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manual:billing_visits

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Billing Visits

Visits

Select the ledger you wish to view information for.
The dashboard at the top of the page shows you key visit information for the ledger you are viewing. These fields reflect your filter selections to provide you with 'at a glance' summary information.
To hide the dashboard, click on the pie chart icon.

The visits table displays visits in the following columns:

  • Date
  • Patient
  • Provider
  • Billing Type
  • Items
  • Status
    • This field reflects Medicare Claim status and is not reflective of whether the visit is paid or not. To see if a private billing item has been paid, refer to the invoices tab.
  • Amount
  • Medicare Paid
    • Will display $0.00 for private billing and claims either not yest sent to or paid by Medicare
  • Edited By

The table can be sorted by column, clicking the column title once to sort A-Z and twice to sort Z-A. Additional filters and search fields are available:

  • Keyword search
  • Billing Type
  • Status

And by clicking on Advanced additional filters:

  • Patient
  • Provider
  • Validation Errors - filter for, or exclude draft visits with errors to be corrected
  • Include Reclaimed
  • Date Range fields
  • Item Number

To report on the visits created, set the filters to display the information you wish to report and click Export. Exported reports can be configured to meet your exact requirements.

Adding Visits

From Patient Management Pages

There are multiple places to add Visits for a patient.

  • From the Billing Module on the Visits tab, click on Add new visit.
    • If a patient record is open, patient name will populate visit.

  • Right click menu on the Patient Search page
    • Patient name will populate visit

  • Right click menu on a Patient appointment
    • Patient name, appointment time and duration will populate visit fields
    • Clinician name will populate if the appointment is in a provider (not a custom) calendar

  • Right click menu from Patient Tracking
    • Patient name will populate visit

From the Clinical Record

Within the clinical record that you can add a visit for a patient.

  • Bill Patient button in Clinical Record - display of this option is an organisation setting

  • A range of forms include billing prompts that will take you to the Create Visit page. Examples of these forms include Health Checks, GP Management Plans, GP Mental Health Plans.

Add visits

To add a visit click Add New Visit

On the Create Visit screen, select the patient, the billing type date and duration. Enter the provider number details, the treatment location and treatment location provider number if required.

Add the Billing items and click Add Visit

You will be alerted to any key errors in the visit record immediately after the visit is saved. The errors will be noted at the top of the page. Addressing the errors now will reduce the number of errors and rejected batches later.

View Patient's Billing History

There are multiple places where you can access a summary of the patient's Billing History.

  • In the Add appointment window when you have selected the patient you will see a View Billing History link

  • Right click menu on the Patient Search page

  • In the Action column of the Patient Widget

Online Patient Verification

Whilst creating visits and claims, you see the following warning message(s): If this message appears, click the Verify Now link.

You can also verify outside of the billing process by clicking on Verify in the Patient Widget, or in the right click menu on the patient search page.

The Online Verification Page will open in a new tab

Click on Verify Medicare Details or Verify DVA Details button at the top of the page.

  • If you receive a message 'The patient details have been matched against the Medicare (DVA) record'
    • close the tab and continue with the visit/claim.
  • If you receive a green message stating, 'The individual has been matched using the submitted data however differences were identified. Please check the information returned and update your records,'
    • click on the Accept Changes button at the top of the page before closing the tab, returning to and completing your claim.

NB: For data integrity and privacy reasons the 'Update Medicare Details' DOES NOT change any information within the MMEx patient record.
Medicare numbers and expiry dates need to be manually updated in the patient file by the clinician/clinic admin.

The Medicare service for verification does not present any data regarding the new card's expiry date.

Complete a Bulk Billing Visit

When creating a visit with a patient record open, the patient details will automatically populate the patient field. If no patient record is open, start typing the patient's name in the patient field and select the correct patient from the short list.

With the Create Visit screen open, if the default Billing Type has not been set in the patient record demographics page, or in the organisation centre, select Bulk Billing from the Billing Type menu.

The start time will default to the time that you opened the visit screen. If opened from the Bill Patient link in the Clinical Record the duration field will be populated by the visit timer. If there is no number in the duration field, enter the duration of the visit being billed. You may use the number selection arrows to select the time or type numbers in.

The provider field will default to the provider who clicked the Bill Patient link in the Clinical record. If required, record the treatment location and location specific provider number and if billing for a specialist, select the related current referral. If relevant, select the Treatment Location and location specific provider number.

In the Billing Items field, type in the MBS code you wish to bill for. From the drop down list of options, highlight the one you wish to select and click on it. When you highlight the item the full text explanation of the item will display to assist with selecting the correct code. After selecting the item a pop up will display to show the full description, the option for adding bulk-billing incentive items (Yes or no will default based on your organisation setting.) Click OK to confirm. All selected items will display at the bottom of the screen.

