Billing Accurately Under Medicare

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:
  1. The Health Insurance Act 1973 determines the rules for billing Medicare services 
  2. Detailed information on the Medicare Benefits Schedule (MBS) is available at http://www.mbsonline.gov.au/
  3. The person whose provider number is used for billing purposes is legally responsible for those services
  4. The servicing provider is legally responsible to ensure that patient referrals and requests are medically necessary for the treatment of the patient
  5. 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.
  6. 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:
  1. Ensure that all items are billed in accordance with MBS requirements
  2. Ensure you're able to substantiate all claims made under your provider number
  3. Advise Medicare if you are aware of incorrect Medicare payments, using the Voluntary acknowledgement of incorrect payments form 
See also

    • Related Articles

    • Registering Providers with Medicare - Online Provider Agreement Form - HW027 and HW052

      Medicare/Bulk Bill and DVA claims will not be processed online if the Online Provider Agreement Form ( HW-027) has not been completed. This allows for one provider number. If the provider has multiple provider numbers, these need to be added to the ...

    • Registering providers with Medicare

      Overview Before you can submit electronic claims, 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 of providers ...

    • Handling Medicare Verification Warnings and Errors

      Verifying a patient's Medicare Card details may result in a complete match, resulting in a green "Verified" date. It's important to note that Medicare verifications don't require the family name to match if the other factors (first name, DoB, ...

    • 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  ...

    • WAGMSS billing

      WAGMSS is the Western Australian Government Medical Services Schedule. It's used in WA for Contracted Medical Practitioners working in government hospitals engaged under a Fee for Service Medical Services Agreement. See this link for more details ...