Billing options for services provided

• Medicare Benefits Schedule (MBS) items for psychological services
• Billing options
• Medicare Safety Net
• Billing practices contrary to the Act
  
  

Medicare Benefits Schedule (MBS) items for psychological services

A table of the indexed fees and rebates for all Medicare items that can be provided by psychologists under the MBS has been prepared for members (effective 1 November 2012).

Download Table of Medicare Benefits Schedule fees and rebates for psychology items (PDF, 54KB)   (as of 1 November 2012) 

 

Billing options

There are two choices for billing of services provided under Medicare:

• Bulk billing
• Private billing

It is the decision of providers to determine which billing method they use for each client. Psychologists providing services under Medicare may set their own fees but the Medicare rebate for each item is a set amount (Medicare rebates are usually indexed in November each year). Providers are encouraged to bulk bill clients who are Health Care Card holders.

 

BULK BILLING

When bulk billing for services rendered, the psychologist receives direct payment from Medicare by completing direct billing forms for every service provided to the client. If the psychologist decides to use the bulk billing method, clients 'assign' their right to a benefit to the psychologist, as full payment for the psychological service. The psychologist cannot make any additional charge for a service if it has been bulk billed, and will receive the relevant Medicare rebate or 'benefit' from Medicare Australia for the service provided.

• Submission of claims by post
• Online submission of claims

 

Submission of claims by post

Please read carefully as previous advice provided by the APS in October 2012 has been superseded.

New interactive manual bulk bill form Effective from 1 September 2012, Medicare Australia introduced interactive manual bulk bill forms which are available on the Medicare website in a printer-friendly version. The relevant online forms for psychologists are: Claim form: Non–hospital patients allied health professional (DB1N-AH Form) Assignment of benefits form: Bulk bill voucher – allied health professional (DB2-AH Form) The blank form can be completed electronically and then printed. Details are entered into the first part of the form (Medicare copy) and automatically populate into the client and practitioner copies. Alternatively, the form can be printed and completed by hand. Either way, the completed form still needs to be printed by the Medicare provider, signed by the client and submitted to Medicare Australia by post. The forms and instructions on how to use them can be downloaded at: www.medicareaustralia.gov.au/provider/pubs/medicare-forms/index.jsp#N10051 Carbon bulk bill forms Providers who have existing stock of the carbon bulk bill forms can continue to submit these forms for processing, until their existing stock is exhausted. Only those providers who do not have access to a computer or the internet, or who undertake consultations outside of consulting rooms, are able to continue to order and use these forms from Medicare Australia. All orders for forms will be followed up with contact from Medicare Australia’s Business Development Officers to discuss other claiming options. The Medicare stationery order form can be downloaded at: www.medicareaustralia.gov.au/provider/pubs/medicare-forms/index.jsp#N10051 All enquiries about the new arrangements for bulk bill forms can be made to bulk.bill.forms.feedback@medicareaustralia.gov.au

 

Where a client presents without a Medicare card, the practitioner may call the Medicare enquiry line on 132 150 to obtain the client’s Medicare card number. If a client’s Medicare number is not available, Medicare can still be bulk billed if the client’s name, date of birth and current address are included on the form. The claim will be delayed while additional checking is done but and if eligibility cannot be confirmed, the claim will be rejected.

Lodging of bulk bill claims

All assignment of bulk bill benefit claims must be lodged within two years of the date of service. After this time, claims need to be submitted with a Late Lodgement Application form available from the Medicare website:
www.medicareaustralia.gov.au/provider/pubs/medicare-forms/index.jsp

All forms must be mailed to Medicare (GPO Box 9822 in each capital city) and cannot be sent by email or fax. Bulk bill forms must still be retained for two years, either in hard copy or electronically/scanned.

Payment (manual) of bulk bill claims

A benefit cheque will be sent to the psychologist together with a statement of benefit listing all services that have been paid. The statement will also show:

• a reason code for any rejected services;
• where the benefit paid differs from the benefit claimed;
• where a Medicare number has changed or was not present on the assignment form; and
• where a Medicare card is about to expire.

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Online submission of claims

There are currently two online claiming options available to psychologists:

• Medicare Easyclaim
• Medicare Online

Medicare Easyclaim

Medicare Easyclaim allows Medicare claims to be lodged using an EFTPOS terminal from a financial institution, with payments being made into a nominated bank account within 24 hours. The electronic system is designed to process bulk billing claims, paid client claims and unpaid client claims.

