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48
If you chose to go with the patient claim
option, the advantages for you (the doctor)
are that you are free to set your fee as you see
fit; you have full rights under the general law
to recover the debt and you can add various
other costs that you can't add when bulk
billing (such as bandages).
The disadvantages are that, unless you
have excellent systems in place to ensure
ALL patients pay on the day or even in
advance, you will inevitably have more
bad debts and will have to deal with the
consequent headaches involved in chasing
patients to pay their bills. And you may not
have as many happy patients!
For the patient, there are no clear
advantages to the patient-claim option and
the disadvantage is higher fees, but, as our
reader explained, you don't have to charge
higher fees. You have complete control over
the amount you charge your patients when
doing patient claims and therefore also the
out-of-pocket amount your patients will be
required to pay.
As our reader suggested, you can charge
the equivalent amount that you know the
patient will recover from Medicare. And even
though the patient will have to pay the full
amount upfront, if you are claiming online
using either an Ezyclaim terminal or online
claiming software, you can submit the claim to
Medicare for your patient right at the point of
service, and your patient will have their rebate
within minutes or, at worst, overnight.
INVOICE EXAMPLES
Here are some sample invoices to demonstrate
correct and incorrect itemisation of this
scenario. Remember, this is a hypothetical
claim whereby the Medicare rebate payable to
the patient will be $30. I have used item 23 to
keep it simple but the actual rebate for item
23 is more than $30.
This invoice has been incorrectly itemised
because, under regulation 13 of the Health
Insurance regulations 1975
, the full amount
of the service (item 23) must be itemised on
your account. This begs the question: Is the
bandage part of the service or should it be
itemised separately?
The definition of a `professional service'
relates to clinical relevance and each item
in the MBS is intended to be one complete
professional service. However, it is not
always simple to work out what's in and
what's out, and there are no decisions or
rulings to assist us but, in our current
example, it's pretty easy.
Medicare has made it clear that we
cannot add the fee for a bandage if we are
bulk billing a service because the bandage is
viewed as being part of that service.