Medicare Rebates

Follow

This page relates to Medicare rebates paid to patients. 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 from Medicare.

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

Processing Medicare rebates through Halaxy

To process Medicare and DVA rebates through Halaxy, you need to do two things:

  1. Add your Provider Number for the Medicare funder on the Identifications page

  2. Register for online Medicare rebates claiming

Once you have done these two things, you can process Medicare 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 credit. There is no charge for rejected claims.

Adding patient deposit account details

Adding patient bank account details to the profile ensures Medicare can provide rebates to them overnight. Only savings and transaction accounts can be added, as 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.

The rebate amount is provided to the patient (or claimant) in one of three ways:

  • into their bank account, using the bank deposit account details that you have entered on the Funding page of their profile;

  • into their bank account, using the bank deposit account details that the patient has provided Medicare directly (NOTE: not all patients have done this, so adding patient bank account details to the patient profile in Halaxy is preferable); or

  • If no bank details are available, in a cheque sent to the patient at their address listed with Medicare.

Automatically processing bulk bill, Medicare and DVA rebates

Halaxy allows you to automatically process your Medicare, bulk bill and DVA rebates for a completely hands-off approach. Please see the instructions in the linked article.

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. This 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.

What to do if a Medicare claim is unsuccessful

If a claim is not successful, 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 first. If that is unsuccessful, in all cases you should contact the Medicare eBusiness Service Centre on 1800 700 199.

Resetting a Medicare rebate for reprocessing

To reset a Medicare claim, go to the invoice and click Get Report, then click Reset and confirm. This will allow you to resubmit the claim.

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

Note

When you click Get Report while resetting a Medicare claim, there will be no report available because you have not successfully submitted the claim. The message from Medicare tells you how many days ago you tried to process the claim.

0 out of 0 found this helpful

Comments

0 comments

Article is closed for comments.