Set up Medicare Claiming

Hey, Damien here from Power Diary.

Today I want to take you through a walkthrough of setting up Medicare claiming. This is Medicare claiming for Australian businesses, not for US customers. So if you are in the US, this does not apply to you, this is for the Australian Medicare system.

Okay, so what I’m going to do is take you from start to finish. This is a free account. This is what the account would look like when you first start a trial and I’ll take you through each of the steps. The important thing to remember is you only have to do this stuff once.

Setting up Medicare

To start off with, what we’re going to do is click on ‘Tools’ and then go to ‘Medicare’ and you’ll see here, it says ‘Click here to apply’. When I click that and what it does is generate a location ID and you can see now, this location ID has been created. This will actually remain your location ID that you’ll use throughout. It doesn’t matter how many practitioners you have, you will use this location ID and it tells Medicare that you are linked to this account. You’ll also see here [‘Step 2: Complete a Medicare application’], a form. If you’re going to be processing Bulk Bills, click on this form, complete it and send it to Medicare. You can use the Medicare claiming in Power Diary without this form being completed but you cannot process Bulk bills. Medicare won’t approve them, you can submit them but you won’t get paid. So definitely make sure you complete the form here for any practitioners that will be using Power Diary, Bulk billing, and send it off to Medicare.

Account Setup

Okay, now let’s get straight into the account setup and what we’re going to do is ensure that Medicare is actually set up as one of your insurers. So we go into ‘Setup’ here and go to ‘Custom lists’. Just ensure that you actually click on ‘Insurers’ here and that you have Medicare listed here [under ‘Insurer name’].

Now depending on how you set up your account, by default, we’ll often add this to an account if we can recognise this an Australian account. But if not, you can easily add it by clicking on ‘Add insurers’. I’ll show you what it looks like here. It is the ‘Insurer name’, you will see a ‘Type’ here so if you are adding it yourself, just make sure that you select ‘Medicare Australia’, ‘Show on the invoice’ – yes and here ‘Medicare provider number’. This was just so if we are showing information on your invoice in relation to your provider number, we’re using the right terminology, so obviously for Medicare, this is correct! So just click on ‘Save’ if you haven’t already and then now you have it.

Setting up Clinicians

So now let’s set up your clinicians. So we’re going to click on to ‘Calendars’ and then we’re going to click on this calendar here. So this is Julie Talbot. Now, so if we click on Julie, we will open up Julie’s details and we’re going to click on here which is for ‘Insurers’ and we can see that there is no current insurance. Medicare is considered a type of insurer so what we do here is we just want to add this in for Julie. So here, we’re going to say the insurer type is Medicare, the service type, for instance, psychologists and will typically find it listed as ‘Specialist’ and now we’re going to add in a provider number. So here I will just make a provider number up. These two fields [‘Payee Provider Number’ and ‘Payee Provider Name‘], you can normally ignore. This is only if you want payments made to a different provider. Sometimes the principal psychologist or principal or practitioner in a clinic will have the money deposit into their account via their provider number. But, for the most part, people will typically have the provider number registered to a bank account with Medicare, so you don’t need to worry about that, and importantly we’re looking at where would you like this provider number to be used, for what locations.

Provider Number by Location

Here I’ve added a couple of the locations to this account so Essendon and Melbourne city. Now, you can either select ‘All’, it will default to that, or if this provider number is just for one location, all we needed to select is this location. So here, we’ll click on Melbourne and you can also have this be used for the default for all clients. I’m just going to click on ‘Yes’ for this [‘Default for all clients’] so it means that when you create a new client, by default it will set up a Medicare record in their profile, but it’s not essential. So I’m just going to add this [‘Save’ the information] and what we can see now down here [‘Insurers list’] is that we have this Medicare provider listed and we can see that the location is included there.

