bsbmed302b prepare and process medical accounts

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BSBMED302B Prepare and Process

Medical Accounts

Medical Administration Training

Written by Jennifer Atkins

www.mediweb.com.au


Copyright

Copyright © Jennifer Atkins 2013.2

© 2009 Version 1

This training manual is copyright under the Copyright Act 1968.

Any third party copyright material included in this publication is attributed.

Jennifer Atkins asserts her ownership of the Intellectual Property contained in this

training manual. All rights are reserved. No part of this publication may be

reproduced, transmitted, transcribed, stored in a retrieval system, utilised,

distributed, or translated into any other language in whole or in part, in any form or

by any means, by any other party whether it be electronic, manual, photocopying,

recording, or otherwise.

Copying without authorisation is illegal.

Disclaimer

Every attempt has been made to ensure this workbook is free from errors or

omissions. However, as an educational resource, all effort should be made to

ensure you seek professional advice before relying on any statement or fact

contained herein. Material in this workbook is current at the time of writing.

Jennifer Atkins Medical Administration Training

www.mediweb.com.au


Table of Contents

Resources: Helpful Websites ........................................................................................ 4

Chapter 1 – Provide advice to patients about fee structure .................................. 9

Medicare schedule of fees (1.1) ................................................................................... 9

Medicare Benefits Schedule (MBS) ............................................................................ 11

Advise patients regarding entitlements and rebates (1.2) ........................................ 14

Medicare Safety Net ................................................................................................... 19

Net medical expenses tax offset ................................................................................ 22

Medical appointments (1.3) ....................................................................................... 24

Chapter 2 – Process referrals to specialist practitioners ....................................... 33

Valid referrals (2.1) ..................................................................................................... 33

Correct referral procedures (2.2) ............................................................................... 39

File referral letters according to legislation and policies and procedures (2.3) ........ 42

Chapter 3 – Prepare medical accounts for bulk billed and private patients .......... 45

Accurately follow procedures for billing (3.1) ............................................................ 45

Procedures which are not eligible for a Medicare rebate (3.2) ................................. 50

Account and billing documentation (3.3) ................................................................... 52

Follow procedures for preparing Veterans’ Affairs, Workers Compensation and motor vehicle third party accounts accurately (3.4) ........................................... 54

Forward medical account to designated person or organisation (3.5) ...................... 63

Chapter 4 - Process accounts ............................................................................... 67

Receive and document payments (4.1) ...................................................................... 67

Prepare and issue receipts (4.2) ................................................................................. 70

GST and medical services ........................................................................................... 71

Reconcile Medicare payments with claims made by the medical practice (4.3) ....... 75

Overdue accounts (4.4) .............................................................................................. 80

Financial records (4.5) ................................................................................................ 82

Revision Sheet 1 ................................................................................................. 87

Revision Sheet 2 ................................................................................................. 91

Revision Sheet 3 ................................................................................................. 95

Revision Sheet 4 ................................................................................................. 99

Answers to Self Review Questions .................................................................... 103

Glossary of Terms ............................................................................................. 107

Assessment Criteria .......................................................................................... 109


