Support Center

Billing Accurately Under Medicare

Last Updated: Jul 14, 2013 02:32PM AEST
While the support staff at Cutting Edge are happy to provide general advice about how to correctly bill Medicare for medical services, it's the responsibility of the servicing provider to ensure that all services for their provider numbers are billed correctly. Medicare provides a resource at www.humanservices.gov.au/billingaccuracy to assist with this.
Please note the following:
  • The Health Insurance Act 1973 determines the rules for billing Medicare services. See http://www.comlaw.gov.au/Details/C2012C00842/
  • Detailed information on the Medicare Benefits Schedule (MBS) is available at http://www.mbsonline.gov.au
  • The person whose provider number is used for billing purposes is legally responsible for those services
  • The servicing provider is legally responsible to ensure that patient referrals and requests are medically necessary for the treatment of the patient
  • Medicare may undertake compliance audits or reviews from time to time. The electronic claim is considered to be a legal record of the service actually provided.
  • If services have been billed incorrectly, the servicing provider is responsible for the repayment of benefits. The Commonwealth are legally obliged to recover such debts.
What you need to do:
  • Ensure that all items are billed in accordance with MBS requirements
  • Ensure you're able to substantiate all claims made under your provider number
  • Advise Medicare if you are aware of incorrect Medicare payments, using the Voluntary acknowledgement of incorrect payments form  http://www.medicareaustralia.gov.au/provider/pubs/medicare-forms/files/4703-1301en.pdf
See also
http://www.medicareaustralia.gov.au/provider/business/audits/files/4772-health-insurance-act-1303.pdf
http://www.medicareaustralia.gov.au/provider/business/audits/files/4823-compliance-audit-flowchart.pdf

Contact Us

  • Email Us
  • Call Us @ 1300 CESOFT (1300 237 638)
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