So let’s add another insurer. I’ll just close that off [‘Edit insurers’], you can see this insurer listed here. So now I’m going to add another insurer and this is for the scenario where we have a couple of different provider numbers. Now, we want another insurer for a different location so here we’ll select Medicare again and we’ll select the same details and now we’re going to add in a different provider number and this time for the location we are going to use, the other one. But this is just so that you’ll end up with … oh, well there you go, this is sort of some validation that has popped up to detect if the provider number is likely to be incorrect so that’s a handy thing to have had happened so I can show you. And now it is creating this record here so we’ll just close this now. It’s been saved and you can see that for this diary, for the psychologist, let’s say Julie, we have two different provider numbers that are recorded in the system for two different locations. And this becomes important, of course, because we know that Medicare requires different provider numbers to be used at different locations most of the time. What Power Diary will do is to take the location that you provide an appointment at and we’ll actually use the right provider number for that particular appointment. It just means that your claims go through the first time rather than having them rejected or having a problem in terms of claiming with the wrong provider numbers.

Setup Services

Okay, next I’m going to show you how to set up services. So we go ‘Setup’ and click on ‘Services’ and we’re just going to add a service here. We’ll call this, let’s say, ‘Medicare Standard’ and we’ll call this ‘50 mins +’. You can use whatever you like here in terms of the name, it won’t affect anything. But it’s helpful from a receipt point of view if you’re generating invoices that someone might be claiming manually for some reason, that you do have a name that Medicare would recognise but it’s not vital for a client claiming. This part is though! The item code, so this is the item number. Here we’ll put ‘80110’ as an example, don’t put anything else in there, just put the Medicare item number. That is the duration, I’m going to set to 60 minutes. It doesn’t matter, overall if it’s longer than this 51 minutes at a minimum that we have for this particular item number, 60 minutes is nicely rounded out. I mean you can put of course 51 or whatever length of session you have them here. We want to select the tax status for this service so this, of course, is tax-exempt and for the price here we’ll just put in $180.00.

Now a category. We don’t have any category setup in this account here but if you had a lot of services and a lot of products, you can actually set up categories to group them together and it just means they’re a little bit more organised. We keep ‘No’ this, for now, this [‘Active’] is just if you want to take a deposit on the client portal if someone was booking this online. We’ll ignore this for now. So I’ll just click ‘Save’ and you’ll see now, we have this Medicare service and that we have an item number listed, we have a price limit, a status and we are good to go.

Setting Up a Client Account

Next up, I’m going to set up a client and to show you how this works. So we’ll just pinch one of these clients that came with the account here. Let’s take John Smith and you’ll see here that John already has a Medicare field here ready to be completed. This is where we add John’s Medicare details. So I’ll just add-in, let’s say, my number here. This is not a real number but hopefully, we can still get it. There we go, you can see it turned red so that just means that it detected it was not the right format, I had one too many letters in there. So then we’ll put in an expiry date as well and we’ll click ‘Save’. So this just records a Medicare number here for John.

Now let’s say for instance you found that there was no Medicare field here so there are circumstances where a client profile can be created perhaps before you would set up Medicare and therefore you may not have a field here for each one. You can actually fix that by just going to ‘Billing’, ‘Insurance’ and you can add insurance here so you can see Medicare is there because I just added it but we could also have a different insurer. So for instance, if they also had private health and so forth, they could have those details here and adding new insurance. If you are missing their Medicare field, that’s where to find it. While we are in this client, what I’m also going to do is add in a referral because we know, in most circumstances, Medicare requires a referral. So we’re just going to click on ‘Profile’, ‘Referrals’ and we’ll add a referral. Now I have cheated here and I have added a referrer, so a GP. Now if you were setting it up yourself from scratch, you can just go to ‘People’ over here on the left, ‘Create’, and ‘Referrer’. You can actually have had a referrer directly here. But we’ve obviously added one in for time-saving purposes here. We want to add in the start date of the referral and this is usually the date that the GP either processed a mental health care plan if that was the case but usually the data of the referral, the Medicare plan is fine. So here we’re just going to put April as the end date. We normally put in approximately but of course, it can be longer or indefinite. We’re going to say this is the default [‘In Default’ toggle button] and we want to show this on the invoice print [‘Show on invoice print’ toggle button] and we’ll click ‘Save’. So what we’ll see now, is that this client, let’s close this to give us some more space, you’ll see here we now have our referral listed for this patient.

