Australian Medicare Issue

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Just to make all Australian Allied Health Providers aware, if you use the HICAPS terminal to process EPC accounts you better contact Medicare and HICAPS.

If you have not already noticed the settle feature has vanished off the HICAPS machine for medicare. Apparently HICAPS were unable to verify medicare payments accurately so it has been removed.

Our practice has just been informed of this and we have found most of our medicare accounts have been unpaid even though the HICAPS terminal printed out a receipt for each patient stating it had been approved.

Go figure Medicare - I bet this doesn't happen to any GP's.

My advice, check your accounts, because even the ones that appear paid you may not have had any funds transferred for.

 

No troubles like this using iSOFT terminal.

 

Tim, just check statements. The issue is with MEDICARE not HICAPS - its not terminal specific. Even if the terminals are stating the transaction is approved, MEDICARE are not paying the fee to the provider.

Go figure!

 

Tim I use Isoft for claiming medicare and it is a similar story.
The transaction will NOT go through if the patients medicare number is expired or invalid.
However, if the patient's referral is invalid, or they have used more thatn 5 appt's the claim will go through as accepted, but NO PAYMENT WILL BE MADE! unless you look into it, medicarfe will not notify you of this rejected claim, and NO STATEMENTS are sent out.

When I have contacted medicare, their response is as Paul said; you need to get a log on pack to go online and check transactions that have been transfered.

My issue is that this 'delay' and inability to convey correct information regarding the claim automatically only occurs if the practitioner is BULK BILLING.
If the patient was to pay and claim back, the response is automatic...no delay for the same information. Go Figure????

 

All the more reason to make the pt pay your full fee and then go to medicare and have the argument there.

We had a pt yesterday inform us of his dipleasure that medicare rejected his receipt.

We did not know that his GP had given him :

5 physio he used 3

5 podiatry

so when he put in his third pod it was rejected.:butcher:

He came back to us to ask for a refund.:bash:

His excuse was that if he knew that he had only 5 in total he would not have had his appt that day.

Go figure.

we do not bulk bill and will not go down that road for the reasons you have detailed above.

regards David:drinks

 

I too do not bulk bill. I prefer to charge the patient and either claim through the iSOFT terminal or give them a receipt. Either way I am then not in the situation of chasing Medicare up due to a medicare card out of date etc. I have one patient that hasn't been back to the doctor for some time now and I give her a receipt with a referral from 2007 and has no problems claiming. I sure don't understand that one but she is very happy.

 

I don't bulk bill either and make sure that when new Pts phone for the appt, they are told the cost and that they have to take their receipt to medicare for claiming.
Many complain that their doctor said the appt was 'free'- not at this clinic it's not.
Most are ok when you explain to them, those who moan (and produce a fistful of notes at time to pay!!) can go elsewhere.

I even have a grumpy old DVA widow who demanded to know why I was charging $58.85 for her treatment- when I told her that the govt sets the $, she pursed her lips at me and tutt-tutted......................

 

I do bulk Bill and i ring medicare while patient is with me to get confirmation care plan is in place and if any visits have been used. I also ask the patient if they they have recently seen a dietitian or physio (being the most common others on EPC plan) or if the GP wants them to see a dietitian or physio.When they say yes,i investigate whether they have to pay or not when they see another allied health professional
So far so good, i have only missed one payment.
I have been told that it is now the doctors responsibility to make sure care plan is correctly in place,how that works, if they have not done it correctly ,was not made clear.
I have noticed a large influx of EPC's in the last few months,what seemed to be an onerous burden for GP's (i can't tell you how many used to complain about doing them) Now,they are writing them like there is no tomorrow.

Merry Christmas everyone:santa:

 

With all due respect Johnson that is not our job! I shouldn't need to worry abut IF I will be paid, I should just have to worry abut treating the patient.

No idea how MEDICARE can make that work when they won't even tell the GP's what the MEDICARE plan is for!

Considering GP's get paid $250+ dollars to write one - wouldn't you be writing them like there was no tomorrow? MEDICARE needs to get some things sorted, the first is GP payment VS patient claim. How in any right mind a patient can get medical help worth $250 from a specialist whilst a GP gets paid more than that to write the letter is beyond me!

 

Is it true that some patients can now recieve approximately $4000 worth of dental care via medicare?

Will there ever be an increase in EPC visits for podiatry patients?????

 

Agree with you Paul Bowles ,shouldn't be our job, just telling you how I deal with what i am presented with ,to get my money. Not a good situation,but the money is in my bank account.

Hear what you are saying about medicare ,GP's and EPC plans. Merely repeating something said by a medicare employee, to me, on the phone .Your post reminded me of conversation.

$250 is a lot of incentive for a GP to do an EPC plan,so far, business is good.

 

I am so glad I haven't upgraded anything. We have stuck with the old fashioned paper pushing. Easyclaim may pay quicker, but you do not have an easy way to track declined payments. It will go through the terminal and be declined straight away if the pt is getting the rebate. If the pod is bulk billing it is not declined straight away...it's assessed overnight and may still get declined. Ridiculous.

We have a system and it doesn't really take any time at all. I bulk bill because I'm in a high pension area and they won't/can't cough up the cash up front.

We get the patients to sign their slip. We send off a claim for the day's worth and we get the Medicare statements come in telling us any that are declined. Sure we have to wait longer to get paid, but when you send off claims daily the payments catch up. We find it easier to keep as much control as we can.

