Private Claims

Before you begin

When Medicare payment is received for Private claims (if the Derived Fee has been amended to additional Derived Fee only), Medicare calculates and handles the claim and as follows:

  • Medicare Accepts both Base Item and Derived Fee item number and pays amount (due to the amendment - No Gap)

Procedure

  1. Within the Patient > Details window, select the Accounts margin menu, and locate an existing account.
    • f one exists, double-click to open it. Proceed to Step 4.
    • If one does not exist, create a new account by clicking

      Proceed to Step 2.
  2. The New Account window appears. Select the required Practitioner and Class, and then click OK.
  3. The Account > Details window appears. Complete details if required, or click on the OK. button.
    • If either the Practitioner or Class has been selected incorrectly, click the Cancel button to display the New Account window again for correct selection.


  4. Open the appropriate Account, and then click

    to begin issuing a new invoice.
  5. The Medicare Verification window appears; click OK.to verify.
  6. Select the Service > Type if required. There will only be multiple service types if you have pre-configured this.
  7. Enter the appropriate Service > Date and Base Service Item Number (15000). Quantity of 1 and Base Item Fee will populate automatically.
  8. Tab to the Service > Text field, and then double-click the field to reveal the button. Click the button to add text for Medicare if required, and then click OK.
  9. Enter the Derived Fee Service Item Number (15003). Quantity of 1 and Derived Item Fee will automatically populate (base item fee plus excess of 1).
  10. Change Quantity field to the required quantity, and select the Equipment from the drop down menu. This will automatically calculate the Derived Fee total. Ensure to utilise the service text field if required.
  11. There are two scenarios for this step:
    • If billing a Bulk Bill or DVA claim, ensure not to amend the Fee amounts of either item. Medicare will reject the Base item and pay the Derived > Fee amount only. For example, Medicare payment will received will be $50.70 for quantity of 1, $79.75 for quantity of 3.
    • If billing a Private claim, you can leave the auto-generated amounts (the Base Item amount becomes the Gap to the practice), or amend the Derived Fee amount to the additional portion amount only of the Derived Fee. For example,: amend the item 15003 fee to $17.10 for quantity of 1, $51.30 for quantity of 3.


      A Derived Fee for the additional Derived Fee amount can be setup in Practitioner Details > Private Fee list. This will automatically populate the additional Derived Fee amount in a Private Account, so the item would not require amending in each claim. Refer to the Derived Fees – Field Quantity Setup section.
  12. Click

Results