Claiming choices
On this Page:
- How different channels compare
- Help your patients claim
- Electronic patient claiming
- Electronic claiming myths
- Transitional support package for electronic Medicare claiming
- Pathology providers
- 90 day pay doctor cheque scheme (for specialists and pathologists)
- Medical software vendors
- Frequently asked questions
The Medicare claiming channel your practice chooses can make a big difference to productivity, cash-flow and patient service. Medicare Australia understands that practices have different needs, which is why we’re offering more ways to make Medicare claims. In this section, you’ll find information to help you compare the different Medicare claiming options available, and work out which is the right one for you and your patients.
Did you know…electronic claiming is growing...
- Of the 29 million patient services Medicare Australia received between July and December 2007, 2.76 million were received electronically. Of these, 2.67 million were via Medicare Online and 88,00 were via Medicare Easyclaim. These claims were lodged by practices for their patients.
- In December 2007, 17.6% of GP patient claiming services were transmitted through Medicare Online (compared to 13.7% in December 2006).
- During the same month, 61.4% of GP bulk bill claims were transmitted electronically (compared 54.9% in December 2006).
Did you know… A transitional support package is available to support practices taking up electronic Medicare claiming.
Did you know… allied health professionals, dentists and dental specialists are able to submit claims electronically using either Medicare Easyclaim or Medicare Online.
- Tell me more about:
- Medicare Online (patient and bulk bill claims)
- Medicare Easyclaim (patient and bulk bill claims)
- Stand-alone (does not require PC or Internet connection)
- Integrated (‘talks to’ practice management software)
- Paper claiming (patient and bulk bill claims)
- Registering for quick EFT payment [PDF, 77Kb]
- Easy ways to help your patients claim
- More information for practice managers:
How different channels compare
Help your patients claim
The claiming channel your practice selects can make a big difference to your business’ cash flow and customer service.
Our research tells us that over 80% of patients who pay to see their doctor want to claim their Medicare rebate on-the-spot.
Electronic patient claiming
Medicare Australia is making it easier for practices to help their patients claim their rebate on-the-spot.
Instead of filling out a form, practices can send patient claim information direct to Medicare Australia through their PC using Medicare Online or their EFTPOS terminal, using Medicare Easyclaim. Rebates are paid directly into the patient’s savings or cheque account automatically. Claims submitted using Medicare Online can also be paid via cheque.
Find out more about these claiming channels:
Did you know …if you already have Medicare Online, it’s easy to ‘switch on’ patient claiming. To find out more, contact your software vendor or Medicare Australia.
Did you know…practices using Medicare Online for patient claiming don’t have to ask for bank details directly. Patients can register their bank details with Medicare Australia instead and still claim on the spot.
Patients can also choose to receive payment from Medicare Australia as a cheque.
More information
Find out more about patient claiming through Medicare Online and Medicare Easyclaim.
Call Medicare Australia on 1800 700 199 to find out more about electronic patient claiming.
Electronic claiming myths
Transitional support package for electronic Medicare claiming
What is the transitional support package?
The transitional support package comprises a range of incentives for general practitioners, specialists, pathologists and software vendors to support the take up of electronic Medicare claiming.
About the package
|
Eligible target group |
Incentive |
|
GPs and specialists (excluding pathologists) |
|
|
Pathologists |
|
|
Medical software vendors |
|
|
90 Day cheque |
|
General practitioners and specialists (excluding pathologists)
Practice payments
A practice payment of $750 for metropolitan areas and $1000 for regional/rural areas will be paid to eligible practices taking up Medicare Online or Medicare Easyclaim between1 September 2007 and 31 December 2009.
Who is eligible?
The practice payment is available to general practitioner and specialist practices (excluding pathology) that:
- Use Medicare Online for bulk bill and take up patient claiming either through Medicare Online or Medicare Easyclaim.
- Use manual claiming (paper) and take up either Medicare Online or Medicare Easyclaim for bulk bill and/or patient claiming.
- Migrate from Medclaims or IBA Healthpoint and take up either Medicare Online or Medicare Easyclaim for bulk bill and/or patient claiming.
Practices that received an incentive under the Medicare Online grant scheme and did not transmit a patient claim after 1 July 2007 are eligible for the practice payment if they began or restarted transmitting patient claims using Medicare Online from 1 September 2007.
Practices that started using Medicare Easyclaim before 1 September 2007 are eligible for the practice payment.
Practices that were using Medicare Online before 1 September 2007 for bulk bill will only be entitled to a practice payment if they also commenced using Medicare Online or Medicare Easyclaim to transmit patient claims in addition to transmitting bulk bill claims.
