Medicare Rebates

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This page relates to patient-paid Medicare rebates. Please click this link for information about bulk billing and DVA rebates.

A patient-paid Medicare rebate is where the patient pays the whole invoice and a rebate is paid to them - for example, your appointment fee is $110 and the rebate is $80, so the patient pays you the whole $110 and then claims back $80.

A video that demonstrates invoices, payments and how to process Medicare rebates is available here:

Processing Medicare rebates through Halaxy

After you have registered for online Medicare rebates claiming, you can process Medicare and DVA rebates with just a few clicks in Halaxy. Patient Medicare rebates are processed overnight without the hassle of going to a Medicare office, and without the expense of investing in an EFTPOS facility (which is more time-consuming to use than online claiming).

If you have any queries about a specific invoice, you can contact Medicare on 1800 700 199.

Individual claims can be processed manually, or you can set up manual batch processing or completely automated processing, saving you time.

Processing a claim costs 1 Halaxy credit; there is no charge for rejected claims.

Adding patient deposit account details

Adding patient bank account details ensures Medicare can provide rebates to them overnight. Only savings and transaction accounts can be added because Medicare will not pay rebates into credit cards (though debit accounts are acceptable).

To add patient bank deposit account details:

  1. Go to a patient's profile and click the Funding tab.
  2. In the Bank Account section, click Add Account.
  3. Enter the patient's account name and deposit account information (branch code and account number), then click Save.

The account details are saved to the patient's profile. Whenever you successfully submit a rebate claim to Medicare on behalf of the patient, the rebate will be deposited into this account.

If a claimant is listed, the rebate is paid into the claimant's account and not the patient's.

Manually processing Medicare rebates

You can process Medicare rebates for eligible appointments and invoices by following these steps:

  1. Go to the invoice and accept payment through electronic payments processing or by clicking Mark as Paid. The invoice must be marked as paid in full before you process the rebate; if there is no payment marked or only partial payment, Medicare will send the rebate as a cheque in your name to the patient's address, which is usually inconvenient for practitioners and patients.
  2. In the Patient Rebates section, click Process Rebate. A pop-up will appear.
  3. From the pop-up, you can:
    • select which fees to process if the invoice has multiple eligible fees;
    • Click Additional Information to add additional information if the claim would otherwise be ineligible (entering information into this field will cause the claim to be processed by a Medicare representative rather than automatically, which may delay payment by 1-2 days); and
    • for patients who have recently been in hospital based on Medicare's records, confirm in the drop-down menu whether the treatment was aftercare-related or not (if the treatment is not aftercare-related, Medicare pays the claim; if the treatment is aftercare-related, Medicare does not pay the claim). This is not relevant for DVA claims.
  4. Click Process.

If the claim meets Medicare’s criteria, you receive a message that the claim was successfully submitted to Medicare, with the Statement of Claim and Benefit shown. These can be provided to the patient. If Medicare accepts but cannot immediately process the claim, you are provided with the Lodgement Advice (that you may provide to the patient) and the claim goes through an extra level of checking by a Medicare officer with the rebate generally processed up to three days later.

If the claim is not successful, Medicare advises you of the error code so that you can rectify the issue. The claim status will show as "Not processed" and can be reprocessed from the invoice.

The rebate amount is provided to the patient (or claimant if you have added a claimant to whom the rebate is paid) in one of three ways:

  1. into their bank account, using the bank deposit account details that you have entered on the Funding page of their profile;
  2. into their bank account, using the bank deposit account details that the patient has provided Medicare directly (NOTE: only a small proportion of patients have done this, so adding patient bank account details to the patient profile in Halaxy is preferable); or
  3. If no bank details are available, in a cheque sent to the patient at their address listed with Medicare.

What to do if a rebate claim is unsuccessful

If you receive a message that the rebate claim was unsuccessful, you will receive a message stating the error code as well as a link to a report from Medicare which may describe the error. You can either click Accept to continue submitting the claim to Medicare for a case officer to review (you will be provided a Lodgement Advice), or click Reject to stop the claim being processed so that you can rectify any errors before submitting the claim again. Try to resolve the issue yourself first by following any instructions the error code provides (e.g. by adding the patient's deposit account name for error 9323). If that is unsuccessful, in all cases you should contact the Medicare eBusiness Service Centre on 1800 700 199. Common error codes are listed below.

 
Common error codes
Code Medicare description Further information and action
10 Invalid The provider number is not linked to a bank account. Contact Medicare.
2023 Invalid The report has not yet been made available by Medicare. Try again in another day.
3001, 3004 Communication error; check that you have a current internet session There is a problem with connection either from Medicare, Halaxy or your end; check your own internet connection and you are connected to the internet, wait a few minutes and try again.
7078 Medicare Item Num Relevant for DVA claims. Specify the number of kilometres for travel claiming purposes in the invoice (edit the invoice if needed).
9119-9125 The provider is identified as inactive for Online Claiming purposes You usually receive this error when Medicare has not yet processed your Medicare online claiming registration. It usually takes 5 business days for Medicare to register practitioners, so wait until this time has elapsed before trying again (see here for more information on registering for Medicare).