Resources: Helpful Websites

Professional Associations and Medical Standards

AGPAL Australian General Practice Accreditation Ltd www.qip.com.au

Australian Association of Practice Managers www.aapm.org.au

Australian Health Practitioner Regulation Agency http://www.ahpra.gov.au/

Australian Medical Association (AMA) www.ama.com.au

General Practice Computer Standards http://www.racgp.org.au/your-practice/e-

health/cis/ciss/

General Practice Registrars Australia www.gpra.org.au

Health Services Commission http://www.health.vic.gov.au./hsc/

Medical Practice Act 1992

www.austlii.edu.au/au/legis/nsw/consol_act/mpa1992128/s167.html

NSW Rural Doctors Network www.nswrdn.com.au

Royal Australian College of General Practitioners (RACGP) www.racgp.org.au

State and Territory Doctors Health Advisory www.doctorshealth.org.au

Funding Agencies for Medical Services

Centrelink www.centrelink.gov.au

Comcare www.comcare.gov.au

Department of Health and Aged Care www.health.gov.au

Department of Human Services, Victoria www.dhs.vic.gov.au/ahs

Department of Veterans' Affairs (DVA) www.dva.gov.au

HICAPS www.hicaps.com.au

Private Health Insurance Administration Council www.phiac.gov.au

Royal District Nursing Service www.rdns.com.au

Transport Accident Commission www.tac.vic.gov.au

Victorian WorkCover Authority www.workcover.vic.gov.au

http://www.qip.com.au/

http://www.aapm.org.au/

http://www.ahpra.gov.au/

http://www.ama.com.au/

http://www.racgp.org.au/your-practice/e-health/cis/ciss/

http://www.racgp.org.au/your-practice/e-health/cis/ciss/

http://www.gpra.org.au/

http://www.health.vic.gov.au./hsc/

http://www.austlii.edu.au/au/legis/nsw/consol_act/mpa1992128/s167.html

http://www.nswrdn.com.au/

http://www.racgp.org.au/

http://www.doctorshealth.org.au/

http://www.centrelink.gov.au/

http://www.comcare.gov.au/

http://www.health.gov.au/

http://www.dhs.vic.gov.au/ahs

http://www.dva.gov.au/

http://www.hicaps.com.au/

http://www.phiac.gov.au/

http://www.rdns.com.au/

http://www.tac.vic.gov.au/

http://www.workcover.vic.gov.au/


Medical Appointment Software

Pracsoft demo disc http://www.hcn.com.au Phone 1300 788 802 for demo disc.

Medilink has a 7 minute online demo go to:

www.medilink.com.au/MEDILINKxp_OnlineDemo_2.html

Practice 2000 has a free 30 day trial. Go to:

http://www.abaki.com/tryout/purchase.htm

For further information on Medicare

Medicare Australia

Patients can view and update their Medicare details online, view their Medicare tax

statements, request another card, and view their Medicare claims history.

Health professionals can get the latest information on programs and services

available, plus get information sheets they can print out for patients, and they can

also access Mediguide.

http://www.humanservices.gov.au/customer/dhs/medicare

Department of Health and Aging

Manages Medicare Benefits Schedule and provides timely information on the

Pharmaceuticals Benefits Scheme.

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-

medicarebenefits-index.htm

Medicare Benefits Schedule Book

Contains details of all item numbers and schedule fees for medical services.

http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Medicare-

Benefits-Schedule-MBS-1

http://www.hcn.com.au/

http://www.medilink.com.au/MEDILINKxp_OnlineDemo_2.html

http://www.abaki.com/tryout/purchase.htm

http://www.humanservices.gov.au/customer/dhs/medicare

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-medicarebenefits-index.htm

http://www.health.gov.au/internet/main/publishing.nsf/Content/health-medicarebenefits-index.htm

http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Medicare-Benefits-Schedule-MBS-1

http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Medicare-Benefits-Schedule-MBS-1


BSBMED302B: Prepare and Process Medical Accounts

Description

This unit describes the performance outcomes, skills and knowledge required to

provide advice to patients regarding fee structures and process referrals, and to

prepare and process medical accounts for a range of patients.

Performance criteria

Element Performance Criteria

1.Provide advice to patients about fee structure

1.1 Identify and advise patients of schedule of fees for different services

1.2 Advise patients regarding entitlements and rebates

1.3 Schedule medical appointments using appropriate booking and account systems

2. Process referrals to specialist practitioners

2.1 Check referrals to ensure validity

2.2 Follow correct procedures for referrals

2.3 File referral letters according to legislation and enterprise policies and procedures

3. Prepare medical accounts for bulk billed and private patients

3.1 Accurately follow procedures for billing based on account type

3.2 Identify and cost procedures which are not eligible for Medicare rebate

3.3 Select and complete appropriate account and billing documentation according to enterprise and legislative requirements

3.4 Follow procedures for preparing Veteran's Affairs, workers compensation and motor vehicle third party accounts accurately

3.5 Forward medical account to designated person or organisation according to legislation and account processing procedures

4. Process accounts

4.1 Receive and document payments

4.2 Prepare and issue receipts to person or authority according to legislation and office policies and procedures

4.3 Reconcile Medicare payments with claims made by the medical practice

4.4 Follow-up overdue accounts

4.5 Provide and store financial records and data in accordance with policies and procedures of the medical practice


About this workbook

This workbook is suitable for students in a range of situations, from classroom

based learning to distance education learning.

The workbook is developed as a step-by-step learning guide. You are to complete

each element before moving onto the next section. Activities are provided for you

to work through, and once the relevant skills are developed then you can move on

to the next part of the book.

As this is a nationally recognised unit, the activities throughout the book will

require you to draw upon your experiences in life, and your simulated experiences

in a medical environment. These exercises will be the basis of your learning so you

will develop the skills necessary to meet the required competency for the unit.

The focus of this resource is private practice, and all scenarios are based on a

private medical practice, referred to as Summerhill Medical Centre.

Employability Skills

Employability Skills are skills that apply across a variety of jobs and life contexts.

They are sometimes referred to as key competencies or transferable skills. The

current term is Employability Skills.

Employability Skills are defined as "skills required not only to gain employment, but

also to progress within an enterprise so as to achieve one's potential and contribute

successfully to enterprise strategic directions."

There are eight Employability Skills: communication, teamwork, problem solving,

initiative and enterprise, planning and organising, self-management, learning, and

technology.

These Employability Skills are covered in each area of your learning, which ensures

you have achieved these skills.