Click on Save when all required details have been recorded a successful save message will display.

Assigning claim to provider

Before you can claim a bulk billing visit, you must confirm that the patient has signed the DB4 to assign claiming rights to the nominated provider. Click Print DB4 to print the form and Confirm DB4 to confirm that the patient has signed the form to assign their claim to the provider. You will be prompted to confirm that the patient signed the DB4 form.

Bulk Billing Incentives

If your organisation is eligible to claim Bulk Billing Incentives 10990, 10991 or 10992 and have activated the setting to add this incentive item automatically, the incentive item check box will display in the visit screen.

The incentive box will be automatically checked if:

  • the patient is 15 years or younger OR
  • the patient has a valid concession card (including expiry date) recorded in the Patient Identifiers list on the demographics page.


The incentive item box will appear, but be unchecked if:

  • the patient is 16 years or older AND
  • the patient DOES NOT have a valid concession card (including expiry date) recorded in the Patient Identifiers list on the demographics page.

Adding the Concession Card

On the Demographics Tab, record the patient identifier - to trigger the incentive checkbox it must be selected from the Concession Cards options in the Concession card section of the list.

When added correctly the concession card details will display at the top of the visit for easy reference.

If the details need to be updated, click on Show More to open the patient demographics in a new tab for easy updating.

Advanced visit options

At times you may need to record additional details about an MBS item.

When creating a visit you will see the Advanced Options button under the date and duration fields. Clicking this button will display the following additional fields:

  • Treatment Location
  • Referral details - will only display when the provider is a Specialist

After adding an MBS item, click on the Medicare Details button.

The following options are available for recording:

  • Aftercare: Indicates if service is part of normal aftercare for the patient.
  • Restrictive Override: This indicator is used to allow payment for service where the account provides indication that the service is not restrictive with another service either within the same claim or on the patient history.
  • Account Reference Number: A reference identifying the service for the locations records. Sometimes known as an invoice number or medical record number
  • Service Text: Free text used to provide additional information to assist with the benefit assessment of the service. Only 50 characters will be transmitted for Bulk Billing of Patient Claims, and 100 for DVA
  • Hospital Indication: Indicates if service rendered in hospital or not.
  • Duplicate Service Override: Indicates if practitioner attended patient on more than one occasion on same day.
  • Multiple Procedure Override: Indicates whether service part of a multiple procedure or not.
  • Self Deemed: A Self Deemed service is a service provided by a consultant physician or specialist as an additional service to a valid request. A substituted service is a service provided that has replaced the original service requested.
  • Equipment ID: The identification number of equipment used for the service provided (allocated by the Dept. of Health and Ageing).
  • LSP Number: Location Specific Practice Number Only to be used in association with services listed in the Diagnostic Imaging Services Table and Group T2 - Radiation Oncology services in the General Medical Services Table.

Assign payment to another provider

In instances where a provider number for the location is not available and a solution has been approved by Medicare.

At the time of recording the visit, select the provider who provided the service. In the Payee Provider Number field, record the provider number that will be used to receive the payment from Medicare. Process the visit and claim as usual.

Example: a locum will be in a practice for less than two weeks and will not be returning there; the locum has discussed with Medicare (and received approval to use) the option to, for example, use one of the locum’s other provider numbers with explicit Medicare approval.

Specialists (Referrals required)

In MMEx users who require a current referral in order to be able to bill Medicare for services are classified as a “Specialist” provider; a regular user who can bill Medicare without requiring a current referral are classified as a “General” provider.

These are referred to as Service Types.

  • General – refers to a claim that does NOT need a Specialist Referral attached. Therefore GP claims will be General. Dentists and Optometrists are also included in this Service Type
  • Specialist – refers to claims by providers who DO need a Specialist Referral attached. This includes all Allied Health Providers, including ATSI Health Workers, and Specialist Physicians (eg Ob/Gyn, Paediatrician, Psychiatrist etc)

Configuring a user as a Specialist

As an Organisation Administrator, open the user's profile, or as a user, open your own profile by clicking on My Profile on the Settings menu.

Scroll down to the Provider Type field and select Specialist.
Scroll to the bottom of the page and click on Submit Changes.

Referral - Specialist

MMEx needs to ‘link’ the referral to the Medicare claim for Allied Health and Specialist Doctors

On the Add Visit page, with your specialist provider selected, click on Advanced Visits Options to reveal the referral selection field.

From the drop down menu select Referral.

You may record the referral details here, however, if an existing referral has been recorded for the patient click on the Use Existing Referral button.
You will see a list of current referrals.

Click on the correct referral for this visit and provider. The details will populate the fields.

Continue to add the remaining visit details.

