EPC patient fees

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Just wondering what people generally charge EPC patients? Given the new schedule is up for review do people increase fees accordingly?

 

I normally don't charge a gap, I couldnt be bothered arguing that the treatment isn't 'free' :-/

Is there anywhere to view the new schedule? Just wondering when the new fee's are normally introduced?
(im new to EPC's)

 

New scheduled fee is the same as DVA's $59.90. The rebate is usually 85% of that rounded so I would figure $51.00.

 

Oh thanks, so Im taking from that, it will most likely increase from $50.05 to $51?

 

Should be.

 

Thanks.
I would still be interested to hear other responses!

 

The new MBS schedule is here, effective 1st Nov 2010.

The "scheduled fee" is $59.90, and the MBS rebate (85%) is $50.95.

We charge our regular standard (20min) consultation fee for concession/pensioners, which is $65.00. We don't like the hassle of dealing with claims and rejections, so they take their receipt to Medicare and fight it out with them. Very few GPs in our area bulk bill, so patients aren't suprised we also don't bulk bill.

LL

 

Thanks for passing that on. I know that no question is 'stupid' but this is one is borderline

What is the difference between 'scheduled fee' and 'benefit'???

 

Since the introduction of Medicare, the government of the day/DoHA determine what they feel is a reasonable fee for all fee-for-service item number activities covered by the Medicare Benefits Schedule.

Then they determine that from the health budget, they will cover 85% of that fee - which is the Medicare Rebate (benefit).

If you choose to 'bulk bill', then you are accepting that 85% of what the government suggests is the 'appropriate' reimbursement for the item number you are billing is sufficient to meet your business and financial requirements.

However, what YOU think is the appropriate fee for your time and overheads may be very different to what the government thinks it is (ie the scheduled fee). In our case, this is why our fee is higher than the sceduled fee.

This is also the position of the AMA, who is one of the few health professional representative organisations who still publish a recommended schedule of fees for its memebrs for medical services covered by the MBS (sanctioned by the ACCC as is is just a 'guide'). It is routinely for many years been substantially higher than the 'scheduled fee'.

LL

 

Thanks mate,
I always got confused there. Big help

 

I would also like to hear what others are charging, up until now we have been bulk billing everyone, but I think this really sells our services short. We are currently reviewing our policy with a view to either charging up front for general and keep bulk billing pensioners or just charge all up front and they can fight it out with Medicare as Lucky stated.
Cheers.

 

In a previous practice I have charged the normal 012 fee in $ value, and left the pt to fight it out with Medicare. They still get covered a large rebate as a % of the fee so they are still better off and happy. It also means that they are "seen" to be getting charged the same as someone who does not have the EPC program. I see difficulty with charging fees according to sub-groups eg pensioner rate.
In my current practice we do so few of them so slighly irrelevant, but we do bulk bill

 

Charge them upfront then get THEM to fight with Medicare.

On another note, what exactly are we expected to perform in 'medicare' consult?

Eg- if they are diabetic(and most are) I do a full assessment (vascular/neuro) discuss the results with them, footwear advice etc. in a half hour appt.
If they want nails cut, corns removed etc, they have to make another appt for this to be done in another 1/2 hr. Unless of course, they present with an ulcer or some other problem that needs immmediate attention.

Most are genuinely happy and grateful that I have taken the time to discuss and explain things to them.
Others - only want their 'nails done' and whinge about having to come back another time to do so. (AND are the ones who want the consult for 'free')
AAAARGGHH....................

 

Hi, I have a part-time Home Visiting practice in a rural area. It is physically difficult for many clients to get to the major town where all the pods are located. I charge $15 co-charge plus do the paper work saving them having to get to medicare (if they live further than 20mins drive I increase the co-charge accordingly).

My overheads are low and I group clients together geographically. I have never had a client query the co-charge, infact, they think they are getting a bargain...no taxi fees, no having to organise family to transport them etc etc. Within the next 6 months I will most likely increase to $20. There is already one lady who insists on paying this amount as she is so grateful that I will come to her rather than her daughter having to struggle to get her in and out of wheelchairs and cars to get her to a clinic.