If you are an allied health practitioner and the first claim you ever process is a DVA claim, you receive error 9125 (it is a bug in DVA's claiming system, that does not happen when the first claim you process is a Medicare claim). The way to overcome it is to run an Online Veteran Verification first (which allows you to check whether the DVA card details you have are correct or not), then process the claim. All future claims will be processed normally.

9201 Invalid format for data item Something required for processing purposes has been left blank - e.g. the patient's Medicare number or date of birth, the referral date or the referring GP's provider number is missing. Check and edit the invoice and process the rebate again.
9205 Data item empty The claim requires a Medicare officer to review it. Call Medicare on 1800 700 199 to discuss it.
9301-9304 Patient's Medicare card number (9301), reference number (9302), first name (9303) or surname (9304) must be supplied The required patient information is missing. You can add the patient's first name or surname in the Patient section of the invoice (which updates their patient profile), or the Medicare card or reference number in the Medicare claim section of the invoice (which updates the patient's Funding page).
9305, 9308 Servicing Practitioner's Provider Number (9305) or Referring Practitioner's Provider Number (9308) must be supplied Your Provider Number or the referring GP's Provider Number is missing or incorrect. Edit your Provider Number on your Identifications page, and/or edit the referring GP's Provider Number by clicking the Edit icon in the Medicare claim section of the invoice, and process the claim again.
9309 Referral issue date must be supplied The date of the referral is missing or after the date of your appointment with the patient. Edit the referral date in the Medicare claim section of the invoice (which updates the referral information on the patient's Funding page), and process the claim again.
9313, 9314, 9315 Patient/Claimant address line (9313), locality (9314) or postcode (9315) must be supplied or all claimant address elements removed One or more of the patient's address details that you have entered on Halaxy are spelt wrongly or is incorrect. Go to the Patient section of the invoice and check and update the patient's address, particularly spelling of street name and suburb (e.g. Lake MacDonald might be incorrectly spelt as Lake McDonald). Updated information is also saved on the patient profile.
9323 Incomplete banking details - BSB code, account number and account name must all be supplied The patient's bank details are incorrect or are missing some requirement elements. Confirm the bank details with the patient (or claimant), and update the patient's bank details on their Funding page.
9630 Please check the request or referral details The referral is either incorrect or has run out, due either to the number of appointments or the referral date having expired. Check the referral information on the patient's Funding page and make sure the referral date and the referring practitioner's provider number are correct.
9638, 9312 Claimant details required - patient or quoted claimant is a minor, or claimant details are missing (9312) The rebate cannot be provided to the patient because the patient is under the age of 18. Add a claimant (e.g. a parent) or edit details of a claimant to whom the rebate is paid by adding their Medicare and deposit account details on the Medicare Claim section of the invoice.


Resubmitting and cancelling rebates

You can resubmit invoices that have not yet been paid as many days after you first submitted the claim as you need. You can also cancel patient rebates through Halaxy on the same day that you processed them. You cannot cancel rebates after the day that you processed them through Halaxy - you must contact Medicare on 1800 700 199 to discuss the situation with them.

Resetting and resubmitting rebates

To resubmit an invoice, you first need to reset the invoice, which you can do by going to the Invoice and clicking Get Report. Because you have not successfully submitted the claim, there will be no report available, and the message from Medicare tells you how many days ago you tried to process the claim. Click Reset and confirm that you want to reset the invoice. You can then re-submit the invoice straight away.

You can "unreset" an invoice that has already been reset by following this process and clicking the revert icon.

Cancelling patient rebates on the same day

Under Medicare's rules, you can cancel a patient Medicare rebate on the same day as you submitted the claim before 9.00 p.m., but not after that time (to cancel a bulk bill rebate you must call Medicare).

To cancel a patient rebate on the same day, click Cancel Rebate at the bottom of the invoice, then select the reason for cancellation (e.g. incorrect item number or patient details) in the pop-up box. Click Yes that you are sure you would to cancel the rebate, and the rebate processing is cancelled.

Cancelling rebates after the same day

Because Medicare processes rebates on the same day that you process the claim (with rebates going to you or your patient overnight), you cannot cancel rebates that have been processed after the day that you processed the claim.

Voiding Medicare rebates

If you have processed a Medicare or DVA rebate but need to change the fee to another funding body (i.e. not Medicare or DVA), you can void the Medicare fee. This keeps a record of the Medicare/DVA fee for audit purposes but removes it from the physical copy of the invoice.

To void a fee, click the Delete (trash) icon next to the fee and then select Void. You can add the new fee by clicking Add Another Fee. You can access the previous Medicare or DVA fee by clicking the Settings icon at the top right of the screen, which is also where you can "unvoid" the Medicare/DVA fee.

Cancelling and resetting a Medicare rebate paid to a patient

You can cancel a Medicare rebate paid to a patient by clicking the Submitted link on the invoice and then the Cancel icon. Then click Reset.

The rebate is now reset to not yet processed and the rebate cancelled. You can only do this on the same day that you processed the claim; otherwise, call Medicare on 1800 700 199.

 

 

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