Billing Accurately Under Medicare
While the support staff at Cutting Edge are happy to provide general advice about how to correctly bill Medicare for medical services, it's the responsibility of the servicing provider to ensure that all services for their provider numbers are billed correctly. Medicare provides a resource at www.humanservices.gov.au/billingaccuracy
to assist with this.
Please note the following:
- The Health Insurance Act 1973 determines the rules for billing Medicare services
- Detailed information on the Medicare Benefits Schedule (MBS) is available at http://www.mbsonline.gov.au/
- The person whose provider number is used for billing purposes is legally responsible for those services
- The servicing provider is legally responsible to ensure that patient referrals and requests are medically necessary for the treatment of the patient
- Medicare may undertake compliance audits or reviews from time to time. The electronic claim is considered to be a legal record of the service actually provided.
- If services have been billed incorrectly, the servicing provider is responsible for the repayment of benefits. The Commonwealth are legally obliged to recover such debts.
What you need to do:
- Ensure that all items are billed in accordance with MBS requirements
- Ensure you're able to substantiate all claims made under your provider number
- Advise Medicare if you are aware of incorrect Medicare payments, using the Voluntary acknowledgement of incorrect payments form
Registering providers with Medicare
Overview Before you can submit electronic claims via Cutting Edge, all providers must be registered with Medicare for online claiming. There are two ways to manage this. Via the provider's PRODA account, suitable for single providers or small numbers ...
How to report incorrect Medicare payments
It is the servicing provider's responsibility to advise Medicare if you are aware of incorrect Medicare payments, using the Voluntary acknowledgement of incorrect payments form ...
Handling Error 8018 - Date of Birth doesn't match Medicare Records
If a Medicare verification returns an error code 8018 it means that the patient's date of birth entered doesn't match Medicare records. You will not be able to submit a claim for this patient until it is resolved. Check you've correctly entered the ...
Can a PDVC Medicare cheque be mailed to the doctor/practice?
No. When you submit a Medicare claim and the patient has not paid the account in full, Medicare will mail a benefit cheque to the claimant made payable to the practitioner. This is called a "Pay Doctor Via Claimant" cheque (PDVC). It's the patient's ...
An Overview of the Software
Cutting Edge (CE) is a medical billing application for Australian providers. It has been written especially for online claiming and payment, but also handles printed invoices and receipting. It runs on both MAC and WINDOWS. The online claiming ...