For surgeons and assistant surgeons, where there are several billable surgical items on an invoice the appropriate Multiple Operation Rule will apply. CESoft will apply the appropriate rule when you select a fund.
In most cases this is the MBS rule which pays 100% of the surgical item with the highest value, 50% of the second item and 25% for all subsequent items. Surgical items are all items in Group T8 of the CMBS other than Subgroup 12 (amputations items 44325 - 44376) which are paid at 100% for each item.
The AMA rules pay 100% of the item with the highest value, and 75% of all subsequent items. The exceptions here are for amputations, dislocations, and fractures which always pay at 100%, and for some spinal and neurosurgical items MZ731 to MZ871 (MBS 51011 to 51171) which also pay at 100%.
WorkCover NSW follows the AMA rules, and pay 150% of the derived fee for orthopaedic procedures
WorkCover Victoria follows the 100% rule for dislocations and fractures that require operative treatment, the 100:75 rule for orthopaedics (Group T8, subgroup 15 of the MBS, other than fractures and dislocations) and the 100:50:25 rule for other surgical items. NOTE: No benefit is payable for item 48415 when billed in combination with any shoulder surgery code (items 48900 – 48960).
CESoft also gives you the option to override the multiple operation rule for private billing. This should not be used for claims to funds as it will generate an incorrect fee.
Assistant Surgeon Invoices
The Invoices screen for Surgeons has an Assist check box which should be ticked for Assistant claims. Uncheck the Assist box for other claims, such as consultations and non-surgical procedures, or if you are the primary surgeon. NOTE: You don't ...
Is my data secure on Cutting Edge?
YES! Our software meets the stringent Australian Government requirements for Medicare, DVA and ECLIPSE online claiming. We operate under a Notice of Integration and a Cloud Computing Licence Agreement with Medicare Australia All data transmissions ...
Making adjustments to ECLIPSE claims
Once an ECLIPSE claim is submitted electronically, it is generally not possible to make adjustments electronically. Typical reasons for requiring adjustments may include changing date or place of service amending the fees charged adding services that ...
Dealing with Part Paid claims
From time to time electronic claims may only be paid in part. The Invoice Status will be Part Paid, so you can easily locate them on the Part Paid tab in the Invoices listing page. The resolution depends on the cause of the part payment. Here are ...
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 ...