The following financial institutions have signed on to deliver Medicare Easyclaim:

• Commonwealth Bank of Australia
• National Australian Bank
• Tyro Payments
• ANZ
• Suncorp Bank
• Cuscal Limited
• HICAPS

For further information on Medicare Easyclaim, go to the Medicare Australia website:
http://www.medicareaustralia.gov.au/provider/medicare/claiming/index.jsp

Medicare Online

The other online claiming available to allied health professionals is Medicare Online. This allows practices to lodge Medicare claims via the internet using Practice Management Software (PMS). It can be used to process both bulk bill claims and patient claims, and payments from Medicare can be made within 2-3 days.

A practice requires the appropriate software, a PC and an internet connection and to be registered with Medicare Online. A practice also needs to ensure that they have appropriate digital certificates to ensure online security. The cost of digital certificates is sponsored by Medicare Australia and can be applied for on the Medicare website.

For further information on Medicare Online, go to the Medicare Australia website:
http://www.medicareaustralia.gov.au/provider/medicare/claiming/index.jsp

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PRIVATE BILLING

When clients are billed privately for services from a psychologist, the settlement of the account is the responsibility of the client. Clients may claim a rebate by lodging a claim through Medicare. When a client is billed they can either:

• pay the full amount of the consultation and use their detailed receipt to claim a Medicare rebate; or
• pay the difference between the Medicare rebate and the total account amount, and then claim the rebate from Medicare to forward to the psychologist later; or
• claim from Medicare using their unpaid account.

Evidence of the psychological service having taken place must be provided in the form of an account if unpaid, or an account/receipt if paid in full. The account must clearly indicate whether or not it has been paid. The following information must be included on the account or account/receipt:

• Name of client who received the psychological service
• Date on which the service was provided
• MBS item number and/or description of the service
• Name and practice address or name and provider number of the psychologist who actually provided the service
• Name and provider number of the referring medical practitioner and date of referral
• Amount charged, total amount paid, and any amount outstanding in respect of the service.

Client claims now only paid electronically From 1 July 2012, Medicare service centres began the transition to a cashless system and all Medicare benefits across Australia are now paid electronically. Clients are required to register their bank account details to receive their claim at a Medicare service centre: Using Credit EFTPOS where the client’s debit card is swiped and the claim is immediately credited to their account; OR Through Electronic Funds Transfer (EFT) where the Medicare benefit is credited to the client’s bank account the next working day. Clients can also claim some items through Medicare Online Services. Medicare items are increasingly being incorporated into the online system, but at this stage only the Chronic Disease Management initiative psychologist item (10968) is available. To claim online, clients need to register (either online or at a Medicare service centre) for an australia.gov.au account.

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Medicare Safety Net

Clients may incur out-of-pocket costs if they are charged a fee in excess of the Medicare rebate for services received from a psychologist. These out-of-pocket costs will count towards the Medicare Safety Net for that client.

The Medicare Safety Net is designed to protect high users of health services from large out-of-pocket expenses. For more information on the Medicare Safety Net, go to: www.medicareaustralia.gov.au.

 

Billing practices contrary to the Act

Under the Health Insurance Act 1973 (as amended), it is not permissible to:

• Include the cost of a non-clinically relevant service in a consultation charge. Medicare benefits can only be paid for clinically relevant services. If an allied health professional chooses to use a procedure that is not generally accepted in their profession as necessary for the treatment of the patient, the cost of this procedure cannot be included in the fee for a Medicare item. Any charge for non-clinically relevant services must be separately listed on the account and not included in the fee billed to Medicare.

• Include an amount for goods supplied for the patient to use at home in the consultation charge (e.g. wheelchairs, oxygen tanks, continence pads). Charges can be levied for these items, but they must be listed separately on the account and not billed to Medicare.

• Charge part or all of an in-patient procedure to an out-patient consultation. If an allied health professional charges part or all of an in-patient procedure to an out-patient consultation, the account issued by the practitioner is not an accurate statement of the services provided and would constitute a false or misleading statement.

• Re-issue modified accounts to include other charges and out of pocket expenses not previously included in the account. The account issued to a patient by an allied health professional must state the amount charged for the service provided and truly reflect what occurred between the patient and practitioner. While re-issuing an account to correct a genuine error is legitimate, if an account is re-issued to increase the fee or load additional components to the fee, the account is not a true statement of the fee charged for the service and would constitute a false or misleading statement.

Where a Medicare benefit has been inappropriately paid, Medicare Australia may request recovery of that benefit from the practitioner concerned.

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