Claiming choices
The Medicare claiming channel your practice chooses can make a big difference to productivity, cash-flow and patient service. Medicare Australia understands that practices have different needs, which is why we’re offering more ways to make Medicare claims. In this section, you’ll find information to help you compare the different Medicare claiming options available, and work out which is the right one for you and your patients.
Did you know…electronic claiming is growing...
- Of the 29 million patient services Medicare Australia received between July and December 2007, 2.76 million were received electronically. Of these, 2.67 million were via Medicare Online and 88,00 were via Medicare Easyclaim. These claims were lodged by practices for their patients.
- In December 2007, 17.6% of GP patient claiming services were transmitted through Medicare Online (compared to 13.7% in December 2006).
- During the same month, 61.4% of GP bulk bill claims were transmitted electronically (compared 54.9% in December 2006).
Did you know… A transitional support package is available to support practices taking up electronic Medicare claiming.
Did you know… allied health professionals, dentists and dental specialists are able to submit claims electronically using either Medicare Easyclaim or Medicare Online.
- Tell me more about:
- Medicare Online (patient and bulk bill claims)
- Medicare Easyclaim (patient and bulk bill claims)
- Stand-alone (does not require PC or Internet connection)
- Integrated (‘talks to’ practice management software)
- Paper claiming (patient and bulk bill claims)
- Registering for quick EFT payment [PDF, 197Kb]
- Easy ways to help your patients claim
- More information for practice managers:
How different channels compare
Help your patients claim on the spot at your practice
The claiming channel your practice selects can make a big difference to your business’ cash flow and customer service.
Our research tells us that more than 80 per cent of patients who pay to see their doctor want to claim their rebate on the spot. We’re helping practices help their patients claim on the spot.
Patients are now being encouraged to register their bank account details with us so there is no need for you to collect these details. As at 18 August 2008 more than 837 289 patients have registered their bank account details with us.
Electronic patient claiming
Instead of completing a form, practices staff can send patient claim information directly to us through a secure internet connection using Medicare Online, or through their EFTPOS terminal using Medicare Easyclaim. Rebates are paid directly into the patient’s nominated cheque or savings account within two to three working days (sometimes even sooner). Claims submitted using Medicare Online can also be paid by cheque.
Find out more about these claiming channels:
Did you know… if you already use Medicare Online, it’s easy to ‘switch on’ patient claiming. To find out more, contact your software vendor or call 1800 700 199 to talk to one of our Business Development Officers.
Did you know… practices using Medicare Online for patient claiming don’t have to ask their patients for their bank account details. Patients can register their bank details with us instead and still claim their rebate on the spot at your practice.
Did you know… Medicare Online lets you submit patient claims even if you don't have the patient’s bank account details. Simply select 'cheque' as the payment method and we will take care of the rest.
More information
Find out more about patient claiming through Medicare Online and Medicare Easyclaim, or call 1800 700 199 to talk to one of our Business Development Officers.
Electronic Medicare claiming myths
Electronic Medicare claiming testimonials
Electronic Medicare claiming makes a difference to productivity, cash flow and patient service.
Below are two testimonials that show that electronic Medicare claiming really does make it 'better for your patients and better for your business'.
'Medicare Online makes good business sense. It provides an integrated solution for patient claiming including paid claims, bulk bill and Veterans' affairs. With ECLIPSE, an extension of Medicare Online, you can have direct communication with Medicare Australia and private health funds all in the one transaction. Your practice will reap the benefits of fewer rejections, increased cash flow and streamlined billing processes, and your patients will appreciate the service.'
Colleen Sullivan
Practice Consultant and past National and State President, AAPM
'Four years ago we introduced Medicare Online to our practice. It has proved to be a rewarding decision for both our practice and our patients. Initially, I was concerned that there would be problems introducing a new system. Once we had settled in, and trained the staff, the claiming process ran very smoothly. Importantly, it has not increased the workload for our reception staff.'