Practices will only receive one practice payment under the transitional support package. For example, if a practice receives a payment for Medicare Online and then takes up Medicare Easyclaim, they will not receive a second payment.
Who is not eligible?
Allied health professionals, optometrists, pathologists, dental practitioners and accredited dentists are not eligible for the practice payment.
Optometrists and accredited dentists are able to access a payment under the existing Medicare Online grant scheme until 30 June 2008.
Practices who received a payment under the Medicare Online grant scheme after
1 September 2007 will not be eligible for the practice payment.
How is the practice payment calculated?
The amount a practice is entitled to is determined by the eligible practice’s Rural Remote Metropolitan Area (RRMA) index. A practice payment of $750 is available for practices in metropolitan areas and $1000 for practices located in regional/rural areas.
| RRMA | Practice payment |
|---|---|
| 1–2 | $750 |
| 3–7 | $1000 |
How do practices register?
Eligible practices will receive a letter and an application form [PDF, 138Kb] in April 2008. Once the practice returns the application form to Medicare Australia, we can assess it and if eligible, make payment
Forms are also available:
- by calling 1800 700 199
- by emailing tsp.payments@medicareaustralia.gov.au
Application form for the transitional support package for electronic Medicare claiming [PDF, 138Kb]
Guidelines for the transitional support package for electronic Medicare claiming [PDF, 136Kb]
How is the practice payment made?
Medicare Australia will pay the practice payment by electronic funds transfer (EFT) into the bank account that the practice nominates.
When are the practice payments being made?
Practice payments commenced in late April 2008 and will be paid in arrears.
18 cents incentive
General practitioners and specialists (excluding pathologists) will be paid an 18 cents incentive calculated with reference to each electronic bulk bill and patient claim transmitted between 1 September 2007 and 31 December 2009.
This incentive is intended to support the practice in taking up electronic Medicare claiming.
For the purpose of the 18 cents incentive, a transaction is defined as a successfully assessed electronic Medicare claim (a single transmission). The claim may include one or more services for an individual patient.
Who is eligible?
General practitioners and specialists (excluding pathologists) who transmit electronic bulk bill and patient claims between 1 September 2007 and 31 December 2009.
Who is not eligible?
Allied health professionals, optometrists, pathologists, dental practitioners and accredited dentists are not eligible for the 18 cents incentive.
When will the 18 cents incentive be paid?
The first 18 cents incentive payment was made in June 2008 calculated with reference to each bulk bill and patient claim transmitted between 1 September 2007 and 31 March 2008. It was deposited by electronic funds transfer (EFT) into the nominated account for payment of Medicare benefits.
It is intended that all future payments calculated with reference to each bulk bill and patient claim transmitted between 1 April 2008 and 31 December 2009, will be made to an account nominated by the practice. This is because the incentive is intended to support the practice in taking up electronic Medicare claiming and in some cases the practice account is different to the account nominated for Medicare benefits.
Over the coming months, Medicare Australia will be contacting practices to confirm future payment arrangements.
Can vouchers still be sent in batches?
Yes—the 18 cent transaction payment is based on the number of vouchers per batch. Payments will not be calculated on the number of batches sent so there is no need for practices to change the way they send their claims to us. Medicare Online bulk bill claims should still be sent through in batches. For example, if a practice sends one voucher in a batch, this will only attract one payment. If they send through 20 vouchers in a batch, this will attract the 18 cent transaction payment 20 times.
What about Department of Veterans’ Affairs (DVA) payments?
At this stage DVA payments are not included.
Does the 18 cents incentive apply to in-hospital services using ECLIPSE?
Yes— electronic transmissions involving ECLIPSE will attract the 18 cents incentives.
Pathology providers
There is a tailored support package for pathology groups to assist with their transition from Medclaims to Medicare Online. The package includes:
- a payment to pathology groups who have taken up Medicare Online either directly or via the translator, to assist in meeting the costs associated with this transition, and
- once legislation is passed, the 90 day cheque cancellation scheme will be extended to specialists, including pathology, where the claim is submitted electronically either through Medicare Online or Medicare Easyclaim.
Software vendors supporting pathology groups to take up Medicare Online will be eligible for the software vendor payments.
What about practices that offer other services as well as pathology services—will they still get the practice payment and the 18 cents incentive?
Pathology practices paid under the Pathology incentive package are not eligible for the GP and specialist practice payment. They will be entitled to the 18 cents incentive for other eligible specialist services.
These practices have received support to commence electronic claiming under the pathology incentive package.
90 day pay doctor cheque scheme (for specialists and pathologists)
There will be a 90 day pay doctor cheque scheme for specialists including pathologists where the claim is transmitted electronically to Medicare Australia.
