FAQ

  • Can you do the initial health fund registration for me?

    Yes absolutely. We will assist you in this process for FREE when you register a provider number linked to Australian Medical Billing Service.

  • Do you process the claims electronically?

    Yes. We utilise the best medical software available and use ECLIPSE (Electronic Claim Lodgement Service), so most claims are paid within 3-7 days for those health funds who are registered to use ECLIPSE. This equates to much faster payment for you.

  • Does the payment go directly to my bank account?

    Yes. Unlike some of our competitors, who use trust bank accounts, when you partner with Australian Medical Billing Service your payments are made directly into your own bank account.

  • How often do I receive financial reports?

    We will provide you with a monthly reconciliation of accounts. You will also receive a monthly report of all claim information including payments received, claims awaiting payment and any outstanding accounts.

  • What do you do with outstanding accounts?

    We will follow up any rejected claims from the health funds. The medical software we use will check the validity of patient details, Medicare details and health fund information prior to processing, which will minimise rejection. We can then follow this up and submit electronically.

    If there is outstanding patient payment for Known Gap Invoicing we will follow this matter up directly with the patient. The process we follow is to telephone and email the patient. We will call and email and then we may refer the matter to you to see if you wish to engage a debt collector.

  • What are the types of accounts claimable?
    No Gap:

    When there is no difference between the fee payable and what Medicare reimburses to the patient – regardless of whether they have private health cover or not. The account is submitted directly to the health fund and informed financial consent is not required.

    Practitioners may choose to register with individual health funds for ‘known gap’ or ‘no gap’ schemes. Registered Gap Scheme Providers receive well above the MBS fee without the patient being charged a gap. Different health funds pay different rates, usually between 20% and 50% above the scheduled fee. Such schemes include HBA Eziclaim and Medibank Gapcover.

    Known Gap:

    In the case of known gap accounts we recommend the patient pre-pays the known gap before their procedure. This reduces instances of bad debts.

    It is up to the practitioner to ensure that the patient knows about costs payable. Where possible, patients should sign an acceptance form prior to the procedure. Informed Financial Consent forms can be downloaded from the Registration Page.

    For known gap accounts, two accounts are processed. We send one account directly to the patient for any out of pocket expenses that are payable and one to the health fund.

    Please be aware that not all health funds offer a Known Gap for Assistant Surgeons or Anaesthetists. The list of private health funds that don’t offer a known gap includes: NIB, MBF Alliance, MBF, HCF and HBA.

    Bulk Billed

    Direct Patient Account:

    The account is sent directly to the patient and the patient gets a receipt which they take to Medicare. This method is for those patients who aren’t registered with a private health fund. In this case informed patient consent is necessary.

    Department of Veterans’ Affairs (DVA):

    Authorisation to provide care for DVA patients must be obtained from your State DVA office. You will be required to state in writing your intention to commence private practice as a specialist and you’ll need to provide all relevant details for inclusion on their database. This must be done prior to the commencement of treatment.

    The DVA reimburses 100% of Medicare Benefits Schedule for standard providers. A higher percentage is reimbursed for ‘no gap’ providers.

    Gold Card Holders

    DVA patients with gold card entitlements can be treated in public or private system. You will be paid the scheduled fee.

    White Card Holders

    DVA patients with white cards are entitled to specific treatment only. You will need to check this before the consultation.

    The standard agreement is for the scheduled fee to be charged for in-patient and out-patient treatment for veterans.

    Note: Veterans must have prior approval from DVA under the private patient scheme before admission to private hospitals for surgery or treatment.

    WorkCover:

    When submitting a WorkCover claim an ABN is required. When you treat WorkCover patients you may be paid the AMA fee in some states, but these bodies each have their own fee structure.

  • How is Informed Financial Consent Managed?

    If you provide us with upcoming theatre lists and patient contact details, then we will call the patient and where possible request an email address to issue a written IFC. We will then process pre-payment of Known Gap or full fee on your behalf to obtain IFC.

  • Can you manage my billing across different locations?

    Yes. Australian Medical Billing Service can manage all of your billing.

    The benefits that we provide:
    • Save time
    • Easy to use
    • Fast: streamlined process using ECLIPSE so payment is faster, direct into your account.
    • Convenient
    • Professional expertise: with 25 years experience in health care setting
    • Excellent communications and support
    • Confidentiality assured
    • We can perform more efficiently and economically as we are expert in this area

Enquiries?

If you have any queries as to whether Australian Medical Billing Service can assist you please get in touch.

Contact Us

For more information on Australian Medical Billing Service and how we can help you, please contact us.

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Fees

We have a volume based schedule of fees:

5% + GST for billing processed 0-$100,000
4% + GST for billing processed $100-500,000
3% + GST for billing processed over $500,000

This includes health fund registration, obtaining IFC, arranging Pre-Payment of Known Gap or full amount, data entry, following up any rejected claims and resubmitting, following up any outstanding payments and monthly reporting.

There is a minimum fee of $15.00 per invoice.

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