Jan Chaffey
Practice Manager, Camp Hill Medical Centre and past National and State President, AAPM
Transitional Support Package for electronic Medicare claiming
What is the Transitional Support Package?
The Transitional Support Package comprises a range of incentives for GPs, specialists, pathologists and software vendors to support the take up of electronic Medicare claiming.
About the package
|
Eligible target group |
Incentive |
|
GPs and specialists |
|
|
Pathologists |
|
|
Medical software vendors |
|
|
90 day pay doctor cheque scheme |
|
General practitioners and specialists
Background
This component of the Transitional Support Package is to support practices of GPs and specialists to take up electronic Medicare claiming—either Medicare Online or Medicare Easyclaim.
There are two main elements to the package:
- a one-off, lump sum payment of $750 for metropolitan areas and $1000 for regional/rural areas for practices taking up Medicare Online or Medicare Easyclaimbetween 1 September 2007 and 31 December 2009
- an incentive of 18 cents per transaction for electronic bulk bill and patient claims transmitted between 1 September 2007 and 31 December 2009.
One-off, lump sum payment
Who is eligible?
The one-off, lump sum payment is available to GP and specialist practices currently using:
- Medicare Online for bulk bill and take up patient claiming either through Medicare Online or Medicare Easyclaim
- Manual claiming (paper) and take up either Medicare Online or Medicare Easyclaim for bulk bill and/or patient claiming.
An eligible practice is a registered location of a GP or specialist provider where services and claiming is undertaken at that same location.
Practices that started using Medicare Easyclaim before 1 September 2007 are eligible for the practice payment.
Practices that were using Medicare Online before 1 September 2007 for bulk bill will only be entitled to a practice payment if they also use Medicare Online or Medicare Easyclaim to transmit patient claims in addition to transmitting bulk bill claims.
Practices will only receive one lump sum payment under the Transitional Support Package. For example: if a practice receives a payment for Medicare Online and then takes up Medicare Easyclaim, they will not receive a second payment.
Important: practices that received an incentive under the previous Medicare Online grant scheme and did not transmit a patient claim after 1 July 2007 are eligible for the one-off, lump sum payment if they began or restarted transmitting patient claims using Medicare Online from 1 September 2007.
Who is not eligible?
Allied health professionals, optometrists, pathologists, dental practitioners and accredited dentists are not eligible for the one-off, lump sum payment.
Optometrists and accredited dentists were eligible for a payment under the Medicare Online grant scheme which closed on 30 June 2008.
Practices who received a payment under the Medicare Online grant scheme after 1 September 2007 are not eligible for the one-off, lump sum payment.
How is the one-off, lump sum payment calculated?
The amount a practice is entitled to is determined by the eligible practice’s Rural Remote Metropolitan Area (RRMA) index. A one-off, lump sum payment of $750 is available for practices in metropolitan areas and $1000 for practices located in regional/rural areas.
| RRMA | Practice payment |
|---|---|
| 1-2 | $750 |
| 3-7 | $1000 |
If the practice is not eligible for the one-off, lump sum, will they still receive the 18 cents transaction incentive for electronic claims?
Yes.
How do practices register?
Practices using Medicare Online and/or Medicare Easyclaim were sent a letter and an application form in April 2008. Once returned to Medicare Australia, this application form is assessed and payment made.
Medicare Australia mailed another letter and application form [PDF, 137Kb] to practices in September 2008. This letter invites practices to nominate a practice bank account for the payment of the 18 cents incentives, as well as the one-off, lump sum payment.
Practices that have already received their one-off, lump sum payment can choose to ignore the September correspondence as future 18 cent incentives will be directed to the account where the lump sum payment was made. If the practice wishes to nominate a new practice bank account for the payment of the 18 cents incentives, they will need to complete the application. Where no application for TSP has been received, the 18 cent incentive payments will be made into the bank account nominated by the provider for the payment of Medicare bulk bill claims.
Forms are also available:
- by calling 1800 700 199*
- by emailing tsp.payments@medicareaustralia.gov.au
*Call charges apply for mobiles and pay phones only.