Submitting a Claim

Okay, next up I want to show you how to make a claim. So this sort of information, you really only need to do once and we’re now going to see how it all works. So we click on the appointment, we get the appointment panel here and we want to add the service that was provided. We can see, the new service that I added here is appearing as ‘Medicare standard’ and I’m just going to click on ‘Save’ to show you something because it’s actually going to generate an invoice. Now for most circumstances if you’re claiming with Medicare you’re going to do it electronically obviously with Power Diary.

There might be circumstances where you want to provide an invoice and the person can take it to Medicare. So I’m just going to click on here [pen icon to edit invoice] for ‘Edit invoice’ just to show you what this invoice looks like behind the scenes and you can see here [‘Invoice #1’] that we actually have the referral attached. We can see that it’s linked to Medicare and that we have the details here. So we have a Medicare sent item, you know, the item code, we have the amount, and so forth. Now we can add a payment here [‘Add payment’ on ‘Invoice payments’] or we can add it on the main screen. But it’s going to show that it has all this information on here and if we were to print, it creates a PDF of it. What you’ll also notice is that we have here [‘Provided by’] the Medicare provider number for Julie. So for the psychologist, I provided this in a circumstance, we can see we’ve got the details there and this is actually a compliant Medicare invoice because it has the item number, it has the date the service was provided, it has the payment status, the GST status. It also has the referral details, all automatically included, so the GP that made the referral, the referral date and period, the provider number, and the address. Everything that we need to include is there.

We also have details about who the service was provided to and what appointment date that was. So we actually have everything that we need to submit this to Medicare if it was being done the old-school way and the actual invoice was being sent in. One thing I’ll just show you though whilst we are on this here and I’m just going to close out this invoice and go back. I’m going to move this appointment across, I’m just going to slide it across [from Monday to Friday, from one location to another], to demonstrate something. And what I have done here, you can see it says ‘You have selected a time rostered at a different location. Would you like to update the location of the appointment?’, so this is the system detecting that the roster, you can see that blue and the white reflects two different locations that Julie works across. So let’s say John had the appointment at a different location and now if I go to print the invoice so I’ll just click the print here. What you’ll see is that now Julie’s provider number has been updated to the correct provider number for that location. So you don’t have to muck around with modifying and changing provider numbers. It will always select the right one based on the location of the appointment and it all happens automatically.

Okay now, back to submitting a claim. So we have added a Medicare service and now you’ll see this little ‘M’ over here for Medicare. We’re going to just click on that and you’ll now see that we have a few options here. So we have a DBA option, so the Department of Veterans Affairs, that operates in a very similar way. So I won’t go into that now but if you’re providing DBA you’ll know a bit about it. But here, we’re going to focus on creating a patient claim or create a bulk bill claim. In the mean on the way your practice is set up, it will depend obviously on which one you click here [‘Medicare Invoice Claims’]. If we go to Create Bulk Bill Claim, what you’ll see is that it populates all the information that is required for this claim, puts in the details, puts in the service amount. Now you can see the charge amount here is more, of course, than what Medicare will pay. That won’t matter in terms of the way Medicare see it. However, it would be worth editing the charge amount in the invoice, otherwise, you’ll end up when this is paid, it will still end up showing as money outstanding. So what we typically suggest is that you create different services or whether it’s Bulk billed or whether it’s the full amount. By creating different services, it means you just select that this is Medicare bulk billed or Medicare standard and then you don’t need to be filling around changing the amounts each time.

