Making Medicare claims from your healthcare practice

Mar 15, 2022 | Cloud software, Practice Management Software, Tips

Once you’ve established yourself as a functional health clinic, you and your patients and clientele will likely encounter the task of making Medicare claims.

So, once you’ve provided your particular health services from your clinic, your patents will likely need to be informed as to their ability to claim on Medicare and how to go about processing it.

What is a Medicare Claim?

You’ve received a referral from a GP for one of your clients as part of their healthcare plan (Enhanced primary care plan or mental health care plan). This allows the clients treatment to be subsidised by Medicare.

So, what’s a Medicare claim and how does it work? Whenever a patient uptakes a health service that is not fully bulk billed, they will be allowed to reduce their personal costs by claiming through their Medicare online account.

For example, let’s say you’re a dermatologist (physiotherapist) operating a private clinic. If your fee for a consultation is $150, it may be that your patient is able to recover, say $53 of that fee through a Medicare claim.

What you can claim and how much will be determined by your particular vocation, but there are many practitioners and health professionals who’ll be able to offer such bill reducing claims to their patients.

If your clinic offers Medicare claims, this can be handled in two ways.

  1. You can provide this Medicare claim service on behalf of a patient and process their Medicare claim for them. To do this, your patient simply needs a Medicare card and to have registered a current bank account with Medicare. To facilitate this, you can use the  Medipass integration for processing Medicare payments via Better Clinics. If you require more information on making a Medicare claim for your patient as a health professional, visit Service Australia’s HPOS page.
  1. Your patient can claim online themselves after leaving your clinic using their Medicare online account. To do this, your patient will require a Medicare Plus App or they can log in to their Medicare online account using myGov and process this online.

MyGov connects securely

An easy way for any patient to claim Medicare expenses or access Medicare information, including bills and connected bank accounts is for them to connect Medicare to their MyGov account.

How does Medicare bulk billing work?

Bulk billing is a process whereby a health practitioner will bill Medicare for their services instead of the patent themselves. Not all health services can be bulk billed.

Generally speaking, bulk billing can cover the following services:

  • visits to GPs and specialists that bulk bill
  • tests and scans like x-rays and pathology tests
  • eye tests performed by optometrists.

If you do not fall into these categories, it’s likely there are no Medicare claims allowed, or only partial Medicare claims.

MBS Online: What is the Medicare benefits schedule?

The Medicare Benefits Schedule, or MBS, is a component of the broader Medicare Benefits Scheme which is managed by the Australian Government Department of Health and implemented by Services Australia.

In essence, the scheme is a comprehensive listing of all medical services which can be rendered under the umbrella of Medicare in Australia and are thus subsidised by the government.

Private health insurance claims

Of course, many of your patients will not only have Medicare, they’ll also have private health insurance that can cover a lot of what they can’t claim through Medicare.

So how do you process private health insurance claims?

The simplest way to go about this is through an integration of a software/terminal combo such as TYRO and Better Clinics practice management software or Medipass integration.

To manage private health insurance claims, you simply setup an EFTPOS terminal that is integrated with software that’s designed for health insurance claims.

With TYRO, it takes around 4.5 seconds to process a health insurance claim right there at the point of payment. This simplifies the entire process on both ends and creates a seamless and immediate claim experience.

Gap cover

The difference between your patient’s medical coverage under the MBS and the costs of a session with a medical professional is termed a ‘gap’. If your patient has private health insurance this may help cover the gap and reduce medical costs.

If you would like to see how Better Clinics and integrations like Tyro help you and your patients navigate Medicare and Private health insurance, visit our homepage to learn more. Tyro cannot to Medicare, we only integrate with Medipass for Medicare.


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