Rules for Creating Invoices to Send to Medicare

 

The following rules apply when creating invoices for sending to Medicare.

o       For Bulk Billing the patient must assign their rights for Medicare benefits to the servicing Practitioner using an Assignment of Benefit Form. Two copies of this form will need to be printed out and signed before the claim can be processed further. A copy of this form must be held by the practice for at least two (2) years.

o       If a patient is not eligible to receive a benefit or the 'Assignment of Benefit' form is not signed, the practice must invoice the patient using a non-batching account and recover the monies directly.

o       Additional text is required to be included per service (that is invoice item) under certain circumstances (AfterCare, Duplicate Procedure on the same day).

o       When the invoice is for in-hospital services, the hospital name must be nominated.

o       Invoices cannot be adjusted or deleted once attached to a claim that has been submitted to Medicare.

o       All items on an invoice for a Medicare Online batching class MUST have the same date.

o       Discounts are not allowed.

o       A patient must have a current referral attached to the invoice in order for the invoice to be added to a claim.

o       Distance KMs pertains to DVA claims only. This edit box will only be visible for DVA accounts.

o       All items on invoices for Medicare Online accounts must be dated the same. If services have been performed on different dates, separate invoices are required.

o       Discounts are not allowed.

o       If a patient is not eligible to receive a benefit or the 'Assignment of Benefit' form is not signed, the practice must invoice the patient using a non-batching account and recover the monies directly.

o       If a Practitioner in the practice (that is a Practitioner associated with a room) is providing a service for another Practitioner, they must set themselves up as a locum. Invoices must then nominate the Practitioner as the Locum providing the service. This is to avoid issues with bank transfers and reconciliation of payments between Practitioners.

o       Processing of claims for patients who are known by a single name (as opposed to a first-name/surname combination) is as per usual.  Note however that DVA and OVV do not support single-named patients.

 

 

Rules for Claims

Claims are invoices that have been raised against an account associated with Medicare.

For a claim to appear in the list of claims awaiting processing the invoice must:

o       be for the selected claim type, payee room, Practitioner and service location;

o       have no allocations against them;

o       not be attached to another claim (excluding those claims that are same day deleted);

o       have a balance greater than zero;

o       not be adjusted;

o       not be associated with a deleted patient;

o       have an issue date less than or equal to the current date.

 

Changing any of the filter properties (claim type, payee room, Practitioner, and service location) will remove all choices from the selected location list.