So I’m just going to go back here for now and not submit this and just show you what the patient claim looks like. You can see that it’s almost identical, although you’ll see here, it says: ‘Account is fully paid: NO’. Now, this is highlighted because it means that if you were to submit this, the rebate is going to go to the clinician but of course via a cheque to the client as I’m sure you’re aware of. So what we wanted to do, is make sure, however we can, that your invoice is marked as paid now. You don’t have to, of course, if you’re happy to accept the cheques being sent to the client and then submitted to you, that’s fine. But we find that most people don’t, so what I’m going to do here is just indicate that this has been paid and a select ‘Cash’ so now this is paid all. Now goes to select the claim again, ‘Create a patient claim’. You can see now, the account is fully paid, that means, you’ll collect the money from the patient and now the patient is going to get the rebate amount sent to them. So all this information is prefilled, you don’t need to touch anything. All you need to do is click on ‘Send’ and that will submit it to Medicare.

Now I won’t submit this one because obviously I’ve entered a lot of fake details here and I don’t want Medicare contacting us and asking what we are doing. But if you just click ‘Send’, you’ll get a confirmation message to show that the claim has been submitted. Usually, the patient will get the claim back fairly quickly from Medicare. They do vary slightly but it’s usually overnight in most circumstances.

That is all you need to do. If we had submitted this, you would actually be able to see the claims here if we clicked on [‘All claims for this invoice’], you should actually see a list of all the claims that have been launched for that particular invoice. Let’s say, you did happen to launch one and it was rejected for some reason, then you’d have an opportunity to relaunch it multiple times so you can correct something and then relaunch it again.

Submitting a Claim for a Minor

Okay, a couple of quick tips and questions that we get asked and really this comes down to how you would manage when you’re providing Medicare services to a minor. We know that Medicare doesn’t want to pay the rebate, of course, to a minor. They would rather pay it to the parent or guardian. So let’s imagine here, we’ll go in and we’ll say that Mary Lee is the minor. Now what we can do here is actually add a contact. So if we have a contact here, now I’m going to say that John Smith is the [father] and here [‘John Smith is the …. of Mary Lee’], I’m going to select the relationship, it will say ‘John Smith is the father of Mary Lee’ so this has established the relationship between them.

If John was not an existing client, you would see on that previous screen that there is an option to add, of course, a new contact who was not already in your system. But the only thing about this example is that John already has a Medicare profile in Power Diary. If John didn’t have a Medicare profile, let’s say as a new person you’re adding as a contact, you can just make sure that you had the details here – to reflect that. This way you can actually record this here and make sure that this person is utilised when we are doing a claim. So you can see now that this relationship is set up and then when claiming, you now have the option to select John as the claimant, so John is the father.

Check Status of Claims

Okay, that’s about it I think for now. I think that sort of gives you a quick overview of the claim processing and how to get everything up and running. The final thing to say is that when you want to go back and check the status of claims, we just click on this Medicare, so ‘Tools’ and ‘Medicare’ button. What you’ll see here is information and now you see this table is empty because we haven’t submitted claims but you’ll see the status of different claims. If you’ve been batching bulk bills and so, if you’ve been batching them to submit at the end of the day, you can go through and you can submit all of those.

Alternatively, if you wanted to check what bulk bills have been paid, you can have a request for a bulk bill payment status report, then we’ll get all the information back for you. And, of course, you have a bunch of filter options here if you’re trying to track down something in particular. So if you wanted to narrow down, look at a provider particularly, over a particular date range and so forth. So lots of stuff that you can do here. We’ll likely make another video with how to use this dashboard at a later time. We’ll just need to use one with a lot of data in it from a Medicare account. In other words, an account that Medicare knows is fake so that we can show you that without getting ourselves into any strife.

Help Centre

Okay, I hope that is helpful. If you go to our help section [in the main menu], click on ‘Help’, you’ll see this [‘Instant Answers’] here and you can always search here [Search box], so we’ll have lots of help files that we just type in Medicare, you will find that we have a whole bunch of articles on Medicare, including how to check claim statuses and troubleshooting and the different error codes you might get and so forth. So if you’re looking for anything then, you’re usually better to find it and the knowledge base or, of course, you can click on this ‘Ask here’ and you can ask one of our team either by a chat if it’s during our chat hours or if it’s after hours you can send us an email.

All right, I hope that’s helpful if you have any questions do let us know. Thank you!