedule to HBF.
  4. Add the surgical item numbers.
  5. Manually adjust the item fee to include the desired gap. (e.g., HBF Rate + Gap = New Fee).
  6. Verify the 'Patient Gap (est.)' in the fee breakdown is correct before sending.

Know The Card, Know The Rules

Gold Card

Comprehensive cover for all clinically necessary conditions. Generally, you can bill directly without prior approval.

White Card

Covers only specific, service-related conditions. You MUST get approval before treatment.

Getting DVA Billing Right

  • Mantra: \\\"White Means Wait.\\\" Never proceed with planned treatment without written approval.
  • Funding Requests: For higher fees (e.g., AMA rates), submit the D1328 form at least 3 weeks in advance.
  • Inform the Hospital: Always send a copy of the DVA approval letter to the hospital's billing department.

The Golden Rule of WC

When dealing with work-related injuries, we are billing a third-party insurer, not the patient or Medicare. There is one rule that you must never, ever break.

PRE-APPROVAL IS EVERYTHING

The insurer MUST approve all planned appointments and procedures BEFORE they happen. No approval = No payment.

From Request to Remittance

  1. Create a Quote using 'Other' Account Type and 'Worker's Compensation' Template.
  2. Email Quote & clinical notes to insurer for Approval.
  3. WAIT for signed approval to be returned.
  4. After procedure, convert Quote to Invoice.
  5. Email Invoice & Op Record to insurer for payment.
  6. Receive remittance and manually Receipt Payment in Gentu.

Can We Bill for an Assistant?

An assistant can only be billed if the primary surgical item in the MBS has \\\"(Assist.)\\\" in its description.

Laparotomy... for benign disease (including ectopic pregnancy...) not being a service associated with hysterectomy) \\(Anaes.)(Assist.)

If you try to claim an assistant on an ineligible item, you will get an error and the claim will be rejected.

51300 vs 51303

The correct assistant item number depends on the total fee of the main surgical items.

Use Item 51300

When the aggregate surgical fee is LESS THAN $651.30 (as of Jan 2025).

Use Item 51303

When the aggregate surgical fee is MORE THAN $651.30 (as of Jan 2025).

Why Accuracy is Non-Negotiable

\\"Garbage In, Garbage Out.\\" Every detail you enter has a direct impact on cash flow and workload.

Ensures Timely Payments

Correct claims get paid faster. It's that simple.

Minimises Rework

Avoids the frustration of chasing rejected claims and re-submitting.

Maintains Compliance

Accurate records are essential for audits and medico-legal integrity.

Avoid These Common Errors

!

Incorrect Account Holder information (e.g., child instead of parent).

!

Wrong Site of Service (e.g., billing telehealth from the hospital).

!

Incorrect Date of Service.

!

Missing or expired Referral.

!

Using Item Numbers that are incorrect or ineligible for the provider.

Pillars of Billing Excellence

Informed Financial Consent

Is about compliance and risk management. Get it signed, get it paid, get it filed.

Health Fund Rules

Is about attention to detail. The right account type prevents shortfalls.

Third-Party Payers

Is about following the rules. DVA cards and WC approvals have unique workflows.

Overall Accuracy

Is about getting paid correctly the first time. Double-check everything.

Q & A

What questions do you have?

Day 1 Contents