Medicare Claiming Procedures - Australia

Instructional videos and written guides on how to make use of Power Diary

Damien Adler

Hello there, it's Damien from Power Diary.

In today's lesson, I'm going to guide you step-by-step through the process of establishing a Medicare claim. This is Medicare claiming for Australian businesses, not for customers in the United States of America. Therefore, if you are located in the United States, this does not apply to you; the information presented here pertains to the Medicare system in Australia.

Okay, so what I'm going to do is walk you through the entire process, beginning to end. This account is completely free. If you were to sign up for a trial, your account would initially look like this, and I'll walk you through each of the following steps. Remember that you only have to complete these tasks once, as that is the most important thing to keep in mind.

Establishing the Medicare System

To begin, what we're going to do is go to the 'Tools' menu, click on it, and then navigate to the 'Medicare' menu. Once you're there, you'll notice that it says 'Click here to apply' here. If I click that, then what will happen is that it will generate a location ID, and as you can see right now, that location ID has been created. This is going to be your location ID for the entire session, and you will use it throughout. You are required to use this location ID, regardless of the number of practitioners you employ, and it communicates to Medicare that your business is connected to this account. A form can also be found in this section, which is referred to as "Step 2: Complete a Medicare application." You need to click on this form, fill it out, and then send it to Medicare if you are going to be processing bulk bills. Even if you don't fill out this form, you can still use the Medicare claiming feature in Power Diary, but you won't be able to process bulk bills. You can submit them to Medicare, but you won't get paid for them because Medicare won't approve them. Therefore, it is imperative that you fill out this form in its entirety for any practitioners who will be making use of Power Diary and sending it off to Medicare as soon as possible.

Creating an Account

Now that we have that out of the way, let's dive right into the process of setting up your account, and the first thing we'll do is make sure that Medicare is listed as one of your insurers. Now, under "Setup," we navigate to "Custom lists," and we save our changes. Just double check that you actually clicked on the 'Insurers' option here and that Medicare is listed here [under the 'Insurer name' option].

Now, depending on how you configure your account, by default, we'll often add this to an account if we can recognize this as an Australian account. This decision is made based on the information provided by the account holder. In the event that it is not, however, you can easily add it by clicking on the "Add insurers" button. I'll demonstrate what it seems like over here for you. It is the 'Insurer name,' and you will see a 'Type' here; if you are adding it yourself, just make sure that you select 'Medicare Australia', 'Show on the invoice' – yes, and here 'Medicare provider number'. If you are adding it yourself, you will see a 'Type' here. This was just so that if we were showing information on your invoice in relation to your provider number, we would be using the correct terminology. Since this is for Medicare, it goes without saying that this is correct. Simply put, if you haven't already done so, click the "Save" button, and then you'll have it.

Establishing a System of Clinicians

So let's get your clinicians set up, shall we? Next, we will select "Calendars" from the drop-down menu, and then we will select this calendar from the list that appears. That brings us to Julie Talbot. Now, so if we click on Julie, we will open up Julie's details, and we are going to click on here, which is for "Insurers," and we can see that there is no current insurance for Julie. There is no current insurance for Julie. Because health insurance is something that can be purchased, what we are going to do here is simply include Medicare for Julie. Therefore, in this section, we are going to say that the type of insurer is Medicare, the service type will be psychologists, and you will typically find it listed as 'Specialist,' and now we are going to add in a provider number. Consequently, I will just make up a provider number here. In most cases, you can disregard the contents of these two fields ['Payee Provider Number' and 'Payee Provider Name']. Only proceed with this if you want your payments to be sent to a different provider. Sometimes the principal psychologist or practitioner in a clinic will have the money deposited into their account through their provider number. This can happen at any of these positions. You don't need to worry about that, however, as the majority of people will typically have the provider number registered to a bank account with Medicare. With that being said, we are looking into where you would like this provider number to be used and for what locations.

Number of Providers at Each Location

I've added a couple of the locations, such as Essendon and Melbourne city, to this account here. Now, you have the option of selecting "All," which is the setting that will be used by default, or, if this provider number is only for one location, all that we needed to select was this location. So, let's select Melbourne here; you also have the option of making this the default for all of your customers if you so choose. I'm just going to go ahead and click on the 'Yes' button for this ['Default for all clients'] option, which indicates that when you create a new client, it will automatically set up a Medicare record in their profile; however, this is not a required step. So, I'm just going to add this ['Save the information'], and what we can see now down here ['Insurers list'] is that we have this Medicare provider listed, and we can see that the location is included there. So, I'm just going to add this ['Save the information'].