Anyone that doesn't have the full 5 for pod we call medicare to check they haven't exceeded their services. The only thing we need to do is make sure the patients are not exceeding the 5 in the calendar yr. If it's declined for an expired card, you just re-submit the claim with the new card number. I've only had 3 this yr that exceeded services and we gave them accounts they all duly paid when we explained what had happened.

Don't rely on medicare or hicaps to make it easy for you...easyclaim my ass! I want my statements to check off against with a claim number and my bank balance.

 

Nat,

The only difference between what you are doing with paper and what can be done with Electronic claiming is that it is up to the practitioner to access the reports online rather than wait for a statement to be mailed from Medicare. It involves running two reports, one with completed payments and one with refused payments.

If you choose to implement you current system using Electronic rather than paper claiming you would have exactly the same risk.

I will admit that there could be a problem with patient perception as they are holding a piece of paper saying that their benefit has been assigned to the provider and it appears that all has been paid for.

I have been considering a method to prep patients informing them prior to the consult that if Medicare refuses their claim that they will be liable for their visit cost. Is anyone doing this?

Mark

 

Mark,
One of the biggest problems I hear from people using Easyclaim is the difficulty getting their statements online...problems with logging in and being assigned a "key"?? Not sure about that.
Quite frankly I haven't got the time to stuff around with it all. We shove it all in an envelope and send it off...
We do warn patients now that if they are sharing services between allied health, to be careful with the number of visits they're assigned for each and they are liable to pay if medicare rejects for any reason...no real problems yet.
Only a few this yr we've had to bill. One guy came in and complained, until we explained to him that he'd used 6 services by having an extra physio...any that keep complaining or happens again, they won't be re-booked..simple as that.

 

Hi all
I have just read all the posts on Easyclaim and have to say that we do not have any problems with this. It is quick and easy and the money is in our account the next day - instead of waiting for weeks for them to pay us. When we first set this up Medicare talked me through the whole process and now every morning I log onto online services with Medicare and pull up the payment report. If anyone is not on the report that we have seen I pull up the processing report. This has only happened a couple of times and now I call medicare before a patient sees the podiatrist if I am unsure of how many visits they have had.

We have found that we have gained many more patients now that we use Easyclaim as the majority of our patients could not afford to 'shell out' that money in the first place and then travel about 10km to the nearest Medicare branch to claim their money back.

Paul Bowles - I understand it is not your job to check up on whether the patient is eligible for the visit but do you not have an admin/receptionist who can do that????

Merry Christmas everyone

 

I can't believe people are bulk billing. :santa:

Make them pay at least a nominal fee over the rebate amount and let them take their claim to Medicare. Allied health professionals are getting "done over" if they participate in doing the work of HIC.

We don't get paid all of the incentives that medical practitioners are getting to use Easyclaim READ THIS:

LL

 

Aileen you missed my point - it not their job either!

 

Hey guys,

Cash is so much easier.

They pay you immediately.

They then have to go to medicare and argue the toss.

Simple efficient and cost effective to the practice.

If the pt has over used services medicare informs them directly.

What could be easier.

Also if pt has overused we still have our fee, it is the pt who is out of pocket.

Why is it acceptable for the Health Care Practitioner to be out of pcket when the GP is the referring agent

The pt receives the t/t

The Pod provides the service. We need to be paid and payed promptly, and there is no quicker way than CASH or Hicaps.:drinks

It seems increasingly Govt agencies are passing theyre costs on to the providers of care.

regards David

 

What do we know about EPC.
GPs receive about $250 for a consult to write an EPC referral.
They also received an incentive payment to computerise their practice, in order to bill Medicare electronically for patient care. They also receive an additional incentive payment for each billing claim that they make on line.
Allied health providers receive the same amount- $250.25 to provide five EPC consults to the same patient for a total tx time of approx 2.5 hours. They or their receptionist get abused if they do not bulk bill or the billing goes wrong and there is no reimbursement. The allied health practice does not receive any incentive payment to bill on line or via HICAPs etc.
If a patient receives an EPC referral (not to you) in 2008 and elects not to use the visits until 2009. And the doctor receives the letter to indicate the final visit has been completed. The doctor may then write a referral to you (in 2009) for 5 visits not knowing that the annual allocation has been used. You treat the PX and in good faith bulk bill Medicare. You then receive a printout that states that the claim was successful and the PX leaves. Only later you find out that you have not been paid. (error 160)
My understanding is that all claims for Medicare are batched and sent to medicare at the end of the day. They are not in real time hence the problem.

Managing patients EPC claims at no cost could place your business at risk. money has to come from somewhere to pay for this. You are either a not for profit charity and are receiving funding from elsewhere or your non EPC PX patients are paying for it in their fee. Is this fair or ethical.
Telling the PX, after your phone call to medicare that they have used their 5 visits will still result in abuse of you and or your staff.
Until claims are in real time you cannot afford to bulk bill. Perhaps then, you bulk bill when the PX arrives, not when they leave? No surprises then.

Where is the APODA/C on this. Nothing positive has been achieved since the epc system was set up. It is in urgent need of reform.
Paper bulk billing does not help either it just takes you longer to get paid.
(We stopped bulk billing with paper as I was going to have to employ someone part time just to do the EPC billing paperwork and follow up )

Can we generate a list of EPC concerns and the possible solutions on this Forum. We could then all send or take it to our local Federal members. I do not see any other way that the EPC system will work properly otherwise. We need real time billing for EPC plus an extra fee to manage EPC plans. Or the removal of the maximum number of visits and perhaps the GP,s referal which would be a far better solution

What say you. Can we make this happen :bang::craig:

 

We also need GPs to stop telling Pts (or leading Pts to believe) to Pts that our service will be FREE.:craig: