Medicare Online functionality enables you to lodge Medicare
Bulk Bill, DVA medical claims, and patient claims with Medicare
securely over the internet. Your MedicalDirector Practice
Management system allows this secure submission of patient
claims to Medicare, saving your patients a visit to a Medicare
Office. 'Vouchers' are batched-up
into claims and these claims are sent to Medicare for assessment
and payment.
Overview
The patient signs over their Medicare benefit rights to
the servicing Practitioner. The Practice must generate an
Assignment of Benefit form detailing the services provided
by the servicing Practitioner. The Patient must receive a
copy and the Practice must keep a copy for 2 years, both copies
must be signed by the Patient.
Eligibility of a patient for Bulk billing can be performed
in real-time using Online Patient Verification (OPV). The
claim can then be sent as a transmission using Online Claiming.
Claims do not have to be sent immediately, they can be stored
and sent at a later time. The practice will receive a response
(in real-time) as to whether the transmission has been accepted.
Using your MedicalDirector Practice Management system, vouchers
(invoices) can be created for the services performed. These
vouchers can then be grouped into claims and must be authorised
using an electronic signature before they are transmitted
to Medicare. The electronic signature can be represented by
either a Location Certificate or a HCI token specific to the
Practitioner or locum who provided the service. This is equivalent
to signing a DB1 form.
Within three business days of the claim being transmitted
the Practice can then get the results of the assessment (exceptions
or details of what is being paid). Online Claiming generates
a Processing report that can be requested by the Practice.
The Practice can then resolve any exceptions. Within six business
days of the claim being transmitted the Practice can get the
Payment report that details what has been paid. They can then
receipt-off all of the vouchers in the claim.
o Online
Claiming Bulk Bill and Veteran Affairs does not require paperwork
to be sent, unless instructed by Medicare.
o The
processing report is available for collection within three
(3) days of Medicare receiving the submitted claim, and for
six (6) months after initial availability.
o The
payment and processing report can only be successfully retrieved
once.
o The
payment report can only be retrieved after the processing
report has been received.
Rejected
Items
o Each
rejected item must be either rejected or resubmitted.
o Partial
write-offs are not permitted and must be accepted.
Patient
Claiming
o All
services in the Patient Claim must be either in-hospital or
out-of-hospital.
o When
the full amount for the invoice has not been paid, the benefit
will be paid to the Practitioner, regardless of the Claimant.
Claimant details are required so that the cheque can be sent
to the Claimant for forwarding to the Practitioner.
o The
Claimant can either be the patient themselves, or another
interested party.
o The
Claimant must have a valid date of birth and must be at least
12 years old.
o The
Claimant must have a valid and current Medicare card.
o If
the payment is by EFT:
• Account
Name, BSB, and Account number field must be entered, and
• The
Claimant's address must be entered. (An address is required
so that Medicare can send the Claimant a Statement).
o The
Claimant must agree to the terms of the Claimant Declaration
before a Patient Claim can be submitted or stored.
o A
Statement of Claim and Benefit must be printed for successful
immediate claims.
o If
claims are rejected on the basis of incorrect Medicare card
information for the Patient or Claimant, the relevant details
must be updated in Bluechip prior to resubmitting the claim.
o Unsuccessful
claims are deleted in Bluechip to allow for the invoice to
be resubmitted with another Patient Claim. These claims will
not appear in the claims list - their deletion is absolute.
• Note:
Once an invoice has been attached to a Patient Claim it cannot
be attached to another Patient Claim unless the first claim
is deleted. This is the same as Bulk Bill/DVA claims. This
is implemented to prevent the possibility of Invoices being
submitted twice.
o A
Patient Claim can reach the following status during the transmission
process:
• Submitted
• Report
Received
• Successful
• Pending
• Rejected
o No
reports are required as result of transmitting a Store and
Forward claim.
Notes
on Bulk Bill/DVA Claims
o The
patient must assign their rights for Medicare benefits to
the servicing Practitioner using an Assignment of Benefit
form. Two copies of this form will need to be printed out
and signed before the claim can be processed further. A copy
of this form must be held by the practice for at least two
(2) years.
o DVA
voucher forms must be completed and sent by mail to Medicare
for the claim to be processed.
o If
a patient is not eligible to receive a benefit or the Assignment
of Benefit form is not signed, the practice must invoice the
patient using a non-batching account and recover the monies
directly.
o Additional
text is required to be included per service (that is invoice
item) under certain circumstances (Aftercare, Duplicate Procedure
on the Same Day).
o When
the invoice is for in-hospital services, the hospital name
must be nominated.
o Invoice
items must be receipted correctly to be eligible for Patient
Claiming. Acceptable receipting methods are:
• All
invoice items are unpaid - that is no receipt has been issued.
• All
items are partially receipted - each invoice items in the
invoice must be partially paid. Receipting in this manner
has implications to Medicare in respect of the Safety Net
calculations, and the capacity to pay benefits to the Practitioner
and the Patient in the same claim.
• All
items are fully paid - that is the invoice is fully paid.
o Invoices
can include the non-Medicare item MISC, but not other items
from non-Medicare list.
o Invoices
must have at least one service item that has a non-zero amount.
o Non-MBS
items contained in an invoice cannot have a zero amount.
o Standard
referrals used for patient claim invoices must have the referring
Practitioner's provider number recorded.
o A
stored claim will validate and authorise the claim only. No
transmission to Medicare will take place in the storing process.
o A
Lodgement Advice must be printed for successfully created
store and forward claims, or for immediate claims referred
to a Medicare Operator.
o Invoices
cannot be adjusted or deleted once attached to a claim that
has been submitted to Medicare.
o All
items on an invoices must be recorded for the same date.
o A
patient must have a current referral attached to the invoice
in order for the invoice to be added to a claim.
o Distance
KMs pertains to DVA claims only.
o There
can be a maximum of 80 vouchers per claim.
o There
can be a maximum of 14 invoices per voucher.
o The
servicing Provider can only be a locum or the Payee Provider.
Only one servicing Provider can be nominated per claim.
In the Patient Claiming window,
all addresses submitted are considered temporary
addresses by Medicare Online. P.O. Boxes are not
accepted in this field. For Patients who require their cheque
to be posted to a P.O. Box, the address must
be held by Medicare and the appropriate option selected when
storing or transmitting the Patient Claim.
Some rural patients have reported that they have not been
receiving their Medicare cheques this can happen for two reasons:
o The
address held by Medicare is a previous/incorrect address,
or
o The
user is not selecting the Address held
by Medicare option in the Patient Claim window.
The Address held by Medicare is a previous
or incorrect address.
o If
the address held by Medicare is incorrect, the patient can
telephone 132011 to change the postal address to the P.O.
Box.
This must be changed prior to storing
/ transmitting the patient claim, or the cheque will be posted
to the incorrect address.
o Once
Medicare has the correct postal address you may proceed with
storing or transmitting the Patient Claim.
The visit must not be recorded until the address details are
changed with Medicare. You cannot go back and re-store or
re-transmit a patient claim once the visit has been recorded.
o If
it is not possible to change the
postal address with Medicare before
storing or transmitting the claim, a temporary residential
address must be specified for the cheque to be sent to (this
cannot be a P.O. Box)
The user is not selecting the 'Address
held by Medicare' option in the Patient Claim window.
If the patient requests that their cheques should be sent
to their P.O. Box, you must ask the patient if the P.O. Box
is registered as the postal address with Medicare.
o If the P.O. Box is registered with Medicare make
sure you select the 'Address held by Medicare' option when
storing or transmitting the Patient Claim.
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