We can have your private outpatient practice and inpatient billings set up within 10 – 12 working days of lodging your forms with Medicare. While your approval’s pending, we’ll collect your details and set you up on our system. That way, once your registration’s approved you can start claiming right away.

Getting paid is quick and easy. Once we’ve received and processed your billing sheets, we’ll submit them to Medicare. Medicare will then process your billings, passing them onto the appropriate health funds. Although some funds pay within 24 hours of receiving your claim, most will have money in your account within 2 to 3 days.

We use Shexie, a platinum practice management and clinical system. It’s easy to use and is continually updated to ensure your access to the most up to date versions of Medicare and health fund fees, descriptors and guidelines. The data base is stored securely on our server, and we’ll take care of management and troubleshooting, leaving you to get on with patient care.

A Shexie license is included in your Full Practice Support package, along with free training.

Informed Financial Consent - or IFC - is the provision of cost information to patients. It includes notification of likely out of pocket expenses (gaps), by all relevant service providers, prior to admission to hospital or treatment.

All health funds require IFC to be obtained from your patients for inpatient services before we can submit your accounts, particularly when patients are charged an out of pocket expenses for inpatient care. We want obtaining IFC to be as easy as possible, which is why we have a pro-forma for every type of billing. 

Under the No Gap Scheme, health funds reimburse you more than their obligated 25% of the MBS. Under this scheme, individual health funds have a set fee for each MBS item (on average, it’s around 125% of the MBS), which they’ll pay up to. If you choose to use this scheme, your patients won’t be out of pocket, but your payments will be significantly less than the recommended AMA fees.

Under the Known Gap Scheme, your patient will have an out of pocket expense for the treatment provided. It’s therefore your responsibility to obtain the patient’s financial consent before providing the service. 

Under this scheme you can charge a gap beyond the no gap fees, but it’s restricted to the capped gap amount set by the health funds, which varies from fund to fund. The patient pays the gap directly to you, while the remainder of the invoice is sent electronically to Medicare and the health fund for payment into your account. Please note this scheme is still only a percentage of the AMA recommended schedule of fees.

There are some private health funds that don’t support the Known Gap Scheme. Although you’re free to determine your charges for patients in these health funds, Medicare and the health fund will only pay the minimum obligation (100% MBS), and your patient will be out of pocket for the difference.

If you want to charge the AMA fee, Medicare will reimburse their 75% of the MBS, with all health funds only paying their obligatory 25% top up of the MBS. This means your patient will have a larger out of pocket expense, and must grant you IFC. Many doctors choose to charge AMA fees, or a percentage thereof, for uninsured patients. 

If you want to register with health funds for inpatient claiming, you must be registered with Medicare. Registration also allows for automatic bulk billing and DVA claiming. We can handle your bulk billing and DVA claims, as well as electronically sending paid outpatient accounts to Medicare immediately after consultation. Patient rebates will be paid directly into their account within hours of paying your account. We can also arrange DVA transport.

We’re also registered with third party state compensation schemes like WorkCover Queensland, as well as public health schemes, insurance companies and law firms. Our guidelines about payment from third parties are strict, ensuring you’ll be fairly renumerated for your services.

We take privacy and compliance seriously, which is why all our staff undertake ongoing training to ensure they’re up to date with the latest privacy and industrial relations legislation. This keeps you – and us – safe, lowering the risk of anything going wrong. We’re also fully insured and our staff are employed in compliance with National Employment Standards and Fair Work Australia.