EPC patient fees

I was completely unaware of that until yesterday . Thanks for your comments.

 

As of the 1st of March, we're also ceasing to bulk bill medicare patients and will be charging pensioners $60 which is only the scheduled fee rounded up by 10c! We are informing them that there will be a maximum gap of $9.05 depending on their safety net entitlements. We have been giving our patients plenty of notice and have had very few complaints.

We will continue to claim for them through HICAPS but we will NOT be using the bullk bill option on the terminal!

 

Simone Lee wrote previously that you can't charge above the Medicare rate. I think youncan but not then attempt to claim "the gap" through private insurance.

 

That is correct . If you read the second boxed section on the epc referral it mentions it.
FDCB I was unaware of that until recently .

 

Yes ...Thanks ...

 

Why not use the facility ?? Is it a question of financial gain?? Im not sure...I think it is a wonderful thing ..It saves time, and many an older patient is greatful to not have to go to medicare and "claim back"
FDCB

 

Hello,
In response to being quoted:

You can charge above the medicare fee, you just cant bulk bill above the fee and charge a gap.

We charge $60 now for standard EPC appointments and $70 for neurovascular screening. The patient gets their $50.95 but still has to pay the full amount first.

One of the clinics I am at is being investigated by medicare at present.
They have informed me that I need to report more often. (yes I have been a bit slack and not reported sometimes)

They have told me to get onto this (which i have).
I know its probably a little off topic but I guess another thing we all need to be aware of and do as I am not sure what the penalty for something like this would be but I dont want to get some black mark against my name just for a few missing reports..
Cheers

 

We've never bulk billed non-pensioners, but we've recently ceased bulk billing pensioners too. We have had little trouble getting paid by medicare for claimed visits - we've got really strict processes to make sure we never over bill etc. My main concern was that it gave patients the wrong impression about my profession and my ability if i continued to facilitate the idea that podiatry was a 'free' service and, as years go on and the medicare rebate rises $1 annually, the gap between the rebate and my conultation fees would get greater, making it harder in the future to cut out bulk billing.

I expected that patients would be annoyed and we would have plenty of complaints, but not one has voiced any opposition. We may get some drop off as time goes on, but i'm not all that concerned to lose patients that think that little of what i do anyway.

 

Sorry, but I am just absolutely astounded that some practitioners here appear to have been bulk billing Medicare EPC, and then charging a 'gap' payment on top of this at time of consultation. This is completely illegal. Stop this immediately.

Even worse; to bulk bill Medicare, and then subsequently bill a Private Health Fund for any 'gap', is even more worrying.

You face investigation not only by Medicare, but also sanctions and very likely prosecution by the Health Care Complaints Commission for unprofessional conduct.

 

I personally don't charge a gap, however from memory alone (don't crucify me) I thought the rules were you can still charge your standard fee, for example $60, however they would only be rebated the $50.95?

I thought that was all down to you being still able to charge your standard consult fee, but the rebate is the same?

I've definately read though that you cannot also charge a health fund. Thats written all over the epc guidelines


Apologies if I've got it wrong!

 

TheAussie, Fear not dear lad. I shall not crucify you. However, I cannot say the same for our dear friends in the Medicare investigation 'bureau' based in Perth, of which has taken a particular interest in Allied Health professionals in recent times.

Now, to clarify clearly:

You are of course entitled to charge whatever rate you please for your 'standard consultation charge' (e.g. $60). You are correct, the current rebate is $50.95.

By 'bulk billing', however, it means that you elect to accept the Medicare rebate as full and final settlement of the patient's account. By hitting 'bulk bill' on the easyclaim terminal, you agree to accept the $50.95 from Medicare as full payment, and this will be paid to your bank account accordingly. If you choose to do this, you CANNOT then charge the patient any extra money (e.g. you cannot charge the patient an extra $9.05 to bring the total amount billed up to your 'standard consultation charge' of $60).

What some providers here appear to have been doing, is following the aforementioned 'bulk billing' process, however then charging an extra amount or co-payment at the time of consultation. - This is highly illegal.

So, dear friend, if you wish to charge $60 for your standard consultation, all well and good. But do NOT hit BULK BILL on the terminal and then try to recover any 'gap payment' from the patient.

Hope this is clear!

Cheers!

 

Hi all,
Just a query, does everyone charge a gap fee for their epc clients?
I thought that if you bulk bill that you cannot charge extra.
Most clients appreciate the convenience of bulk billing, however we have found that more and more of our clients are going on care plans even if they have private health insurance/non pensioners. It's becoming difficult to absorb the fee reduction of bulk billing compared to the previous fees paid.
Some practices charge a gap to their non pensioners only.
Just curious to see what the majority are doing in their practices these days.
Thanks for your thoughts,

 

You need to investigate point of service claiming where you charge the patient the full fee and they then claim the rebate through HICAPS straight after.
Most GP practices offer this service.
You can't just charge the gap or you will be in breach of your agreement with Medicare

 

Thanks for the quick response.
In non metro melb most of us bulk bill, I think no one wants to be the odd one out in case one practice gets a more favourable response from the referrers. Do practices in Melbourne feel that pressure or is it accepted well by the clients to have a rebate only?

 

From what I have heard around the traps, there is a bit of a mix with the well established practices are less likely to bulk bill