What can i claim from medicare

what can i claim from medicare

On this page

Adjustments for omitted bulk bill incentive or Patient Episode Initiation (PEI) items

How do I lodge omitted bulk bill incentive or PEI items for a claim where the date of service is under 2 years old?

You can lodge a claim for the omitted bulk bill incentive or PEI item with a date of service under 2 years old through your electronic claiming facility.

You will need to transmit the same details as the original claim however you must only submit the omitted bulk bill incentive or PEI item. The original service item number(s) must not be included.

My practice management software only allows me to transmit Medicare bulk bill claims for a period of 6 months from the date of service. What should I do?

Contact your software vendor to update your software.

What if I am not able to submit the adjustment electronically?

Can I lodge omitted bulk bill incentive or PEI items for a claim where the date of service is greater than 2 years old?

No. From 2 June 2014, the department will not accept requests to add omitted item(s) to previously paid bulk bill claims where the date of service is greater than 2 years old.

Adjustments to a previously paid bulk bill claim

Can I adjust a bulk bill claim on the same day it has been lodged?

If you want to adjust a claim you lodged that day, you can contact the Provider Hotline on 132 150 (local call rates apply) and press option 2. This line is available 24 hours, 7 days a week.

Can I adjust a bulk bill claim lodged on a previous day?

If the claim has been processed and you need to change an item number or other details, that has a date of service under 2 years old, you need to submit a manual request for adjustment and provide:

All Assignment of benefit forms are available under Bulk Bill claim forms page or contact the Provider Hotline on 132 150 (local call rates apply).

Why do I need to complete a new Assignment of benefit form and get the patient to sign it?

If you request a change to any information for a previously paid claim, you are altering the original agreement entered into when accepting the patient’s assigned benefit(s).

Any change to a previously paid claim requires a new Assignment of benefit form, completed with the correct information and signed by the patient.

What if my patient can’t/won’t sign the new Assignment of benefit form?

You cannot request an adjustment unless your patient or a third party (including a parent, guardian or power of attorney) signs a new Assignment of benefit form.

Late lodgement of Medicare bulk bill claims

What is late lodgement?

The Health Insurance Act 1973 (the Act) states that a Medicare claim must be lodged with the department within 2 years from the date of service.

The Act also enables the Chief Executive Medicare (or their delegate) to consider applications from providers to extend this period having regard to all matters considered relevant including any hardship that may be caused to the claimant if a longer period is not allowed.

An application to extend the 2

year lodgement period is known as a late lodgement.

Can the 2 year lodgement period be extended?

The Chief Executive Medicare (or their delegate) will consider applications to extend the 2 year lodgement period where the servicing provider can provide evidence that:

  • demonstrates a serious personal issue or natural disaster prevented the claim from being lodged within the 2 year period from the date of service
  • if a longer period is not allowed it will impact the ongoing viability of the practice

The Chief Executive Medicare (or their delegate) will not accept claims which are late because of an administrative error.

Who can apply for late lodgement of a Medicare bulk bill claim?

The provider who rendered the Medicare eligible service can apply for late lodgement of their Medicare bulk bill claim.

Where the servicing provider is incapacitated or deceased, then the person who holds their legal authority, such as their power of attorney, can apply for late lodgement.

Where do I get an application for late lodgement from?

Applications for late lodgement of assigned Medicare benefits form can be requested by contacting the Provider Hotline on 132 150 (local call rates apply).

How do I apply for late lodgement of assigned Medicare benefits?

To apply for late lodgement, you must submit:

  • Application for late lodgement of a claim for assigned Medicare benefits form
  • Correctly completed original Assignment of benefits form(s)
  • Evidence to support the application for late lodgement detailing the circumstances preventing lodgement and evidence to demonstrate the impact on the ongoing viability of your business (for example, certified copies of bank statements or tax returns)

Applications and supporting documents must be submitted to:

Department of Human Services

Medicare Claims Section

PO Box 9822

in your capital city

The department will let know your application has been received within 5 working you days. The department will not assess incomplete applications.

If my application is approved, does that mean the claim will be paid?

No. Approving the late lodgement application means the department will accept the claim for processing outside of the two year claiming period. Late lodged claims are assessed in the same way as any other claim.

How will I know if my application for late lodgement is approved or not approved?

The Chief Executive Medicare (or their delegate) will notify you of the outcome of your application in writing.

How long will it take to assess my application?

It will take a minimum of 28 days for the delegate to consider your application. If further information is required, the process may take longer.

Is there an appeals process?

No. The decision of the Chief Executive Medicare (or their delegate) is final.

What legislation applies to late lodgement?

Section 20B(2)(b) of the Health Insurance Act 1973, advises the requirement to submit claims to Medicare within 2 years.

Section 20B(2)(b), subsection (3A) of the Health Insurance Act 1973. advises the requirement for the Chief Executive Medicare to consider applications to extend the 2 year legislative claiming period.

Some documents on this page may require the free Adobe PDF reader .

Last updated: 11 June, 2014

Source: medicareaustralia.gov.au

Category: Insurance

Similar articles: