Chronic Disease Management Medicare items: How to bill for services provided

Medicare Benefits Schedule (MBS) item for psychological services under the Allied Health and Dental Care initiative

Billing options

There are two choices for billing services provided under Medicare:

1. Private billing of clients
2. Bulk billing (direct payment from Medicare via assignment of benefit voucher)

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.

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.

Bulk billing

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 this service if it has been bulk billed, and will receive the relevant Medicare rebate or 'benefit' from Medicare Australia for the service provided.

Bulk billing forms

When bulk billing is used, the psychologist receives direct payment from Medicare by completing direct billing forms for every service provided to the client. These direct billing forms consist of:

• a claim form (Non-hospital patients allied health professional - DB1N-AH)
• assignment of benefits form (Bulk bill voucher (Allied Health Professional) - DB2-AH).

The DB1N-AH comes in a duplicate carbon copy (psychologist and Medicare copy), and the DB2-AH comes in a triplicate carbon copy (psychologist, Medicare, and client copy).

The direct billing forms (and instruction sheets) can be ordered from Medicare by calling 1800 067 307. A form for ordering direct billing forms can also be downloaded here.

Completed stationery re-order forms should be sent to:

Leigh-Mardon
by fax: (02) 6230 0477

or by mail to:

Medicare Australia
Locked Bag 4444
Tuggeranong, ACT 2901

Completing bulk billing forms 

Information on completing forms is included with each supply of forms.

The assignment of benefits form (DB2-AH) should be completed using the client’s current Medicare card by writing details of the Medicare number and card reference number, first name, initial and surname of the client being treated. 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 voucher. The claim will be delayed while additional checking is done but if eligibility cannot be confirmed, the claim will be rejected.

The name and provider number of the referring medical practitioner and date of referral must appear in the 'referral details' box on the DB2-AH form. Clients must sign the assignment of benefit form after the service has been provided and the form completed. A copy of the completed assignment form must be given to the client.

Submitting 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 Medicare . All bulk bill claims should be mailed to Medicare (GPO Box 9822 in each capital city) or can be left at Medicare offices.

Practitioners who have organised access to Medicare Easyclaim (see Medicare electronic claiming) can lodge bulk billing claims using an EFTPOS terminal. Practices that have organised access to Medicare Online (see Medicare electronic claiming) can lodge bulk bill claims over the internet.

Payment of bulk bill claims

Medicare Australia has a preference for electronic funds transfer (EFT), where payment is made directly into a nominated bank account. The practice must be registered for electronic payment with Medicare to access this method of payment. An application form for EFT payments for Medicare bulk billing can be downloaded here:

• www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/Medicare_EFT1_0607.pdf

Alternatively, 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. 

Medicare electronic claiming

• 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.

Medicare Easyclaim commenced in late 2007 and is being rolled out gradually. The Commonwealth Bank is currently the only EFTPOS provider accredited to offer Medicare Easyclaim. Three other financial institutions (National Australia Bank, Tyro Payments [a new EFTPOS provider], and ANZ) have signed on to deliver the new service and are expected to start their roll-outs later in 2008.

For further information on Medicare Easyclaim, go to the Medicare Australia website:

• www.medicareaustralia.gov.au/provider/medicare/claiming/easyclaim/index.shtml

How Medicare Easyclaim works

Using Medicare Easyclaim for bulk billing

1. The client's Medicare card is swiped through the practice's EFTPOS terminal.
2. Details of the services being claimed are entered via the terminal keypad.
3. The claim is sent to Medicare Australia for verification and an approval message is sent back.
4. The client then presses a button on the keypad to assign their Medicare benefit to the psychologist and the terminal prints a client receipt.
5. The psychologist receives a single payment in their nominated account within 24 hours.

Using Medicare Easyclaim for paid client claims

1. The client pays by their usual method and their Medicare card is swiped through the practice's EFTPOS terminal
2. Details of the services being claimed are entered via the EFTPOS keypad.
3. The claim is sent to Medicare Australia for verification and an approval message is sent back.
4. The client swipes their own EFTPOS card through the terminal, enters their PIN and the Medicare rebate is paid directly into their nominated account.

Using Medicare Easyclaim for unpaid client claims

1. The client's Medicare card is swiped through the practice's EFTPOS terminal.
2. Details of the services being claimed are entered via the terminal keypad.
3. The claim is sent to Medicare Australia for verification and an approval message is sent back.
4. Medicare sends a ‘pay psychologist via claimant' cheque to the client, who then brings it back to the practice along with any outstanding balance.

Accessing Medicare Easyclaim through the Commonwealth Bank

The Commonwealth Bank's Medicare Easyclaim system is called MediClear. MediClear is designed as a standalone system and does not communicate with Practice Management Software. Once a terminal is installed with MediClear, the Commonwealth Bank provides training on how to use the EFTPOS terminals to process Medicare claims.

For current Commonwealth Bank EFTPOS users, MediClear can be added to an existing EFTPOS terminal by calling 13 1998. Non-Commonwealth Bank EFTPOS users, can arrange to have a terminal installed at their practice by calling 1800 730 554.

For further information on the Commonwealth Bank's MediClear system go to the Commonwealth Bank website.

Medicare Online

The other claiming channel now available to allied health professionals is Medicare Online. This works by letting practices lodge Medicare claims via the internet using Practice Management Software. A practice needs the appropriate software, a PC and an internet connection. It can be used to process both bulk bill claims and patient claims, and payments can be made within 2-3 days.

Practices will need to have appropriate software to do business online with Medicare Australia. This could be pre-built into the PMS. To check what software is appropriate look on the Medicare website at www.medicareaustralia.gov.au/provider/business/online/vendors/index.shtml.

Practices will need to have an internet connection and register the business with Medicare Online. This can be done by going to the Medicare Australia website at www.medicareaustralia.gov.au/provider/business/online/register/index.shtml or by calling 1800 700 199. A practice 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 by going to the Medicare website at www.medicareaustralia.gov.au/provider/business/online/register/apply.shtml.

Once registration is complete, a practitioner can use their Practice Management System to fill out claiming forms and complete Medicare claims online. For further information on Medicare Easyclaim or Medicare Online, please visit the Medicare Australia website at www.medicareaustralia.gov.au/provider/medicare/claiming/index.shtml. 

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