BSBMED302B: Prepare and Process Medical Accounts

This unit describes the performance outcomes, skills and knowledge required to

provide advice to patients regarding fee structures and process referrals, and to

prepare and process medical accounts for a range of patients.

This unit has four chapters. Each chapter has a number of performance criteria that

explain what you need to do to ensure demonstrated competency for this unit.

Chapter 1:

Provide advice to patients about fee structure

This chapter discusses the different Medicare schedule fees, and benefits available.

It also addresses the various types of medical appointments available, including

electronic appointment software.

Chapter 2:

Process referrals to specialist practitioners

This chapter talks about the need for specialist referrals to be valid, accurate, and

filed according to acknowledged procedures. Referral procedures for Workers

Compensation and Veterans’ Affairs patients are discussed.

Chapter 3:

Prepare medical accounts for bulk billed and private patients

The techniques required for identifying and costing procedures is discussed in this

section. Procedures for billing Veteran’s Affairs, Workers Compensation and

Transport Accident Commission (TAC) are clarified.

Chapter 4:

Process accounts

Preparation of medical receipts is addressed, as well as the reconciliation of

Medicare payments with the claims of the medical practice.


Chapter 1 – Provide advice to patients about fee structure

Performance criteria addressed:

Medicare schedule of fees (1.1)

The process of preparing accounts in a medical environment is procedural.

Medicare has certain requirements which ensures doctors are paid the correct

entitlement for each service they provide. It is essential for medical administration

workers to have a working knowledge of the Medicare system, item numbers,

benefits, and the procedures required to bill patients.

What is Medicare?

Medicare provides public health insurance to Australian residents. It was

introduced in 1984 to provide health care to all Australians according to their ability

to pay. Medicare provides treatment which includes medical consultations,

optometry, specified dental care (certain services only), specified allied health

treatment, and free treatment as a public patient in public hospitals.

1.1 Identify and advise patients of schedule of fees for different services

1.2 Advise patients regarding entitlements and rebates

1.3 Schedule medical appointments using appropriate booking and account systems


Medicare Australia funds the following:

Medicare schedule fees

PBS (Pharmaceutical Benefits Scheme)

30% private health insurance rebate

Hearing services

Australian organ donor register

Veteran’s Affairs medical payments

How is Medicare funded?

Medicare is provided by the federal government, and funded by taxpayers. For

2012/2013 all Australian residents pay:

Medicare levy – which is 1.5%

of a taxpayers taxable income

once they earn over $22,828.

Medicare surcharge – which is

a minimum of 1% of a

taxpayers taxable income once

they reach $84,000 taxable

income for a single, and over

$168,000 for a couple or

family.

Taxpayers are exempt from the Medicare surcharge if they have private health

insurance, but there is no exemption from the Medicare levy.


Medicare Benefits Schedule (MBS)

All items that attract Medicare benefits have a schedule fee and an item number.

An item number is a number which is designated for each Medicare service. All item

numbers have a schedule fee.

Scheduled fees are managed by the Department of Health and Aging. The benefit a

patient receives from Medicare is based on a percentage of the schedule fee.

Medicare services and their schedule fees can be searched online at

www.mbsonline.gov.au.

The schedule fee determines what a patient receives from Medicare, but does not

determine what a patient pays a practitioner for the service they receive. Doctors

can charge their own fee; they are not bound by the schedule fee.

Professional Attendances

Consultations by medical doctors to determine a patient’s medical condition or

prepare a management plan are called “professional attendances” for Medicare

purposes. These attract a payment of 100% of the schedule fee by Medicare.

There are a number of issues which determine the item number of a consultation:

Location of the consultation (Did it occur at a medical practice, a nursing

home, or the patient’s home?)

Time of the consultation (Did it occur during normal day time hours or

after hours?)

Day of the consultation (Did it occur on a weekday, weekend or public

holiday?)

Nature of consultation (Was it standard [non-urgent] or life-threatening

[urgent]?)

Length of consultation (How long was spent with the patient?)

Complexity of the consultation (Was there one condition or multiple

conditions attended to?)


Commonly used Medicare item numbers

ITEM NO 3 LEVEL ‘A’

Professional attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.

CONSULTATION AT CONSULTING ROOMS (Professional attendance at consulting rooms)

Schedule Fee: $16.60 Benefit: 100% = $16.60

ITEM NO 23 LEVEL ‘B’

Professional attendance by a general practitioner lasting less than 20 minutes, including any of the following that are clinically relevant: taking a patient history; performing a clinical examination; arranging any necessary investigation; implementing a management plan; providing appropriate preventive health care; in relation to 1 or more health-related issues, with appropriate documentation.



ITEM NO 36 LEVEL ‘C’

Professional attendance by a general practitioner lasting at least 20 minutes, including any of the following that are clinically relevant: taking a detailed patient history; performing a clinical examination; arranging any necessary investigation; implementing a management plan; providing appropriate preventive health care; in relation to 1 or more health-related issues, with appropriate documentation.



ITEM NO 44 LEVEL ‘D’

Professional attendance by a general practitioner lasting at least 40 minutes, including any of the following that are clinically relevant: taking an extensive patient history; performing a clinical examination; arranging any necessary investigation; implementing a management plan; providing appropriate preventive health care; in relation to 1 or more health-related issues, with appropriate documentation.



Source: The above items have been extracted from the Medicare Benefits Schedule (November 2012).


Activity 1 – Consultations

Use the following table to fill in the details which distinguish

Levels A – D. Level A has been completed for you.

Level Location Length of consultation Complexity

A Consulting

rooms

Short duration

(5 minutes)

Straightforward nature, short

patient history, limited

examination

B

C

D

Activity 2 - Professional attendances

Fill in the missing details for the following table.

Level Item number Schedule fee Length of consultation

A

B

C

D


Bulk billing

When a patient is bulk billed they incur no out-of-pocket expenses. This happens

when the doctor bills Medicare directly for the schedule fee. This means the patient

signs a Medicare form, to assign their right to a Medicare benefit, to the

practitioner, as full payment for the service they received. A medical practice may

choose only to bulk bill patients with a pension card or health care card, or they

may bulk bill all patients who attend their practice. There are also bulk billing

incentives for doctor’s that bulk bill children under-16 and concession card holders.

This entitles them to claim further funding from Medicare as an incentive to bulk

bill.

A medical practice cannot bulk bill a patient and charge an additional out-of-pocket

expense, such as an administrative fee, or a fee for equipment used during a small

procedure.

For example, if a patient has a small dressing performed, the cost may be an

additional $10 - $15, just to cover the cost of the antiseptic, wound dressing and

bandage. If bulk billed, the practice cannot charge an additional fee for the

dressing.

A medical practice has two options:

Bulk bill Medicare directly for a Level B consultation and receive $36.30.

Bill the patient, who is then reimbursed by Medicare. The doctor may

charge any fee to the patient (for example, $45), and then charge an

additional fee for medical supplies if necessary (such as $20); thus

receiving $65.

Doctors may choose to charge more than the schedule fee, and for private patients

(that is, non bulk billed patients) they usually charge anywhere from $15 to $30

more than the scheduled fee for a Level B consultation.


Activity 4 – Consultations

Summerhill Medical Centre bulk bills pensioners and concession

card holders. Otherwise it charges the following fees for

consultations.

Level Item number Fee charged

A (less than 5 minutes) 3 $20.00

B (less than 20 minutes) 23 $50.00

C (20 – 40 minutes) 36 $80.00

D (more than 40 minutes) 44 $110.00

Record the fee charged, Medicare schedule fee and out-of-pocket expenses, using

the consulting times as a guide to which item number to bill.

Patient name Length of

consultation

Fee

charged

Medicare

schedule fee

Out-of-pocket

expenses

Sam 5 minutes

Christine 15 minutes

Anne (pensioner) 30 minutes

Jo (concession card) 15 minutes

Matthew 50 minutes

Activity 5 - Out-of-pocket expenses

Determine the schedule fee and any amount the patient will be

out-of-pocket.

Details Schedule fee Out of pocket

Suzie had a tetanus injection which took a couple

of minutes. She paid $20.00

Jonathon had a level C consultation and paid

$80.00

Kirsten spent 15 minutes with the doctor and

paid $50.00

Joshua had a 30 minute consultation and was

charged $80.00


Types of Medicare cards

There are three types of Medicare cards (green, yellow and blue). All cards have a

10 digit number, the last digit changes with each new card issued (called the Card

Issue Number). The Valid To date is the card expiry date. There are a maximum of

five family members on each card, and a maximum of nine family members for each

Medicare number. Each person has a Patient Reference Number.

Green Medicare card – For Australian residents

All Australian residents are entitled to full

Medicare benefits, as identified by a green

Medicare card.

Yellow Medicare card – For residents from reciprocal countries

A yellow card is also called a reciprocal health

care card, and is for residents of countries which

Australia has reciprocal health agreements with.

Residents must produce their passports with

their Medicare card to obtain treatment. The

Yellow card does not cover treatment as a

private patient in a public or private hospital.

Blue Medicare card – For an interim period A blue card, also called an interim card, is issued

to people applying for permanent residency.

Cover is limited to a specified time period. Blue

Interim Medicare cardholders have access to all

eligible Medicare services.

Below is a table showing the amount of Medicare benefits paid for the 12 months ending June 2010.

Medicare benefits paid for July 2009 to June 2010

NSW VIC QLD SA WA TAS

$Benefit $Benefit $Benefit $Benefit $Benefit $Benefit

5,644,832,000 3,914,077,000 2,908,490,000 1,157,240,000 1,260,018,000 319,072,000


Medicare Safety Net

Individuals and families with high medical costs are provided additional financial

support from the Medicare Safety Net. This covers a range of out-of-hospital

services which are covered by the Medicare Benefits Schedule. Services provided

when you are in hospital, or medical services that are not eligible for a Medicare

rebate, do not count towards the Medicare Safety Net.

