Benefits we offer

No Gap

This is when there is no difference between your fee and what is reimbursed to the patient by Medicare, with or without private health fund cover. There is no ‘out of pocket’ charged to the patient. We process and submit one account direct to the health fund. Informed Financial Consent is NOT required.

You may choose to register with the individual health funds for ‘no gap’ or ‘known gap’ schemes. Registered Gap Scheme Providers receive 20-50% above the MBS fee without the patient being charged a gap. Your fee is then set by the health fund. All health funds differ. You may choose to participate in these schemes on an individual basis, but must be registered to take part.

Known Gap

Two accounts are processed. One account is submitted to the health fund, and an account is also sent direct to the patient for the ‘out of pocket’ expense.

We strongly recommend that the patient PRE-PAYS the known gap PRIOR to their procedure.
Informed Financial Consent is required. It is your responsibility to ensure that the patient is informed of costs and signs acceptance prior to the procedure, where possible. You can download an Informed Financial Consent form from the Registration page.

Not all health funds offer a Known Gap for Anaesthetists or Assistant Surgeons.

Private Health Funds that do NOT offer a known gap include: HBA, HCF, MBF, MBF Alliance, NIB.

Bulk Billed

Direct Patient Account

One account is issued directly to the patient. Informed Patient Consent is necessary. The patient is issued a receipt to take to Medicare. This is for patients who do NOT have private health fund insurance.

DVA

You will need to be registered as a DVA provider prior to commencement of treatment. Veterans must have prior approval from DVA before admission to private hospital for surgery or treatment. DVA reimburses 100% of MBS for standard providers, and a higher % for ‘No Gap’ providers.

Gold Card Holders: can be treated in public or private system.

White Card Holders: are entitled to specific treatment only, this should be checked prior to consultation.

WorkCover

An ABN is required when submitting a WorkCover claim. These bodies have their own fee structure, and payment is slower.

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 $12.50 per invoice.

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