If you forget to add a referral for a Specialist you will see the following warning when you save the visit. You should select the referral now to prevent the claim being rejected by Medicare.

Referral - Request

If billing for services such as Pathology or Diagnostic Imaging, select Request from the drop down list and record the relevant information.

Referral - Override

If as a Specialist you need to record why there is not a current referral for the visit, select Override and then the override reason from the drop down list.

Add visits to claims

What was previously called “batch/batching” is now referred to as “Claim/claiming” To add a visit to a claim click Add to a claim MMEx will identify all draft visits, with no errors and DB4 signed and add them to a single claim for each billing type, for each provider.

After doing this, any visits still in Draft status, but not showing an error, requires the DB4 to be confirmed.

Resolving Visit Errors

Common pre-claim errors How to resolve
The patient's medicare number or medicare index is missing or invalidAdd a valid Medicare number and index to the patient's demographic details
The patient's gender must be suppliedAdd a valid gender selection to the patient's demographic details
The patient's name cannot have bracketsModify the patient's name so that it meets Medicare naming conventions
Servicing provider number cannot be emptyAdd a provider number to the user's MMEx profile
The servicing provider's Location ID is missing or invalidThe organisation's Location ID configuration is not correct - contact MMEx helpdesk for assistance
The servicing provider's Provider ID is missing or invalidCorrect the provider number recorded in the user's MMEx profile
The servicing provider's service type code is missing or invalidSelect a Provider type (General or Specialist) in the user's MMEx profile
A request or referral needs to be provided for a specialist visitSelect the correct, valid referral to link to the visit
A treatment location must be specified under Advanced Visit Options.Click on Advanced treatment options and add a Treatment Location
The servicing provider's Location Certificate could not be verified. Please contact MMEx support.There is an issue with your Medicare setup. Call MMEx Helpdesk.
The date of service cannot be more than two years past.The visit must be edited and a valid date within the past two years recorded
The service date must be within the last two years and must not be in the future.The visit must be edited and a valid date recorded

Visit Status - Bulk Billing

You can see the status of a visit by looking a the status column on the Visits page, or the Breadcrumbs at the top of each individual visit.

Draft

DB4 Signed

Added to Claim

Pending Submission to Medicare

Sent to Medicare

Paid/Partially Paid

Failed

Complete a DVA Billing Visit

When creating a visit with a Patient record open the patient details will automatically populate the patient field. If no patient record is open, start typing the patient's name in the Patient field.

With the Create Visit screen open, if the default Billing Type has not been set in the patient record demographics page, select DVA Billing from the Billing Type menu.

The start time will default to the time that you opened the visit screen.

If opened from the Bill Patient link in the Clinical Record the duration will be populated by the visit timer. If there is no number in the duration field, enter the duration of the visit being billed. You may use the number selection arrows to select the time or type numbers into the field. If required record the treatment location and location specific provider number and if billing for a specialist, select the related current referral.

In the Billing Items field, type in the item code you wish to bill. From the drop down list of options, highlight the one you wish to select and click on it. When you highlight the item the full text explanation of the item will display to assist with selecting the correct code. After selecting the item a pop up will display to show the full description, the option for adding bulk-billing incentive items (Yes or no will default based on your organisation setting.) Click OK to confirm.

All selected items will display at the bottom of the screen.

Click on Save when all required details have been recorded a successful save message will display.

Recording Travel

Adjacent to the Billing Items field you will see

Click the button to record the travel allowance. Record the number of kilometres travelled for the service and click OK.

Advanced visit options

At times you may need to record additional details about an MBS item.

When creating a visit you will see the Advanced Options button under the date and duration fields. Clicking this button will display the following additional fields:

  • Treatment Location
  • Referral details - will only display when the provider is a Specialist

After adding an MBS item, click on the Medicare Details button.

The following options are available for recording:

  • Aftercare: Indicates if service is part of normal aftercare for the patient.
  • Restrictive Override: This indicator is used to allow payment for service where the account provides indication that the service is not restrictive with another service either within the same claim or on the patient history.
  • Account Reference Number: A reference identifying the service for the locations records. Sometimes known as an invoice number or medical record number
  • Service Text: Free text used to provide additional information to assist with the benefit assessment of the service. Only 50 characters will be transmitted for Bulk Billing of Patient Claims, and 100 for DVA
  • Hospital Indication: Indicates if service rendered in hospital or not.
  • Duplicate Service Override: Indicates if practitioner attended patient on more than one occasion on same day.
  • Multiple Procedure Override: Indicates whether service part of a multiple procedure or not.
  • Self Deemed: A Self Deemed service is a service provided by a consultant physician or specialist as an additional service to a valid request. A substituted service is a service provided that has replaced the original service requested.
  • Equipment ID: The identification number of equipment used for the service provided (allocated by the Dept. of Health and Ageing).
  • LSP Number: Location Specific Practice Number Only to be used in association with services listed in the Diagnostic Imaging Services Table and Group T2 - Radiation Oncology services in the General Medical Services Table.