Let's add one more insurance company, shall we? I'll just close off that ['Edit insurers'] option; you should be able to see this insurer listed here. Now I'm going to add one more insurer, and this one is for the situation in which we have a few different provider numbers. Now, we want another insurer for a different location, so here we will select Medicare again, and we will select the same details. After that, we are going to add in a different provider number, and this time for the location that we are going to use, the other one. However, this is done solely for the purpose of ensuring that you will finally arrive at... This is some sort of validation that has come up to determine whether or not the provider number is likely to be incorrect. Since that is a useful thing to have happened, I can show it to you now. And at this very moment, the record is being created right here; therefore, we will just close this now. It has been saved, and you can see that we have two different provider numbers that are recorded in the system for two different locations for this diary, which belongs to the psychologist named Julie, for example. This is significant, of course, given that we are aware that Medicare stipulates that unique provider identification numbers must be used in various settings the majority of the time. Power Diary will take note of the location that you schedule an appointment for, and then it will make sure that the appropriate provider number is used for that specific appointment. Simply put, it ensures that your claims are accepted on the first try, eliminating the risk of having them turned down or of running into complications due to submitting them with the incorrect provider numbers.

Installing the Services

Now that we've gotten that out of the way, let me show you how to configure your services. Now all we need to do is go to the "Setup" menu, select the "Services" option, and add a service right here. Let's say we'll refer to this as the 'Medicare Standard,' and we'll refer to this as the '50-minute mark.' Regarding the name, you are free to choose anything you want, as it will not have any impact on the situation. If you are generating invoices that someone might be claiming manually for some reason, it is helpful from a receipt point of view if you do have a name that Medicare would recognize, but it is not necessary for a client to have a name that Medicare would recognize in order to claim reimbursement. This particular portion is though. This is the item number, which corresponds to the item code. As an illustration, we will write "80110" in this space; do not write anything else in this space; just write the Medicare item number. That will be the length, and I'm going to make it an hour long. It makes no difference, in the grand scheme of things, if it is longer than this minimum requirement of 51 minutes that we have for this specific item number; sixty minutes is a nice, even round number. I mean, you can put course 51, or whatever length of session you have them for here, whatever the case may be. We are going to select the tax status for this service, and since it is obvious that this should be tax-exempt, we will simply enter $180 for the price here. 00

Now a category This account does not have any categories set up, but if you had a lot of products and services, you could actually set up categories to group them together so that they are a little bit more organized. We do not currently have any categories set up in this account. We are going to keep this set to "No" for the time being; the only time it will be set to "Active" is if you want to take a deposit on the customer portal for an online booking of this service. This will be disregarded for the time being. So all I have to do is click the "Save" button, and then you will see that we have this Medicare service, along with the fact that we have an item number listed, a price limit, and a status, and that we are ready to go.

Establishing a Relationship with a Customer

Following this, I will create a client in order to demonstrate how everything operates. Therefore, we will simply pick one of these customers who came with the account here. Let's take John Smith as an example; as you can see, John already has a Medicare field that's waiting to be filled out here on this page. This is the section where we enter John's Medicare information. I'll just go ahead and insert my number here for the time being. This is not a real number, but let's keep our fingers crossed that we can still get it. There we go, as you can see, it has turned red, which indicates that it has determined that the format is incorrect; more specifically, that I have included one letter too many in there. After that, we will also enter an expiration date, and after that, we will click the "Save" button. So all that happens here is that a Medicare number for John is recorded.

Now let's say for example that you found that there was no Medicare field here; therefore, there are situations in which a client profile can be created perhaps before you would set up Medicare, and as a result, you may not have a field here for each individual client profile. You can actually fix that by going to "Billing," "Insurance," and adding insurance there. As an example, you can see that Medicare is included because I just added it; however, we could also have a different insurer if we wanted to. Therefore, if they also had private health insurance and other similar coverage, for example, they could have those specifics here in addition to adding new insurance. If you are looking for information about their Medicare field, you can find it there. While we are working with this client, I will also be adding in a referral because we are aware that Medicare, in the majority of cases, necessitates the use of a referral. So now all we have to do is go to our "Profile" and then our "Referrals" tab in order to add a referral. Now I am going to cheat here, and I am going to add a referrer, which is a GP. If you were going to set it up by yourself from scratch, all you would need to do is go to "People" over on the left side of this page, click "Create," and then select "Referrer." You could have been referred to this location directly by someone else. On the other hand, in order to save time here, we obviously had to include one. We want to add in the start date of the referral, and this is usually the date that the GP either processed a mental health care plan if that was the case, but usually the data of the referral, the Medicare plan is fine. We want to add in the start date of the referral. To simplify things, we'll just list April as the closing date here. In most cases, we include an approximation, but it may, of course, be significantly longer or even indefinite. We are going to set this as the default by toggling the 'In Default' button, and we are going to show this on the invoice print by toggling the 'Show on invoice print' button. Finally, we are going to save our changes by clicking the 'Save' button. You'll see here that we now have our referral listed for this patient. Let's put this away for the moment to make some more room. So what we'll see now is that this client, let's put this away for the moment to make some more room.