And I get a lovely break in between each client...

 

Hi Alison

I was under the impression that if you bulk bill (get them to sign the form) then you cannot charge them any extra.

Are they signing the form and giving you an additional payment?

I bought my business from a podiatrist who asked for an additional payment on top of signing. One patient complained and she got a ticking off.

My understanding is, that if you dont bulk bill. You have to charge them your full fee and they have to go to medicare and claim back their $50.90

I would love for someone to tell me im wrong!!!!

 

Hello Tough Spiders and Allison,
I am also sure that if you bulk bill, then you can only charge the rebate and that co-payments are out. Isn't that the way GPs have always had to do things. Of course if you have Medicare online I believe thay can get the rebate paid straight back into their account.
Does anyone else have any info on this?

 

Hi, I was not under that impression...but will check it out!

Alison

 

Alison,

from the Medicare Australia Website

So you can't charge a co-payment

 

A very interesting discussion.

We bulk bill all EPC patients and claim via On line Claiming on our HICAPS machine and payment is made within 24-36 hours. We have very few concerns with payments as our practice manager is very thorough re number of treatments per referral and number of treatments per calendar year. If we do have a non payment, this is always addressed by a phone call to Medicare.

Patients certainly appreciate us bulk billing them and even though the fee is less than our normal fee ($55), the EPC program has enhanced our reputation, as well as increasing our business and our bottom line.

 

We bulk bill EPC as all pts expect this, we dont have ant problems with the service.

 

I do the same, I have a system on the inside cover of my file for EPC patients. I make sure each visit is recorded so I know the number of visits available. I have a GPRS eftpos facility that I use after each patient (I am mobile) and if an error code or non eligibilty message comes up, I ring medicare. I think as long as you have counted the visits, there is normally no problem....Normally the worst I get is an expired card.
I sometimes wish however I could charge around $55 just to cover the petrol!!!

 

Hi TheAussie

You have a mobile eftpos machine that processes the EPC Medicare payment?
I have a fixed HICAPS machine and HICAPS have told me that a mobile device to swipe medicare cards for EPC's is not yet available. Who do you process this through?

Cheers

 

Hi stirling,

You definitely can through commonwealth bank, I think you can only use a certain model of terminal though. I think suncorp were due to roll one out in September, and I think the other was west pac from memory.
I'm sure I also read somewhere that you can use the terminal with your software to process hicaps? I'm not sure if that's possible, I don't use hicaps

I think it is also possible to use these terminals if you are with another bank, it's just a matter of setting up your bank details to pay it into the correct account.

Hope that helps!

 

Hi there,
I bulk bill pensioners but have stopped bulk billing others. I charge everyone for their first visit and I charge more if they need a full Diabetes Assessment.
Yes I have nurses, GP's and patients telling me they are 5 free visits and I inform them that it does not mean they are free.
I feel we are more appreciated now as a lot of those that just want a free service have gone elsewhere.
I have had problems with getting paid even though I count the visits and this is because the patient has gone to another health professional i.e. dietician. and haven't told us. I then have the fight of explaining this to the patient, getting medicare on the phone to also explain it and then trying to get the money out of them. It is very disheartening and really makes me hate my job and feel extremely un appreciated. :craig:

There are lots of people out there who do appreciate us and I prefer to encourage them and that is why I have changed our policy.
You cannot charge a co-payment either.
Just my 2 cents...

 

Just charge above the rebate level, and then make the patient take the bill to Medicare to fight it out. If this drama is making you "hate your job", then turn the situation around. A minor inconvenience for an individual patient is far better than enternal damnation for you on a repetitive daily basis.

Just a suggestion...works for us. We never have any stress about these patients, because this system absolves us of direct 'responsibility'.

LL

 

Thanks .. I charge either a health fund gap of 25 dollars or a non health fund gap of 20 dollars over the epc rebate . It brings the standard consult fee more into line with general fees charged across allied health .