Visit Status - DVA Billing

You can see the status of a visit by looking a the status column on the Visits page, or the Breadcrumbs at the top of each individual visit.

Draft

Added to Claim

Pending Submission to Medicare

Sent to Medicare

Paid/Partially Paid

Failed

Complete a Private Billing Visit

A quick reference, step-by-step private billing workflow overview has been provided here.

When creating a visit with a Patient record open the patient details will automatically populate the patient field. If no patient record is open, start typing the patient's name in the Patient field.

With the Create Visit screen open, if the default Billing Type has not been set in the patient record demographics page, select Private Billing from the Billing Type menu.

The start time will default to the time that you opened the visit screen. If opened from the Bill Patient link in the Clinical Record the duration will be populated by the visit timer. If there is no number in the duration field, enter the duration of the visit being billed. You may use the number selection arrows to select the time or type numbers i If required record the treatment location and location specific provider number and if billing for a specialist, select the related current referral. If relevant, select the Treatment Location and location specific provider number.

In the Billing Items field, type in the MBS code you wish to bill for. From the drop down list of options, highlight the one you wish to select and click on it. When you highlight the item the full text explanation of the item will display to assist with selecting the correct code. After selecting the item a pop up will display to show the full description, along with the ability to override the amount being charged and select to apply GST. Click OK to confirm.

All selected items will display at the bottom of the screen. If you need to record additional details about an MBS item, click on the Medicare Details button. The following options are available for recording:

  • Aftercare: Indicates if service is part of normal aftercare for the patient.
  • Restrictive Override: This indicator is used to allow payment for service where the account provides indication that the service is not restrictive with another service either within the same claim or on the patient history.
  • Account Reference Number: A reference identifying the service for the locations records. Sometimes known as an invoice number or medical record number
  • Service Text: Free text used to provide additional information to assist with the benefit assessment of the service. Only 50 characters will be transmitted for Bulk Billing of Patient Claims, and 100 for DVA
  • Hospital Indication: Indicates if service rendered in hospital or not.
  • Duplicate Service Override: Indicates if practitioner attended patient on more than one occasion on same day.
  • Multiple Procedure Override: Indicates whether service part of a multiple procedure or not.
  • Self Deemed: A Self Deemed service is a service provided by a consultant physician or specialist as an additional service to a valid request. A substituted service is a service provided that has replaced the original service requested.
  • Equipment ID: The identification number of equipment used for the service provided (allocated by the Dept. of Health and Ageing).
  • LSP Number: Location Specific Practice Number Only to be used in association with services listed in the Diagnostic Imaging Services Table and Group T2 - Radiation Oncology services in the General Medical Services Table.

Click on Save when all required details have been recorded a successful save message will display along with an option to Generate an invoice for the patient.
NB: When you open the visit at any time in the future you will see the following “breadcrumbs” that indicate the progress of the visit from creation through to Complete.

Visit Status - Private Billing

You can see the status of a visit by looking a the status column on the Visits page, or the Breadcrumbs at the top of each individual visit. Draft

Ready for Payment

Partially Paid

Paid

Partially Written Off

Written Off

Generate Invoice

Click on Generate Invoice and you will see a confirmation pop-up. Click OK.

Check the Invoice details and click Save Invoice {{ :manual:pasted:20170828-035901.png }

To finalise the invoice, click Mark as Ready for Payment.

Once marked Ready for Payment the amount will be counted as a debt against the Patient's account.

And a payment section will appear at the bottom of the invoice.

Record Payment

The payment amount will default to the outstanding amount.

  • To record payment of a portion of the amount type the amount being paid into the Amount field.
  • To record payment of the total amount click Set to Outstanding
  • To record payment of the Gap amount click Set to Gap

Record the method of payment and click Mark Payment

The payment will be recorded in the Payment History section.

Billing for Gap Fees

You can record Gap Fees in a number of ways.

At time of creating a visit. Select the MBS item you are billing and in the item screen, enter the fee you charge into the Total Amount field.

This will display in the item list as a rebate amount and the total amount.

You can also configure your gap fees in advance using a billing template

Recently Used Items List

When creating a visit you will build up a recently used items, which appear from the Billing Items field

This list appears differently per user and billing type.
If creating a Private Claim or Patient Claim this list of items builds up once you have created the invoice.

Using Billing Templates

Where a Billing template has been created this may be selected in the Billing items field.
Type the name of the template into the billing item field.
A pop up will show the items included in the template. Select Add.

manual/billing_visits.txt · Last modified: 2020/02/27 04:09 by sarahb