Making a Claim for Compensation

Now that we've covered that, let me demonstrate how to assert something. Therefore, you really only need to complete this kind of information once, and at this point, we are going to look at how everything operates. Therefore, we click on the appointment, which brings up this panel for appointments, and we want to add the service that was actually rendered. We can see that the new service that I added here is now displaying as "Medicare standard," and I'm going to simply click on "Save" to show you something because it's going to actually generate an invoice for us. Now, in the vast majority of cases, if you want to file a claim with Medicare, you will almost certainly do so electronically, obviously using Power Diary.

There may be situations in which you wish to present the individual with an invoice so that they can submit it to Medicare. So just to show you what this invoice looks like behind the scenes, I'm going to click on this [pen icon to edit invoice] for 'Edit invoice,' and as you can see here ['Invoice #1,'] we actually have the referral attached to it. We can see that it is connected to Medicare, and all of the relevant details are presented to us here. So now we have an item that was sent through Medicare, complete with its own item code, its own amount, and so on. Now, we have the option of adding a payment either here (by clicking "Add payment" on the "Invoice payments" screen) or on the main screen. However, it is going to demonstrate that it possesses all of this information on this page, and if we were to print it, a PDF version of it would be generated. You'll also notice that we've listed the Medicare provider number for Julie under the heading 'Provided by' in this section. Because it includes the item number, the date the service was rendered, the payment status, and the GST status, this particular invoice is in fact Medicare-compliant. I gave it to the psychologist in a particular scenario, and we can see that all of the relevant information is present and that it satisfies all of the requirements. In addition to that, all of the referral details, such as the general practitioner who made the referral, the referral date and period, the provider number, and the address, are all automatically included. There is no other information that needs to be included.

Additionally, we have information regarding the individual who received the service as well as the appointment date and time that was scheduled for them. So we actually have everything that we need to send this to Medicare if it were being done the old-fashioned way and the actual invoice was being sent in. If this is being done the way it was done in the past, the While we are discussing this topic, there is something else that I would like to briefly show you before I finish paying this invoice and return to our conversation. I want to demonstrate something, so I'm going to move this appointment, I'm just going to slide it across [from Monday to Friday, from one location to another]. What I have done here, as you can see, is select a time that is rostered at a different location. Would you be interested in changing the location of the appointment? ', so this is the system recognizing that the roster, you can see that blue and the white reflects two different locations that Julie works across, and you can also see that So let's say John had his appointment at a different location, and now let's say I want to print the invoice, so all I have to do is click the print button over here. Okay? You'll notice that the provider number for Julie has been changed to reflect the one that is appropriate for that location. Because of this, you won't need to mess around with modifying or changing the provider numbers. It will automatically choose the appropriate one based on the location of the appointment, and the whole process will take place without human intervention.

All right, let's get back to the process of submitting a claim. As a result, we have introduced a Medicare service, and from now on, you will notice that there is a capital letter 'M' over here for Medicare. We are going to simply click on that, and once we do, you will see that we have a few different options here. So as an alternative, there is a DBA option, which refers to the Department of Veterans Affairs and functions in a manner that is very comparable. I'm not going to get into that right now, but if you're going to be providing DBA, you should be familiar with it. However, this section is going to concentrate on either creating a claim for a patient or creating a claim for a bulk bill. It will depend obviously on which one you click here ['Medicare Invoice Claims'] on in the meantime on the way that your practice is set up, so keep that in mind. If we navigate to the Create Bulk Bill Claim page, you'll notice that it automatically fills in all of the information that is necessary for this claim, including the details, the service amount, and other relevant information. You can see that the amount that is being charged here is, of course, more than what Medicare will pay for it. It won't make a difference to Medicare in terms of how they view it. On the other hand, you should consider modifying the charge amount that is included in the invoice because, if you don't, even after this has been paid, it will still show up as money that is owed to you. Therefore, what we normally recommend is that you develop various services, regardless of whether it will be bulk billed or whether the full amount will be charged. Because you have created multiple services, you can simply select whether this one is Medicare standard or Medicare bulk billed. After that, you won't have to waste time manually adjusting the amounts each time. This is made possible because you have created multiple services.

