Insights into Medicare Online Claiming

1. Insights into Medicare Online Claiming Presenter: Matthew Whitehead Customer Support Manager, Team Bp

2. What is Medicare Online Claiming? • Online Claiming is an electronic transmission of Medicare bulk bill claims • No paper work necessary to claim online • Full audit history within Best Practice Software • Claims can be processed and paid in as little as 12 hours • Incentive items are added automatically to eligible patients • Some claims require manual processing • Multiple Procedures • Care plans • Multiple consultations on same day • Best Practice can claim standard Medicare/DVA bulk bills • Can also send Hospital and Allied Health claims Bp Sunshine Summit 2014

3. How does it work in Bp? • Vouchers/Invoices are created for Medicare/DVA throughout the day and stored. • Claims are sent with multiple vouchers at the end of each day by practice staff. • Claims are handled by Medicare processing team within 48 hours. • Practice staff “Check for Payments” within Bp, updating batches accordingly. • Practice staff handle rejections accordingly. • Process begins again… Bp Sunshine Summit 2014

4. What you need to know • How to handle rejections • When to write off an account • What happens if an item is paid over or under claimed amount? • What happens when there are fee changes to MBS and DVA Schedules? • Manual claims, Manual Payments • How to claim multiple procedures correctly • How to find claiming trail Bp Sunshine Summit 2014

5. What are rejections? • Rejections are items that have been processed by Medicare but contain notes (a.k.a exception reasons). • Rejections can also be items that have been paid lower or higher than the claimed amounts. • A responsible practice staff member must address, maintain and resend rejected items. Bp Sunshine Summit 2014

6. What rejections look like Bp Sunshine Summit 2014

7. What is a write off? • Writing off an item means the practice is accepting the item will not be paid. • Writing off is often used on standard patient invoices when the practice knows they will not receive payment for an outstanding account. • For Medicare/DVA batches, the option to write off is used when an item has been rejected by Medicare and a different item is required to be claimed, or no service is able to be claimed. Bp Sunshine Summit 2014

8. Accepting paid amounts • Accepting paid amounts should only need to occur when an item has not been paid the full amount of what was charged. • Accepting a lesser amount will automatically place an ‘adjustment’ for the item within the patients billing history to reconcile any outstanding amount. • If an item is claimed with a lesser amount, Medicare will pay the full amount and Best Practice will adjust the patients billing history accordingly once payment is received. • Do not ‘mark as fully paid’ – this does not reflect on financial reports. Bp Sunshine Summit 2014

9. Medicare & DVA Fee Changes • Every year, new fees and items are released from Medicare and DVA. • November is the largest fee update, however some can be released at random throughout the year – usually January, May and July. • MBS changes are applied to Best Practice through the monthly Data Updates. • Data updates usually contain PBS and MIMS changes for the clinical side of Best Practice – for more information on data updates, visit bpsofware.com.au • If an account needs to be created for a date prior to an MBS update taking effect, backdating the service date in an account will automatically use the fees that were applicable for the previous schedules. • Back-dating the service date will also assist when an item has been deleted in a new schedule if it’s required to be claimed. Bp Sunshine Summit 2014

10. Manual Claims & Payments • Claims should rarely be sent manually through Best Practice as they take considerably longer to be processed and paid. • If a Medicate batch has been paid manually by Medicare, the Online Claiming screen will not reflect these payments.A batch will need to be created in the manual batching section to allocate the payment which Medicare has processed. • Medicare payments cannot be reversed in Best Practice. Bp Sunshine Summit 2014

11. Claiming multiple procedures • Best Practice will automatically calculate the correct percentages for multiple procedures. • Items must have a ‘service text’ assigned to each procedure to indicate where the procedure was performed. • Tip:- Use ‘invoice notes’ as a quick selection for service text. Bp Sunshine Summit 2014

12. Thank you! Bp Sunshine Summit 2014

13. This session’s over. (But we’re still here for you) For assistance, please visit www.bpsoftware.com.au You can contact our Customer Support Team on: (07) 4155 8800 (07) 4153 2093 support@bpsoftware.com.au Bp Sunshine Summit 2014