It is anticipated that the legislation allowing specialists to participate in a 90 day cheque scheme will be passed in July 2008 with the scheme beginning in November 2008.
The 90 day pay doctor cheque scheme applies only when claims are transmitted electronically to Medicare Australia.
Medicare Australia will contact specialists once legislation has been passed to explain how to access the scheme.
Payments will be paid by electronic funds transfer (EFT) into the bank account that Medicare Australia currently users for practitioner Medicare payments.
Medical software vendors
Medicare Australia recognises that the effort required by a software vendor to facilitate a site’s transition to Medicare Online will vary, depending on the site’s current claiming choice and the product the site is moving to. In recognition of this, the software vendor package has two components: a rollout payment, and a support payment.
Software vendors will be eligible to receive a rollout payment for any general practice or specialist site that commenced using Medicare Online claiming between 1 September 2007 and 31 December 2009. This site must continuously use Medicare Online claiming for a minimum of two full, consecutive calendar months following the month it began transmitting. This payment will be calculated and paid monthly in arrears.
Software vendors will also be eligible to receive a support payment equal to 25 per cent of the total amount of the rollout payment already paid. To receive the full payment, two conditions must be met. Firstly, each practice must maintain the claiming pattern for which the company received the original take-up payment. Secondly, each site must have transmitted consistently using Medicare Online for the preceding two months, as deemed by Medicare Australia.
Rollout payment structure
| Claiming choice prior to 1 September 2007 | Moving to | Incentive |
|---|---|---|
| Medclaims | Medicare Online bulk bill | $750 |
| Medicare Online patient claims | $1000 | |
| Medicare Online bulk bill and patient claims | $1500 | |
| Maximum site payment possible for sites transitioning from a Medclaims environment | $1500 | |
| Medicare Online bulk bill | Medicare Online bulk bill and patient claims | $1000 |
| Maximum site payment possible for sites transitioning from a Medicare Online bulk bill environment | $1000 | |
| Medicare Online patient claims | Medicare Online bulk bill and patient claims | $750 |
| Maximum site payment possible for sites transitioning from a Medicare Online patient claims environment | $750 | |
| Manual | Medicare Online bulk bill | $1000 |
| Medicare Online patient claims | $1750 | |
| Medicare Online bulk bill and patient claims | $2250 | |
| Maximum site payment possible for sites transitioning from a manual environment | $2250 |
Software vendors will receive an application package for completion to take advantage of this financial assistance package which should result in improved claiming convenience for Medicare clients.
Frequently asked questions
Providers
I’ve heard about an incentive payment for using electronic Medicare claiming. Can you please tell me more?
The transitional support package, which includes a practice payment and 18 cents incentive calculated with reference to each electronic bulk bill and patient claim transmitted between 1 September 2007 and 31 December 2009, is available to general practitioners and specialists (excluding pathologists) to support the take up of electronic Medicare claiming.
The package also offers access to a 90 day pay doctor cheque scheme for specialists (including pathologists) for claims transmitted electronically. There is a support package for pathology practitioners and a payment for medical software vendors who support practices to take up electronic Medicare claiming.
Transitional support package
I am a GP/specialist—what does the package mean for me or my practice?
The transitional support package is for general practitioner and specialist practices (excluding pathologist) to take up electronic Medicare claiming (Internet based Medicare Online or EFTPOS-based Medicare Easyclaim).
There are two main elements to the package:
- a practice payment of $750 for metropolitan areas and $1000 for regional/rural areas for practices taking up Medicare Online or Medicare Easyclaim between 1 September 2007 and 31 December 2009.
- an 18 cents incentive calculated with reference to each electronic bulk bill and patient claim transmitted between 1 September 2007 and 31 December 2009.
Practice payments
How do I know if my practice is eligible?
The practice payment is available to general practitioner and specialist (excluding pathology) practices that are currently using:
- Medicare Online for bulk bill and take up patient claiming either through Medicare Online or Medicare Easyclaim.
- Manual claiming (paper) and take up either Medicare Online or Medicare Easyclaim for bulk bill and/or patient claiming.
- Medclaims or IBA Healthpoint and take up either Medicare Online or Medicare Easyclaim for bulk bill and/or patient claiming.
An eligible practice is a registered location of a general practitioner or specialist provider where services and claiming is undertaken at that same location.
Practices will only receive one practice payment under the transitional support package. For example, if a practice receives a payment for Medicare Online and then takes up Medicare Easyclaim, they will not receive a second payment.
Who is not eligible?
Allied health professionals, optometrists, pathologists, dental practitioners and accredited dentists are not eligible.
