Setting Medicare Service Indicators in Blue Chip

 

Under certain circumstances, health professionals are required to provide additional information on the Service Voucher for Medicare Submission so that a service can be assessed by Medicare.

It is important to ensure electronic claims are submitted using the appropriate indicators and fields, where applicable, to minimise the chance of incorrect claim rejections.

The following information should help you to reduce the number of claim rejections.

 

 


Set Referral Override type indicator on Select Referral prompt

Set referral override type when invoicing.

You can set one of the Referral Override Type values for specialist services when there is no valid referral available for the billing patient, or an available referral is not applicable for billing service items or during an Emergency.

The Select Referral window appears when you attempt to issue an invoice for a patient. Selection of any of the following values in the Select Referral window will automatically set the referral override type code for that invoice/voucher for online claim submission.

Medicare recognizes the following accepted referral Override type codes:

o       Lost

o       Emergency

o       Hospital

o       No Referral

o       Remote Exemption (for DVA patients only)

 

 

 


Setting the Multiple Procedure Override Indicator in the Multiple Procedure Scaling Prompt

In the situation where multiple procedure scaling is not applicable for selected surgical service items, you can indicate this to Medicare by overriding the value automatically set in the ’Scale’ column of the Multiple Procedure Scaling window.

The Multiple Procedure Scaling window will open only after selecting the ‘Multiple Procedure’ check box in the Invoice window.

 

Modifying the default percentage/value in the Scale field will mark the service item as a ‘Multiple Procedure Scaling Override’ item, and the Scale field will display in Red. You must enter the applicable reason in the ‘Service Text’ column for multiple scaling overridden items for Medicare submission.

 

 


Setting the ‘Not Duplicate Service’ Indicator in the Service Text Prompt

If you provide the same service to the same patient more than once with in the same day, then when creating an invoice for that service for online claiming (Bulk Bill / DVA/ Eclipse/ Patient Claims), you must indicate that the service is not a duplicate by setting the ‘Not Duplicate Service’ flag in the ‘Service Text’ window.

1.     To access the service text window, locate the Service Text field for the Service Item you wish to record Service Text for, click within the field, and then either;

o       click the  button, or

o       press SPACE + ENTER

 

2.     The Service Text window appears.

 

3.     Select the ‘Not duplicate Service’ option from the Service Flags drop-down list. This selection will eventually appear within the invoice window.

Note that this field is not available if on the New Invoice window you selected 'Pathology' from the Service Type drop-down list.

 

4.     Select an Explanation from the associated drop-down list. Note that this list is initially empty. You can add new Explanation items to this list;

o       By free-typing into the Explanation field (max 50 characters, except for DVA claims which allow for 100 characters), and then clicking the Add button, or

o       Beforehand, via the Billing and Fees tab of Blue Chip's Practice Options.

 

5.     Record the time of the service was performed into the Time of Service text box. This field accepts the Windows time format of HH:mm. For example, to record 2:30 p.m. enter the 24-hour format of 14:30.

 

 


Setting the ‘Not Normal Aftercare’ Indicator in the Service Text Prompt

If a provided service is not ‘not normal after care’, when creating an invoice for that service for online claiming (Bulk Bill / DVA/ Eclipse/ Patient Claims), you must indicate that the service is not a normal after care service by setting the ‘Not Normal After Care’ service flag in the ‘Service Text’ window.

1.     To access the service text window, locate the Service Text field for the Service Item you wish to record Service Text for, click within the field, and then either;

o       click the  button, or

o       press SPACE + ENTER

 

2.     The Service Text window appears.

 

3.     Select the ‘Not duplicate Service’ option from the Service Flags drop-down list. This selection will eventually appear within the invoice window.

Note that this field is not available if on the New Invoice window you selected 'Pathology' from the Service Type drop-down list.

 

 


Setting the ‘Rule 3 Exempt’ Indicator in the Service Text Prompt

This Indicator is used to indicate that Rule 3 in the Medicare Benefits Schedule (MBS) applies to the pathology service. If the patient had multiple pathology tests within a 24 hour period due to a chronic illness (resulting in a higher rebate), when creating an invoice for those services for online claiming (Bulk Bill / DVA/ Eclipse/ Patient Claims), you must indicate that ‘Rule 3 Exempt’ applies to that service by setting the ‘Rule 3 Exempt’ service flag in the ‘Service Text’ window.

1.     To access the service text window, locate the Service Text field for the Service Item you wish to record Service Text for, click within the field, and then either;

o       click the  button, or

o       press SPACE + ENTER

 

2.     The Service Text window appears.

 

3.     Select the ‘Rule 3 Exempt’ option from the Pathology tab, in the Service Text window.

Note that Pathology tab is only enabled if on the New Invoice window you selected 'Pathology' from the Service Type drop-down list.

 

4.     Record the time of the service was performed into the Time of Service text box. This field accepts the Windows time format of HH:mm. For example, to record 2:30 p.m. enter the 24-hour format of 14:30.

5.     On the invoice, set the Requesting Provider details and Request Issue Date, or indicate that this is Self-Deemed by ticking the associated check box.