Eligibility guidelines for the GPs and specialist practices [PDF, 235Kb]
How is a one-off, lump sum payment made?
The one-off, lump sum payment will be paid by electronic funds transfer (EFT) into the bank account nominated by the practice.
When are the one-off, lump sum payments being made?
The one-off, lump sum payments started in late April 2008 and will continue to be made until the beginning of October 2008. Applications received after this date will not receive payment for the one-off, lump sum payments until April 2009.
18 cents incentive payments
An 18 cents incentive payment, calculated with reference to each electronic bulk bill and patient claim transmitted between 1 September 2007 and 31 December 2009 will be paid to GPs and specialists between 1 September 2007 and 31 December 2009. The incentive payments apply to bulk bill and patient claim transactions through Medicare Online, Medicare Easyclaim and ECLIPSE.
Who is eligible?
GPs and specialists practices that transmit electronic bulk bill and patient claims between 1 September 2007 and 31 December 2009 are eligible for the 18 cents incentive payment.
Who is not eligible?
Allied health professionals, optometrists, pathologists, dental practitioners and accredited dentists are not eligible for the incentive. Department of Veterans’ Affairs (DVA) payments are not eligible under the Transitional Support Package.
What is a transaction?
For the purpose of the 18 cents incentive payment, a transaction is defined as a successfully assessed electronic Medicare claim (a single transmission). The claim may include one or more services for an individual patient.
How are 18 cents incentive payments made?
The first instalment of the 18 cents incentive was paid in June 2008 for transmissions received between 1 September 2007 and 31 March 2008. This instalment was paid into the account nominated by the provider for the payment of Medicare bulk bill claims.
A second instalment is scheduled for December 2008. This is for transmissions received between 1 April and 30 September 2008. This and further instalments will be paid by EFT into the account nominated by the practice.
The 18 cents incentive for Medicare Easyclaim transactions will be paid by EFT into the account nominated by the provider for the payment of Medicare bulk bill claims.
A third instalment will be made at the end of January 2009 for transmissions received between 1 October and 31 December 2008.
Thereafter the 18 cents incentives will be paid quarterly—April 2009, July 2009, October 2009 and January 2010.
Can vouchers still be sent in batches?
Yes—the 18 cents incentive payments are based on the number of vouchers transmitted per batch. Payments will not be calculated on the number of batches sent, so there is no need for practices to change the way they send in their claims. Medicare Online bulk bill claims should still be sent through in batches. For example: if a practice sends one voucher in a batch, this will only attract one incentive. If they send through 20 vouchers in a batch, this will attract the 18 cents incentive 20 times.
Do the incentive payments apply to in-hospital services using ECLIPSE?
Yes—electronic transmissions involving ECLIPSE will attract the 18 cents incentive.
Important: some payments to providers using ECLIPSE were not paid with the first 18 cents incentive payment (June 2008). These payments will be backdated to 1 September 2007 and paid in December 2008.
Pathology providers
Background
There is a tailored support package for pathology groups to assist with their transition to Medicare Online. The package includes:
- a payment to pathology groups who have taken up Medicare Online either directly or via the translator to assist in meeting the costs associated with this transition
- access to a 90 day pay doctor cheque scheme. There will be an extension to the 90 day pay doctor cheque scheme to allow specialists and consultant physicians access to the scheme, where an unpaid patient claim is transmitted electronically to Medicare Australia.
What about practices that offer other services as well as pathology services—will they still get the one-off, lump sum payment and 18 cents incentive?
The practice will not be eligible for the one-off, lump sum payment if the site is nominated as a pathology claiming site under the Transitional Support Package Pathology payments. This is because the practice will receive support to start electronic claiming under that package. The 18 cents incentive will still be paid for electronic Medicare claims transmitted for other eligible services.
Software vendor payments
Background
Medicare Australia recognises that software vendors play an important role in helping practices transition to electronic claiming. In recognition of this, the software vendor package has two components: a roll out payment and a support payment.