Optometrists and accredited dentists are able to access a payment under the existing Medicare Online grant scheme until 30 June 2008.
I have moved from Medclaims to either Medicare Online or Medicare Easyclaim. Will I get the practice payment?
Yes—if you use Medclaims and take up either Medicare Online or Medicare Easyclaim for bulk bill and/or patient claiming you will receive the practice payment.
I already transmit bulk bill claims using Medicare Online and if I start using it to transmit patient claims will I get the practice payment?
Yes—if you use Medicare Online for bulk bill and take up patient claiming either through Medicare Online or Medicare Easyclaim after 1 September 2007 you will receive the practice payment. This includes practices that previously transmitted patient claims electronically but stopped before 1 July 2007.
A while ago I lodged patient claims using Medicare Online but stopped. If I start offering patient claiming again will I get the practice payment?
Yes— you will receive the practice payment if your practice didn’t transmit patient claims electronically after 1 July 2007 however restarts transmitting electronic patient claiming using Medicare Online between 1 September 2007 and 1 December 2009.
I started using Medicare Easyclaim before 1 September 2007. Will I still get the practice payment?
Yes—every practice that was using Medicare Easyclaim prior to 1 September 2007 will also receive the practice payment.
I’ve been transmitting patient claims using Medicare Online for ages now. Why won’t I get the practice payment?
The practice payment is available to support practices who take up electronic Medicare claiming and as you have already been offering electronic patient claiming as part of your business practices you are not eligible. However, you will receive the 18 cents incentive calculated with reference to each electronic bulk bill and patient claim transmitted between 1 September 2007 and 31 December 2009.
How much is the practice payment?
The practice payment is $750 for metropolitan areas and $1000 for regional/rural areas for practices taking up Medicare Online or Medicare Easyclaim between 1 September 2007 and 31 December 2009. The payment amount will be determined by the eligible practice’s Rural Remote Metropolitan Area (RRMA) index.
Do I need to register to receive the payment?
Yes—if you are already eligible for a practice payment we will send you an application form [PDF, 138Kb] during April 2008. You will need to return the application to Medicare Australia for assessment to receive the practice payment.
We will continue to contact practices as they commence transmitting electronic Medicare claims and become eligible for payments.
Forms are also available:
- by calling 1800 700 199
- by emailing tsp.payments@medicareaustralia.gov.au
Application form for the transitional support package for electronic Medicare claiming [PDF, 138Kb]
Guidelines for the transitional support package for electronic Medicare claiming [PDF, 136Kb]
When will I receive the practice payment?
Practice payments will begin late April 2008 and will be paid in arrears.
How will the practice payment be made?
Medicare Australia wil pay the practice payment by electronic funds transfer (EFT) into the bank account you nominate on the application form.
18 cents incentive
What is the 18 cents incentive?
It is an incentive of 18 cents for each electronic bulk bill and patient claim transmitted between 1 September 2007 and 31 December 2009. This incentive is intended to support the practice in taking up electronic Medicare claiming.
Who is eligible?
General practitioners and specialists (excluding pathologists) who transmit electronic bulk bill and patient claims between 1 September 2007 and 31 December 2009.
Who is not eligible?
Allied health professionals, optometrists, pathologists, dental practitioners and accredited dentists are not eligible for the 18 cents incentive.
How much is the incentive?
The incentive is 18 cents calculated with reference to each electronic bulk bill and patient claim transmitted between 1 September 2007 and 31 December 2009.
What is a transaction?
For the purpose of the 18 cents incentive, a transaction is defined as a successfully assessed electronic Medicare claim (a single transmission). The claim may include one or more services for an individual patient.
Will Department of Veterans’ Affairs (DVA) claims attract the transition payment?
No—at this stage DVA payments are not included.
Does the 18 cents incentive apply to in-hospital services using ECLIPSE?
Yes—electronic transmissions involving ECLIPSE will attract the 18 cents incentive. The payments will be made in the second half of 2008—they will be backdated to 1 September 2007.
Can I continue to send my vouchers in batches?
Yes—the 18 cents incentive is based on the number of vouchers per batch. Incentives will not be calculated on the number of batches you send, so there is no need to change the way you send your claims to us. Your online bulk bill claims should still be sent through in batches. For example if you send one voucher in a batch, this will only attract one incentive payment. If you send through 20 vouchers in a batch, this will attract the 18 cents incentive 20 times.
When will I receive the 18 cents incentive?
The first 18 cents incentive payment was made in June 2008 calculated with reference to each bulk bill and patient claim transmitted between 1 September 2007 and 31 March 2008. It was deposited by electronic funds transfer (EFT) into the nominated account for payment of Medicare benefits.
