Patient Claiming

Before you begin

A patient claim applies to a situation in which a patient has received professional medical services, but has not assigned their rights to Medicare benefits to the servicing practitioner. Patient Claims are an additional service provided by the Practice to the patient. A statement is forwarded by Medicare to the Claimant within 14 days detailing, or including in the case of payment by cheque, the payment made. It will also contain details if the requested payment was not made. This feature now means patients don't have to visit Medicare Offices to collect their rebates – these benefits are paid directly into the patient's Bank account or using a cheque sent to a specified address

Your MedicalDirector Practice Management System allows individual patient claims to be processed in real time - referred to as PCI (Patient Claims Interactive). Practices also have an alternative method for sending patient claims, as patient claims can be grouped together and sent at a later time in one transmission (called 'Store and Forward Patient Claims'). This means that an Internet connection does not need to be maintained and is an activity that could be scheduled to happen at a specific time (for example at 18:00 every weekday).

No individual signing of patient claims is required. The claims use the location certificates to encrypt/decrypt the claim details.

This article describes the steps required to record, invoice, and submit Patient Claims. The following steps are covered:

Procedure

  1. Add Medicare details and a Practitioner Referral to the Patient Details window.
  2. Create a Patient Claim Account.
  3. Billing for Fully-Paid Patient Claim.
  4. Billing for Part-Paid Patient Claim (gap only).
  5. Receipting the Rebate Medicare Cheque.

    Typical Patient Claiming scenarios:

    • Fully-Paid: The patient pays the invoice in full, and then the claim is submitted to Medicare. Medicare reimburses the patient via the bank details/account provided by the patient, or by cheque. Covered in Step 3
    • Part-Paid (patient pays the gap only): The patient is invoiced in full. However, they only make a part-payment to the account (gap payment only). Later, the claim is submitted to Medicare, and Medicare reimburses via a cheque sent to the patient. However, in this instance the payee is the practitioner, not the patient – the patient is required to forward the cheque to the Practice. Covered in Step 4If the cheque is not presented to the Practice within 21 days, the practice should contact the patient. Medicare periodically conducts searches for cheques that have not been cashed. If after 90 days a cheque has still not been presented to the practice, Medicare will cancel the cheque and credit the Practitioner's account electronically.

Results