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.