When there is no difference between the fee payable and what Medicare reimburses to the patient – regardless of whether they have private health cover or not. The account is submitted directly to the health fund and informed financial consent is not required.
Practitioners may choose to register with individual health funds for ‘known gap’ or ‘no gap’ schemes. Registered Gap Scheme Providers receive well above the MBS fee without the patient being charged a gap. Different health funds pay different rates, usually between 20% and 50% above the scheduled fee. Such schemes include HBA Eziclaim and Medibank Gapcover.
In the case of known gap accounts we recommend the patient pre-pays the known gap before their procedure. This reduces instances of bad debts.
It is up to the practitioner to ensure that the patient knows about costs payable. Where possible, patients should sign an acceptance form prior to the procedure. Informed Financial Consent forms can be downloaded from the Registration Page.
For known gap accounts, two accounts are processed. We send one account directly to the patient for any out of pocket expenses that are payable and one to the health fund.
Please be aware that not all health funds offer a Known Gap for Assistant Surgeons or Anaesthetists. The list of private health funds that don’t offer a known gap includes: NIB, MBF Alliance, MBF, HCF and HBA.
The account is sent directly to the patient and the patient gets a receipt which they take to Medicare. This method is for those patients who aren’t registered with a private health fund. In this case informed patient consent is necessary.Department of Veterans’ Affairs (DVA):
Authorisation to provide care for DVA patients must be obtained from your State DVA office. You will be required to state in writing your intention to commence private practice as a specialist and you’ll need to provide all relevant details for inclusion on their database. This must be done prior to the commencement of treatment.
The DVA reimburses 100% of Medicare Benefits Schedule for standard providers. A higher percentage is reimbursed for ‘no gap’ providers.
DVA patients with gold card entitlements can be treated in public or private system. You will be paid the scheduled fee.White Card Holders
DVA patients with white cards are entitled to specific treatment only. You will need to check this before the consultation.
The standard agreement is for the scheduled fee to be charged for in-patient and out-patient treatment for veterans.
Note: Veterans must have prior approval from DVA under the private patient scheme before admission to private hospitals for surgery or treatment.
When submitting a WorkCover claim an ABN is required. When you treat WorkCover patients you may be paid the AMA fee in some states, but these bodies each have their own fee structure.
Yes. Australian Medical Billing Service can manage all of your billing.The benefits that we provide:
If you have any queries as to whether Australian Medical Billing Service can assist you please get in touch.Contact Us
For more information on Australian Medical Billing Service and how we can help you, please contact us.
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.