Some examples of services which count towards the Medicare Safety Net are:

GP and specialist consultations

Blood tests

CT scans, ultrasounds and x-rays

Pap smears

Psychiatry

Families and couples need to register with Medicare, but individuals are

automatically registered. Registering as a couple or family means you will reach

your threshold sooner, as Medicare combines your medical costs.

Once you reach the threshold, Medicare will pay 80% of your out-of-pocket

expenses (This does not apply to in-hospital medical costs). This means that once

you reach the threshold (which is the total of all out-of-pocket expenses), medical

consultations and tests will incur a smaller out-of-pocket expense. The threshold is

reached when your out-of-pocket expenses reach the annual limit. Your out-of-

pocket expenses are calculated as the difference between the Medicare benefit

paid and the amount the doctor charges you.

The Medicare thresholds as at 1 January 2013 are:

The lower threshold is $610.70 (for concession card holders and Family

Tax Benefit A recipients)

The upper threshold is $1,221.90 (for all Medicare card holders)

For example: If you reach the Medicare Safety Net threshold and then visit your

doctor who charges you $70 for a Level B consultation, you will receive a Medicare

rebate of $36.30. You will also receive 80 per cent of your out-of-pocket costs

(($70.00 - $36.30) x 80 per cent), which is an extra $27.00. So the doctor’s

consultation will only cost you $6.70 out-of-pocket.


The following are Medicare dockets for benefits paid. When a patient goes to a

Medicare office for a cash benefit they will receive a docket similar to this. Note the

second docket shows the patient has reached the Medicare Safety Net.

1.

Medicare

2.

Medicare

STATEMENT OF CLAIM AND BENEFIT RECEIVED


PLEASE RETAIN FOR TAXATION PURPOSES


CARD: 321347927 5 PROVIDER:


Dr N Hughes 223455124Y


PATIENT:1 LEANNE CAMPBELL


ITEM DATE CHARGE SCH FEE BENEFIT

ITEM DATE CHARGE

SCH FEE BENEFIT EXP

23 151112 70.00 36.30 36.30

23 171212 70.00 36.30 63.30 517

I have received the sum of $36.30 in cash.

EXPLANATION OF CODE

ISSUED 15/11/12 16:19

517 EMSN threshold reached - 80% of out of

pocket paid

I have received the sum of $63.30 in cash.

ISSUED 18/12/12 15:50

Activity 6 - Medicare Safety Net

a. What is the schedule fee for the first visit (15/11/12)? ___________

b. What is the benefit for the first visit (15/11/12)?________________

c. What is the benefit for the second visit (17/12/12)? _____________

d. Calculate the benefit for the third visit below (20/12/12).

________________________________________________________

3.

Medicare






ITEM DATE CHARGE SCH FEE BENEFIT EXP

36 201212 90.00 70.30 _______ 517

EXPLANATION OF CODE

517 EMSN threshold reached - 80% of out of

pocket paid

I have received the sum of $____________ in cash. ISSUED 20/12/12 15:50


Medical appointments (1.3)

The appointment register is an important part of medical administration. It ensures

efficiency and streamlines the flow of patients through the practice. Appointments

are usually booked at 15 minute intervals. If a patient requires a consultation for a

more complex issue they may request a longer appointment time. This is referred

to as a ‘double appointment’.

The policies and procedures manual of the practice will outline the process for

seeing patients who walk-in without an appointment. The first priority will be to

patients with appointments, followed by patients without appointments or those

who are late for their appointments. If there is an emergency usually the patient

will be seen by the first available doctor.

An appointment system needs to allow time for emergencies whilst eliminating

undesirable delays for patients with appointments. Patients need to understand

how the appointment system works so they do not become distressed by the wait.

An appointment system needs to allow for the specific preferences of each doctor.

During the week a doctor may like to make hospital visits, home visits, nursing

home visits, perform simple procedures in hospital, attend meetings, develop their

own research, or participate in other work related tasks. This will impact upon the

type of appointment system most appropriate. A busy medical practice could

therefore use multiple appointment systems, which allows for the individual

preferences of each doctor.

An appointment system may use the sequential booking, block release booking,

wave booking, or first in first seen method.


Sequential booking

The doctor may be available from 9:00 am to 5:00 pm Monday through Friday.

Therefore a patient can make an appointment for any time in this period, except for

blocked out periods (kept aside for hospital rounds, nursing home visits, meetings

etc). Some appointments will be 15 minutes and others will be a double

appointment. This allows the doctor the required amount of time for each patient.

Emergencies are seen throughout the day as required, which means there may be

minor delays for patients with appointments.