I'm just going to go back here for the time being, not submit this, and show you what the patient claim looks like. So there you have it. You can see that it's nearly identical, but you'll notice that this one says, "Account is fully paid: NO." This is highlighted because it indicates that if you were to submit this, the rebate would go to the clinician, but obviously in the form of a cheque to the client, as I'm sure you're aware. Now, this is highlighted because it means that if you were to submit this, the rebate would go to the clinician. What we wanted to do, therefore, is make sure that your invoice is marked as paid as soon as possible in whatever way we can. You are not required to, of course, and it is perfectly acceptable if you are content to accept the cheques even if they are first delivered to the customer and then brought to your attention. But our research shows that the vast majority of people don't do that, so what I'm going to do here is just indicate that this has been paid, and then I'm going to select "Cash," so that everything is now considered paid in full. Now goes back to the claim selection and clicks on "Create a patient claim." You can see that the account has been paid in full, which indicates that you will collect the remaining payment from the patient, and the patient will subsequently have the remaining rebate amount sent to them. Because all of this information is already filled in, there is nothing else that you need to do. To send it in to Medicare, all you have to do is click the "Send" button on the submission form.

Now, I'm not going to send this one in because it's pretty obvious that I entered a lot of fake details here, and I don't want Medicare to get in touch with us and ask what we're up to. However, if you simply click "Send," you will receive a confirmation message indicating that the claim has been sent in successfully. In most cases, Medicare will return the patient's claim to them in a reasonably timely manner. There is some variation, but in most cases, it takes place over the course of one night.

That is all that is required of you. If we had submitted this, you would actually be able to see the claims here if we clicked on ['All claims for this invoice']. You should actually see a list of all the claims that have been launched for that specific invoice if you do this. If we had not submitted this, you would not be able to see the claims. Suppose you did launch one, but it was rejected for some reason; in that case, you would have the opportunity to relaunch it multiple times so that you can make any necessary adjustments, and then you would have the opportunity to relaunch it once more.

Putting in a Claim for a Child or Young Person

Okay, a couple of quick pointers and questions that we get asked, and really, this comes down to how you would handle the situation when you are providing Medicare services to a minor. We are aware that Medicare will not pay the rebate, of course, to a person who is under the age of 18. They would prefer to make the payment to the parent or guardian instead. Let's say for the sake of argument that Mary Lee is the less important party in this exchange. Now that we are here, one of the things that we can do is actually add a contact. Therefore, if we have a contact over here, I will now say that John Smith is the [father], and over here I will say that [John Smith is the...] '], I'm going to select the relationship, and it will say that 'John Smith is the father of Mary Lee'; consequently, this has established the relationship between the two of them.

If John was not an existing customer, you would see on the screen before this one that there is an option to add a new contact who was not already present in your system. This would be the case if you were not already working with John. The only other thing to note about this illustration is that John already has a profile in Power Diary dedicated to Medicare. If John did not have a Medicare profile, for example, as a new person you are adding as a contact, you would simply need to ensure that you had the details here to reflect that John did not have a Medicare profile. In this way, you will be able to record this information right here and ensure that we make use of this individual whenever we file a claim. You can see that this relationship has been established now, and when you make a claim, you will have the option to choose John as the claimant, indicating that John is the father of the child.

Check the Current Status of the Claims

I believe that wraps everything up for the time being. I believe that provides you with a kind of high-level summary of the claim processing as well as instructions on how to get everything operational. The last thing that I want to mention is that if you want to go back and check the status of claims, all you have to do is click on this Medicare button, which is located under the 'Tools' menu. What you will find here is information, and although this table is currently empty because we have not yet submitted claims, you will see the status of various claims in the following sections. If you have been grouping your bulk bills into batches, and if you have been grouping them to be submitted at the end of the day, you are able to go through and submit each of those individually.

Alternately, if you wanted to check what bulk bills have been paid, you could make a request for a bulk bill payment status report, and then we'll get all the information back for you after we've compiled it. If you're looking for something in particular, you can make use of the many filter options that are available here. If you wanted to get more specific, you should consider looking at one particular provider over a specific time period, and so on. Therefore, there is a great deal of variety in the activities available to you here. In the future, we will most likely produce another video that demonstrates how to operate this dashboard. Simply put, we will need to make use of one that contains a substantial amount of information and comes from a Medicare account. In other words, a fictitious account that Medicare is aware of, which allows us to demonstrate our point without putting ourselves in any unnecessary danger.

Help Centre

I'll wrap this up now; I really do hope that was informative. You can see this ['Instant Answers'] here and you can always search here [Search box], so we'll have lots of help files that we just type in Medicare if you go to our help section [in the main menu] and click on 'Help.' You will find that we have a great number of articles on Medicare, such as how to check claim statuses and troubleshooting, as well as the various error codes that you could receive, and so on. If you are looking for something, it is recommended that you first look for it in the knowledge base or, of course, you can always search elsewhere. you can send us an email by clicking on the link that says "Ask here," or you can ask a member of our staff a question by chatting with us if it's during our chat hours and clicking on the link that says "Ask here."

All right, I really hope that was informative; if you do have any further inquiries, please don't hesitate to get in touch with us. Thank you

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