Pay In Full
When an invoice is issued to the patient to pay in full, the provider is not participating in a scheme or agreement with the health fund such as MediGap or GapScheme etc.
IMPORTANT NOTE! In this scenario, the funds will only pay 25% of MBS and Medicare will pay 75% of MBS - the patient will receive 100% of MBS as the full rebate for the procedure, and not the usual No Gap rebate.
IMPORTANT NOTE! In this scenario, the funds will only pay 25% of MBS and Medicare will pay 75% of MBS - the patient will receive 100% of MBS as the full rebate for the procedure, and not the usual No Gap rebate.
When issuing an invoice, estimate or a payment link to a patient, the Pay In Full box should be ticked in the Fee Calculation Box in order to adjust the fund rebates correctly.
If you add a gap to a 'Pay in Full' invoice, the gap will be added to the MBS schedule fee, not the Fund schedule fee.
If you add a gap to a 'Pay in Full' invoice, the gap will be added to the MBS schedule fee, not the Fund schedule fee.
Pay In Full is not applicable if Fund Max Gap is selected as the Fee Basis.
Please note that taking payment in full will result in the patient having a higher out of pocket compared to using the gap scheme.
If the Pay in Full box is ticked, you must record the payment on the invoice before you can submit it to the fund.
See also
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