Block release booking

The doctor may be available all day, but only 9:00 am to 12:00 noon is made

available for appointments. When the released time period is 75 percent full then

the next block is made available for appointments from 12:00 noon to 3:00 pm. This

method is often used for new doctors who don’t have sufficient appointments for

an entire days roster. It ensures they do not have long gaps between appointments.

Wave booking

Every half-hour multiple people may be booked in, for the same consultation time.

This ensures patient lateness does not delay other appointments. If three patients

are given an appointment time of 10:00 am and one arrives at 9:55 am, one arrives

at 10:00 am and another arrives at 10:08 am, then they are seen in the order they

arrive. This is a common practice in the Outpatients Department of a Hospital.

First in first seen

With the ‘first in first seen’ method patients are seen by the doctor in the order

they arrive. Emergencies may be seen before regular appointments, but all other

patients see the doctor in order of arrival. This method is often used in 24 hour

medical centres from 10:00 pm onwards, after the appointment book closes for the

day.


Activity 8 - Appointment system

Using the appointment book on the following page, you are

required to set up the appointment book as per the

requirements on the previous page (i.e. cross out the times the

doctor is unavailable), and then make the following

appointments.

On September 22 the following patients’ call with various requests:

1. Lee Johnston rings to make an appointment. She is 3 months pregnant

and requires a pre-natal check. She would like an appointment as early

as possible.

2. Nathan Nemeth wants to see Dr Jen on 23 September after lunch.

3. Janice Smith wants her son Tyler to be seen as late as possible on 22

September.

4. Max Imus wants to change his 22 September appointment to the

morning of 24 September.

5. A drug representative from Pfizer wants to see Dr Jen on 23 September.

6. Katrina Bolus rings at 9:30 am with chronic pain and needs to see the

doctor first thing this morning.

7. A drug representative for Zyban wants to see the doctor today.

8. Christian Seizner wants to get a referral for a Dermatologist. He needs it

by this afternoon for a 1:00 pm appointment with the specialist. He

wants to come by on his way to the specialist appointment.

9. Julie Sunder has run out of her script and wants an appointment for

early this afternoon.

10. Nesta Anne wants to cancel her appointment today and make it for

2:00 pm on 24 September.


Appointment book for 22-24 September

Sept

22

Patient name Sept

23

Patient name Sept

24

Patient name

9:00 Suzie Sue 9:00 Julie Jones

- 3month check

9:00

9:15 Kirsten Jacinta 9:15 9:15

9:30 Joshua

Matthews

9:30 Samantha Susan

- Pap smear

9:30

9:45 9:45 9:45

10:00 Trish Margot 10:00 Gail Slithers

- Pap smear

10:00

10:15 Daniel Peacock 10:15 10:15

10:30 Samantha Day 10:30 10:30

10:45 10:45 10:45

11:00 11:00 Gail Jones

- Pre-natal visit

11:00 Joel Daniel

11:15 Max Imus 11:15 11:15 Dan Matt

11:30 Chris Tine 11:30 Jennifer Gail

- post natal check-up

11:30

11:45 John Boy 11:45 11:45

12:00 12:00 12:00

12:15 Julie Jones 12:15 12:15

12:30 12:30 12:30

12:45 12:45 12:45

1:00 1:00 1:00

1:15 1:15 1:15

1:30 Nesta Anne 1:30 1:30 Brian Bruni

1:45 Glenn John 1:45 Fred Nates

- double appointment

1:45

2:00 2:00 2:00

2:15 Stuart Brians 2:15 2:15

2:30 2:30 2:30

2:45 2:45 2:45


Self-Review

Chapter 1 - True and False Questions Medicare True or False

1. Medicare is public health insurance for Australian residents

2. Medicare provides health care to all Australians according to their ability to pay

3. Medicare covers all health care needs of Australians

4. Medicare funds hearing services

5. Medicare is funded by all taxpayers

6. Medicare is funded by the Medicare Levy and Medicare Surcharge

7. The Medicare Surcharge is 1.5% of a taxpayers income

8. The Medicare Surcharge is reduced to zero for taxpayers with private health cover

9. The Medicare Levy is reduced to zero for taxpayers with private hospital cover

Scheduled Fees

10. All items that attract a Medicare benefit have a schedule fee

11. The Department of Health and Aging manages scheduled fees

12. The schedule fee determines what a doctor charges for a consultation

13. A doctor is obligated to bill according to a schedule fee

Professional Attendances

14. A professional attendance is a consultation by a specialist doctor

15. Professional attendances attract a payment of 100 percent of the schedule fee

16. An item number determines the benefit received

17. A professional attendance can only occur on a weekday during business hours

18. The complexity of the consultation has no impact on the item number

19. Some professional attendances are commonly known as Level A, B, C and D

20. A professional attendance of at least 40 minutes with an extensive history is known as a Level D consultation


21. An obvious problem with a short professional attendance is called a Level B consultation

22. Level B consultation is the most common professional attendance

Benefit of Schedule Fee

23. An out-of-hospital medical service renders 85 percent of the schedule fee

24. 75 percent of the schedule fee is payable for services provided to public patients in a hospital