FDCB

 

Before I comment can you explain this a little clearer... as by the sounds of it your charging the epc fee + a gap of $25 to their private health insurer (if they have it).

 

yes that is correct .

 

thanks LL.
Yes we do charge some people up front.
The main issue is my other clinic in Sunshine. Most of my clients will not pay for anything, they are older pensioners alot not speaking english well and there is no Medicare around.
Although I have started charging up front for some things there (and I am prioritising private patients to increase their numbers) it is very hard to change things completely unless I dont want the business there.
We did try charging up front in the beginning and we had GP's nurses and patients ringing us and coming into the clinic and arguing with us. The nurses and Gp's pretty much bullied us into bbilling saying they wouldnt send us anyone if we didnt and that if we did they would refer alot.
We gave in eventually and I dont know if that was a good thing or not. I think it was good for building up a client base in an area where starting out may have been tougher than other areas.
Now i am ready to change that but I would not be in this position now if i had done things differently then.

 

Hi, we are only allowed to charge to either Medicare or Private health. You cannot bill to both for one consultation.
Cheers

 

My understanding was that this was not aloud, ie. you can not utilise medicare + private health fund on the same service.

 

We have just infromed our patients at one of our practices (Where Fixed costs are higher) that we are no longer Bulk billing pensioners. We got to the point where we had too many accounts that were not paid by medicare because of issues outside of our control. (i.e seeing other health professionals, incorrect Gp referral etc..)

It is now up to the patient to sort the problem out.

We also had an issue, when the new HICAPS systems/machines came out, where the funds were sent to the referring DR, rather than us. An easy mistake to make if you push the wrong button along the sequence to bulk bill a patient....!!! This occurred whilst waiting for the medicare reconciliation to come online...

You are certainly not allowed to claim both medicare and private health funds....I was told be the NSW association medicare did or are doing a cross-reference to catch providers who were doing so.

 

FDCB

You should cease this immediately. It is illegal, and you will suffer the wrath of the Health Insurance Commission.

You can only bill one insurer - either Medicare, or the health fund. Not both.

Your actual fee is you own business, unlike DVA, where you have to accept what they offer.

LL

 

thanks for that ,

 

We bulk bill patients at our clinic - saves the headaches of fighting with GPs and patients. I know of a clinic that bulk bills patients but also charges a small 'administration fee' (something like $15) at the time of the consultation which isn't claimable through private health. Essentially it's a way of charging a gap without actually charging a gap. Do you think this is OK?

 

Kent,

I doubt it's okay. The rules are pretty black and white.

Not that we have managed to make it work, but there is a way using HICAPS (for medicare) where the patient pays you via EFT, and then medicare pays the funds directly to the EFT account....

 

Hi,
You cannot charge a fee outside the bulk billing charge.

We sometimes process the payment through the hicaps terminal. Its easy once you get your head around it.
Basically you take the payment first then to do the rebate you swipe their medicare card and select fully paid and follow the prompts. when you get to the end it asks for the pts eft card to process the rebate and you just swipe that , press their account and they put in their pin. thats it.
I have had pts say their money has gone in the same day!
Hope that helps.
Cheers

 

Ah ha!!

I understand now.

Thanks Simone...

 

"We did try charging up front in the beginning and we had GP's nurses and patients ringing us and coming into the clinic and arguing with us. The nurses and Gp's pretty much bullied us into bbilling saying they wouldnt send us anyone if we didnt and that if we did they would refer alot."

How DARE they come along and tell you how to run YOUR business! Do you tell them how to run THEIRS??

The problem is that other practitioners have NO idea how much it costs to run our practices (except maybe dentists) because they don't have the outlay of instruments and consumables etc that we do, in addition to the general costs (rent/reception etc). Not to mention having to wait 28days to be paid by medicare (if it all goes smoothly).

GET THE MONEY UP FRONT is all I say!! If they whinge, they can go elsewhere.............

 

My experience with orthoses etc , is that if payment is made in full , up front , the patient "always" comes back to collect them....
I have a friend who works in anaesthetics and he bills full payment up front five days before the operation.... Thanks for your thoughts.