The Synapps MBS system allows you to submit multiple claim types in one billing list e.g. known gap, no-gap, patient claims and veterans. Just change the billing type for each patient. Or you can set defaults to be applied across and entire list. Up to you. Below are brief explanations of each billing type:
Patient – You can select this option for all billings, both inpatients and outpatients
If you select this option you will need to send the account to the patient directly. Privately insured inpatients will be entitled to a rebate equal to 100% of the Medicare schedule fee. Uninsured inpatients will be entitled to a rebate equal to 75% of the Medicare schedule fee, and outpatients will receive 85% of the schedule fee. Some GP services attract a rebate equal to 100% of the Medicare schedule fee.
If other payers are involved such as Veterans or workers compensation insurers, the patient may choose to submit the claim to that payer first to obtain available rebates before paying you. So please be patient! There will be inevitable payment delays if you choose this option, because it involves manual handling which you or your staff will need to manage. Obtaining prior Informed Financial Consent (IFC) is highly recommended and best practice if you are charging gaps to your patients. Contact us if you would like us to help you with IFC.
No Gap | WC – You can select this option for inpatients only
Select this option if you do not want your patients to incur any out of pocket expenses for inpatient services.
Once you have selected this option, the system will automatically apply a payer hierarchy algorithm to your claims. For example, if your patient has a worker’s compensation claim number then the claim will be directed there and not to other payers such as Medicare. If your patient has both a Veterans number and a health fund, the system will direct to the health fund, and so on. You can override if required.
All private health funds offer no gap schemes, but the rules and rates vary enormously. You will receive up to 150% of the Medicare schedule fee depending on the fund. It is a bit like bulk billing in that you are prohibited from charging any additional amount.
Known Gap – You can select this option for inpatients only
This a hybrid billing option permitted by most private health funds. Select this option if you are happy to accept a capped gap (on average $500) which your patients will pay. You must have arrangements in place for Informed Financial Consent if you chose this option – it is a legal requirement. You will receive the relevant no gap amount plus the capped gap. Contact us if you would like to discuss our IFC service.
If the app detects a Veterans patient in a Known Gap billing list, it will direct the claim to Veterans. If you do not want this to happen and want to instead bill the Veteran directly, you should instead select the Patient billing type (see above) for this claim. We recommend you also learn more about your rights and responsibilities relating to Veteran’s billing here https://www.aimactraining.com/shop/health-professionals
Medicare/DVA – select this option for outpatients when you do not want your patients to have a gap and will be bulk billing
You will receive the Medicare or Veterans rebate only and your patients will not incur any out of pocket expenses. You are prohibited from charging additional fees. Check out the bulk billing video in the app to see how you can bulk bill compliantly on your phone – pockets full of paper DB4 forms are history!
WC/TP – Select this option if you have regular outpatient workers compensation and third party lists. All gazetted rates have been uploaded to the system and will be automatically applied to your claim. However, if a different rate applies to your claim you can override the system anytime.
PLEASE NOTE: You must include the name of the workers compensation or other insurer, and the claim number, to enable these claims to be processed.