It is intended that all future payments calculated with reference to each bulk bill and patient claim transmitted between 1 April 2008 and 31 December 2009 will be made to an account nominated by the practice. This is because the incentive is intended to support the practice in taking up electronic Medicare claiming and in some cases the practice account is different to the account nominated for Medicare benefits.
Over the coming months, Medicare Australia will be contacting practices to confirm future payment arrangements.
How will the transaction payments be made?
The transaction payments will be paid by electronic funds transfer (EFT) into the bank account that Medicare Australia currently uses for practitioner Medicare payments.
90 day pay doctor cheque scheme
Will the 90 day pay doctor cheque scheme be available to specialists?
Yes—there is going to be an extension of the current 90 day pay doctor cheque scheme for specialists, including pathologists and radiologists where the claim is transmitted electronically to Medicare Australia. We anticipate that the legislation will be passed in July 2008 with the scheme beginning in November 2008. We will contact you once legislation has been passed to explain how to access the scheme.
Pathology providers
I am a pathologist, what assistance can I expect?
There is a tailored support package for pathology groups to assist with their transition from Medclaims to Medicare Online. The package includes:
- a payment to pathology groups who have taken up Medicare Online either directly or via the translator, to assist in meeting the costs associated with this transition, and
- once legislation is passed, the 90 day cheque cancellation scheme will be extended to specialists, including pathology, where the claim is submitted electronically either through Medicare Online or Medicare Easyclaim.
Software vendors supporting pathology groups to take up Medicare Online will be eligible for the software vendor payments.
My practice offers other services as well as pathology services—will I still get the practice payment and the 18 cents incentive?
Pathology practices paid under the Pathology incentive package are not eligible for the GP and specialist practice payment. They will be entitled to the 18 cents incentive for other eligible specialist services.
These practices have received support to commence electronic claiming under the pathology incentive package.
Software vendors
Are software vendors included in the package?
Medicare Australia recognises that the effort required by a software vendor to facilitate a site’s transition to Medicare Online will vary, depending on the site’s current claiming choice and the product the site is moving to. In recognition of this, the software vendor package has two components: a rollout payment, and a support payment.
What is the rollout payment
Software vendors will be eligible to receive a rollout payment for any general practice or specialist site that commenced using Medicare Online claiming between 1 September 2007 and 31 December 2009. This site must continuously use Medicare Online claiming for a minimum of two full, consecutive calendar months following the month it began transmitting. This payment will be calculated and paid monthly in arrears.
What is the rollout payment structure?
| Claiming choice prior to 1 September 2007 | Moving to | Incentive |
|---|---|---|
| Medclaims | Medicare Online bulk bill | $750 |
| Medicare Online patient claims | $1000 | |
| Medicare Online bulk bill and patient claims | $1500 | |
| Maximum site payment possible for sites transitioning from a Medclaims environment | $1500 | |
| Medicare Online bulk bill | Medicare Online bulk bill and patient claims | $1000 |
| Maximum site payment possible for sites transitioning from a Medicare Online bulk bill environment | $1000 | |
| Medicare Online patient claims | Medicare Online bulk bill and patient claims | $750 |
| Maximum site payment possible for sites transitioning from a Medicare Online patient claims environment | $750 | |
| Manual | Medicare Online bulk bill | $1000 |
| Medicare Online patient claims | $1750 | |
| Medicare Online bulk bill and patient claims | $2250 | |
| Maximum site payment possible for sites transitioning from a manual environment | $2250 |
What is the support payment?
Software vendors will also be eligible to receive a support payment equal to 25 per cent of the total amount of the rollout payment already paid. To receive the full payment, two conditions must be met. Firstly, each practice must maintain the claiming pattern for which the company received the original take-up payment. Secondly, each site must have transmitted consistently using Medicare Online for the preceding two months, as deemed by Medicare Australia.
How do I apply?
Software vendors will receive an application package for completion to take advantage of this financial assistance package which should result in improved claiming convenience for Medicare clients.
More information
I want to start using Medicare Online or Medicare Easyclaim—where can I get more information and who should I contact?
You should contact our business development officers on 1800 700 199 (Call charges apply form mobile or pay phones only). They can help you understand the claiming options and how they fit with your practice.
You can also contact your software vendor (if you have one) for Medicare Online or your EFTPOS provider for Medicare Easyclaim.
More information can also be found in the Transitional Support Package QA for Providers [PDF, 174Kb] document.
Email any eligibility and package administration questions to: tsp.payments@medicareaustralia.gov.au
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Last updated: 3 July, 2008