Medicare + Gap

  • 2
  • Question
  • Updated 5 years ago
  • Answered

Is there a way to bulk bill a Medicare payment & process
a patient gap under the same consultation?

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Posted 5 years ago

  • 2
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Rae-Ellen Graham

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When our medicare claiming software was installed I asked the trainer if this could be done and she said it's legally not allowed under Medicare to bulk bill and then charge a gap.  If you want to charge a gap the patient has to pay first and then get the medicare rebate.  We used to only be able to do this on our EFTPos machine which meant we couldn't do it for patients who don't have a card. Now we have medicare online which is much faster & easier because the rebate goes into the pt's bank account and most of them now have a bank account linked to Medicare.
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Cath Gomboc

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We have two item codes.  One for the gap and then the medicare EPC goes direct through the software. 
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Andrew, Community Manager

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Official Response
Hi Diane

Rae-Ellen is correct, you are not allowed to claim under Bulk Bill if you are charging a gap.

For more information please see the official Medicare 'Bulk Billing - Frequently Asked Questions'.
What is bulk billing?
Bulk Billing is when a provider bills Medicare directly for any medical or allied
health service that the patient receives.

Where a provider and a patient enter into a bulk billing arrangement, the:
  • Provider accepts the relevant Medicare benefit as full
    payment for the service, and
  • Patient assigns their right to a Medicare benefit to the servicing provider, allowing the benefit to be paid directly to the payee provider
If a practitioner bulk bills for a service, the practitioner undertakes to accept
the relevant Medicare benefit as full payment for the service. Additional
charges for that service cannot be raised
I hope this helps.