25. Professional attendances by a GP receive 100 percent of the schedule fee

26. For an out-of-hospital medical service with a schedule fee of $200 the patient will receive $150 from Medicare

27. For an in-hospital medical service, a patient will receive $75 for a service with a schedule fee of $100

28. If a patient sees a specialist in hospital, and then another specialist out-of-hospital they will incur the same reimbursement from Medicare for each medical service

29. A Medicare benefit is based on the schedule fee and not the fee charged by the medical practitioner

Bulk Billing

30. A bulk billed patient incurs no out-of-pocket expenses

31. A medical practice who bulk bills, charges Medicare the schedule fee

32. A medical practice cannot bulk bill a patient and charge an additional fee for equipment used during the consultation

33. A medical practice cannot bulk bill some patients and then charge a higher fee for other patients

34. Schedule fees can be looked up online

Medicare Cards

35. The green Medicare card is the most commonly used card

36. The blue Medicare card is only to be used by residents in reciprocal countries

37. The blue Medicare card has a limited time period

38. Residents of reciprocal are covered under the yellow Medicare card for a maximum of 3-months


Chapter 2 – Process referrals to specialist practitioners


2.1 Check referrals to ensure validity

2.2 Follow correct procedures for referrals

2.3 File referral letters according to legislation and enterprise policies and procedures

Valid referrals (2.1)

What is a referral?

A referral is a written request for a patient to see a specialist, either for further

treatment, investigation, opinion, or management. A referral is necessary for a

patient to receive the specialist rate from Medicare. Without a referral they will

obtain a reduced GP rate from Medicare.

A referral may be written by:

A general practitioner to a specialist

A specialist to another specialist

An optometrist to a specialist ophthalmologist

A general practitioner to a consultant

physician.

A referral has a twofold benefit:

1. The patient gets to consult with the specialist or consultant physician.

2. The general practitioner and specialist can liaise regarding the patient’s

condition and treatment.


What types of specialists do patients see?

Patients will see a variety of specialists, all of whom require a referral. There are

many different types of specialists. Below is a list of some of the more common

specialists and which area they specialise in.

Specialist area Study of…

Cardiology The heart

Dermatology The skin

Endocrinology The glands and their secretions

Gastroenterology The stomach and intestines

Gynaecology and Obstetrics The female reproductive system (Gynaecology)

and pregnancy and childbirth (Obstetrics)

Haematology The blood

Immunology The immune system

Neurology The nervous system

Oncology Cancer

Orthopaedics The bones, muscles and joints

Ophthalmology The eyes

Paediatrics Children

Psychiatry The mind

Urology The urinary system


Activity 9 - Referrals

Which specialist area would patients be referred to if they had the

following conditions?

Physical condition Specialist area required

Cancer

Pregnancy

Stomach ulcer

Chronic eye infections

Scarring caused by acne

Schizophrenia

What makes a referral valid?

For a referral to be valid the following needs to transpire:

The patient needs to see the general practitioner to discuss the issues

which require a specialist referral.

The referral must be in writing (either handwritten or typed), and must

be signed and dated by the referring doctor.

The referral must be received by the specialist, in writing, before having

an appointment with the patient (or received on the day of

appointment).

The referral must be for a specific condition.

The referral must be for a specific period.


Chapter 3 – Prepare medical accounts for bulk billed and private

patients


3.1 Accurately follow procedures for billing based on account type

3.2 Identify and cost procedures which are not eligible for Medicare rebate

3.3 Select and complete appropriate account and billing documentation according to enterprise and legislative requirements

3.4 Follow procedures for preparing Veteran's Affairs, workers compensation and motor vehicle third party accounts accurately

3.5 Forward medical account to designated person or organisation according to legislation and account processing procedures

Accurately follow procedures for billing (3.1)

There are two billing options for a medical practice:

1. Bulk bill patients, so Medicare is billed directly, and the patient has no

additional charge

2. Bill the patient directly, at a higher rate, and the patient claims the

schedule fee back from Medicare.

A medical practice may:

Bulk bill all patients

Bulk bill patients with pensioner and health care cards

Bill all patients privately, at a higher rate.


Activity 14 - Medicare benefits

Should Medicare cover this?

Sean Johnson sees his doctor to have a chest cold treated. He also mentions his five

year old son Chris has the same symptoms and asks for antibiotics to treat his son’s

condition. Chris is not present at the medical practice. The doctor bills Sean a Level

B consultation and his son Chris a Level A consultation. Sean signs both Assignment

of Benefit forms himself.

Should Medicare cover both bills? ________________________________________

Is there anything wrong with this type of billing?