What is the rollout payment?
Software vendors will be eligible to receive a roll out payment for any general practice or specialist site that started using Medicare Online claiming between 1 September 2007 and 31 December 2009. This site must continuously use Medicare Online claiming for a minimum of two full, consecutive calendar months following the month it began transmitting. This roll out payment will be calculated and paid monthly in arrears.
What is the rollout payment structure?
|
Claiming choice before 1 September 2007 |
Moving to |
Incentive |
|
Medclaims |
Medicare Online bulk bill |
$750 |
|
Medicare Online patient claims |
$1000 |
|
|
Medicare Online bulk bill and patient claims |
$1500 |
|
|
Maximum site payment possible for sites transitioning from a Medclaims environment |
$1500 |
|
|
Medicare Online bulk bill |
Medicare Online bulk bill and patient claims |
$1000 |
|
Maximum site payment possible for sites transitioning from a Medicare Online bulk bill environment |
$1000 |
|
|
Medicare Online patient claims |
Medicare Online bulk bill and patient claims |
$750 |
|
Maximum site payment possible for sites transitioning from a Medicare Online patient claims environment |
$750 |
|
|
Manual |
Medicare Online bulk bill |
$1000 |
|
Medicare Online patient claims |
$1750 |
|
|
Medicare Online bulk bill and patient claims |
$2250 |
|
|
Maximum site payment possible for sites transitioning from a manual environment |
$2250 |
What is the support payment?
Software vendors will also be eligible to receive a support payment in January 2009 and January 2010. Each support payment will be 25 per cent of the total amount of the roll out payment already paid. To receive the full payment, two conditions must be met:
- Each practice must maintain the claiming pattern for which the company received the original roll out payment.
- Each site must have transmitted consistently using Medicare Online for the preceding two months, i.e. November and December 2008, and November and December 2009.
How do I apply?
Medicare Australia will send out an application package for eligible software vendors to complete in late 2008.
90 day pay doctor cheque scheme
Background
There will be an extension to the 90 day pay doctor cheque scheme to allow specialists and consultant physicians access to the scheme, where an unpaid patient claim is transmitted electronically to Medicare Australia. This new scheme will be known as the ‘90 day pay doctor cheque scheme for electronic claiming’.
Under the new scheme, Medicare Australia will automatically cancel Medicare cheques made payable to an eligible provider via the claimant, when the cheque remains unpresented after 90 days. Benefits will then be paid directly into the provider's nominated bank account via electronic funds transfer (EFT).
The legislation allowing specialists and consultant physicians to participate in the new scheme has been passed in Parliament, with access available to eligible providers for unpaid patient claims transmitted electronically from 1 November 2008.
Who is eligible?
Specialists and consultant physicians (including GPs) who transmit unpaid patient claims electronically to Medicare Australia.
Who is not eligible?
Allied health professionals, optometrists and dentists.
When does the extension to the 90 days pay doctor scheme start?
1 November 2008.
Is there a registration process?
No—specialists and consultant physicians (including GPs) who transmit patient claims electronically do not need to register for the scheme. Eligible cheques will automatically be flagged for monitoring, and if they remain unpresented 90 days after the issue date, will be cancelled and benefit paid via EFT into the nominated account.
Important: Medicare Australia will not be held liable for any bank fees/charges incurred where a cheque is presented 90 days or more after the issue date, and that cheque incurs dishonour bank charges.
Are GPs already registered in the existing 90 day pay doctor cheque scheme eligible for the extension to the scheme?
Yes—if a GP transmits an unpaid patient claim electronically to Medicare Australia they are eligible.
For more information
Email any eligibility and package administration questions to tsp.payments@medicareaustralia.gov.au or call 1800 700 199* for assistance.
For additional information on the 90 day pay doctor cheque scheme call 1800 032 259 or email 90daypay@medicareaustralia.gov.au
* Call charges apply from mobile and pay phones only.
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Last updated: 21 November, 2008