Activity 15 - Medicare benefits

Which of the following services attract Medicare benefits?

Medical service Yes No

Writing a report for a Life Insurance policy

Providing a medical examination for a taxi license

Administering a flu vaccine to a patient at the medical centre

Administering flu vaccines to employees at a local factory

A prescription received after speaking to the doctor over the

telephone

Breast implants as part of breast reconstruction, due to removal of

breasts caused by cancer

Breast implant surgery by a healthy woman in a private hospital


Activity 26 - Banking

You are performing the end-of-day close for Summerhill Medical

Centre. You need to tally the cash and cheques to prepare a bank

deposit slip. Cash and cheques for the day are as follows:

Cash

- Mrs Swanston $55.00

- Mr Douglas $65.00

- Ms Dean $45.00

- Mr Johnston $120.00

Cheques

- Joshua Jones (Westpac) $65.00

- Allianz Insurance (CBA) $147.15

- Transport Accident Commission(ANZ) $263.50

- CGU Workers Compensation (ANZ) $53.58

Complete both sides of the following deposit slip

$ummerhill Bank ABN 123 456 789

DEPOSIT

Branch/bank where CRAIGIEBURN

account is held Date: / /

For CREDIT of (account name) SUMMERHILL MEDICAL CENTRE

Cash: $ .

Paid in by (print name)

Cheques: $ .

No. Chqs

Paid in by (signature)

BSB number

733-053

Account number

65-3995

TOTAL: $ .

Details of cheques (proceeds may not be available until cleared)

Drawer (account name on cheque)

Chq no. Bank Amount Bank use only

100

50

20

10

5 Coin

Cash

TOTAL $


Conclusion

This workbook has provided you with an introduction to Medicare, item numbers,

scheduled fees and the Medicare Safety Net. It has provided you with an

understanding of the various funding sources for a medical practice, including its

referral procedures, billing practices, and the implication of GST for medical

accounts. This ensures you will have a basic understanding of the role of Medicare

and other government organisations and their funding procedures.


BSBMED302B Prepare and Process

Medical Accounts

Revision Sheet 1


1. Medicare

a. Medicare is funded by ______________________

b. Medicare provides _________________________health insurance to

Australian residents

c. Non-residents can / cannot use Medicare

d. The Medicare ______________ is ______% of income once your

income as a single person is over $84,000

e. The Medicare _______________ is ______ % of income once your

income as a single person is over $22, 828

2. Medicare Benefits Schedule

a. The Medicare Benefits Schedule is managed by

______________________________________

b. When you go to Medicare they reimburse a patient the

______________ _______________

c. A doctor can / cannot charge more than the schedule fee

d. Medicare pays ______% of the schedule fee for GPs professional

attendances

e. Medicare pays ______% of the schedule fee for out-of-hospital

services

f. Medicare pays ______% of the schedule fee for in-hospital services

g. Fill in the following chart showing the % of schedule fee a patient will

be reimbursed by Medicare

Service Fee Schedule

fee

% of

schedule

fee

Medicare

benefit

Level B $50.00

Out-of-hospital

service

$200.00 $100.00

In-hospital

service

$200.00 $100.00


h. Fill in the table below to show the missing details including item

numbers, their level, length of consultation, and schedule fee

i. What is the terminology used in Levels A - D to differentiate between

the complexity of consultations

Level Terminology

A

B

C

D

j. Name 5 features on a Medicare card

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Level Item

number

Length of

consultation

Schedule fee

36

D

5 minutes

$36.30


Answers to Self Review Questions

Chapter 1 - True and False Answers Medicare Medicare Safety Net

Qn Answer Your results Qn Answer Your results

1 True 39 True

2 False 40 True

3 False 41 True

4 True 42 False

5 False 43 True

6 True 44 False

7 False 45 False

8 True 46 True

9 False ..... /9 47 False ..... /9

Scheduled Fees Enhanced Primary Care Plan (EPCP)

10 True 48 True

11 True 49 True

12 False 50 False

13 False ..... /4 51 False

Professional Attendances 52 True ..... /5

14 False GP Mental Health Care Program

15 True 53 True

16 True 54 True

17 False 55 True

18 False 56 False

19 True 57 True ..... /5

20 True Net Medical Expenses Tax Offset

21 False 58 True

22 True ..... /9 59 False

Benefit of Schedule Fee 60 True

23 True 61 True

24 False 62 True

25 True 63 False

26 False 64 False

27 True 65 False ..... /8

28 False Medical Appointments

29 True ..... /7 66 False

Bulk Billing 67 True

30 True 68 True

31 True 69 True

32 True 70 False

33 False 71 True ..... /6

34 True ..... /5

Medicare Cards

35 True

36 False

37 True

38 False ..... /4

Chapter 1 Total ....../71

bsbmed302b prepare and process medical accounts

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