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Document last updated on: 29/10/2019

Medicare Easyclaim User Guide

Sections in this Medicare EasyClaim User Guide.

1

Overview of SaaS Medical Systems integrated Tyro Medicare Easyclaim

2

SaaS Web Setup and Configuration

3

Tyro Easyclaim - Bulk Billing

4

Tyro Easyclaim - Patient Claims (Fully Paid)

5

Tyro Easyclaim - Patient Claims (Part Paid and UNPAID)

Overview of SaaS Medical Systems integrated Tyro Medicare Easyclaim

Medicare Easyclaim is used for Medicare Bulk Billing and Patient Claiming
Medicare Easyclaim provides a secure connection through your Tyro EFTPOS terminal to transmit bulk bill and patient claims to Medicare.

Depending on your practice, you may prefer the Medicare Easyclaim integrated solution. Financial institutions developed this solution with software vendors. The integrated solution connects your EFTPOS terminal with your software. This allows practices to combine Medicare Easyclaim and Medicare Online functions for a fully integrated solution. Integrated Medicare Easyclaim is available for doctors, specialists and allied health professionals.

Patients can claim their Medicare benefit and have it paid into their bank account

through your practice’s EFTPOS terminal.

If you are using it for patient claims, you can start lodging claims for your patients once your Tyro EFTPOS terminal is installed.

For bulk billing, you’ll need to register your bank account details first.

Medicare Easyclaim is simple to adopt, requires minimal training and is easy to use.

You can use it 24 hours a day, 7 days a week. Your patients will receive their benefit almost immediately after swiping their EFTPOS card.

Key features of Medicare Easyclaim

Can be used for patient and bulk bill claims
No batching or storage required for bulk bill claims
Single payment for health professionals bulk bill claims in 2-3 working days, direct into a nominated account
Patient claims paid almost immediately into their bank account
More certainty with ‘pay doctor’ cheque - speeds up the process by lodging claims on the spot
No additional bank transaction fees, although standard EFTPOS charges still apply
Concession verification - instant confirmation of patients’ concessional status
Available to doctors, dentists, specialists and allied health professionals

Things that can't be claimed through Medicare Easyclaim

Some medical services can't be claimed using Medicare Easyclaim. These include:

services for veterans, Department of Veterans' Affairs claims
childhood immunisation, Australian Childhood Immunisation Register information
in-hospital services
complex pathology

These services can be claimed using other claiming channels, such as Medicare Online.

Allied health professionals, dentists and dental specialists

Allied health professionals, dentists and dental specialists can use Medicare Easyclaim and Medicare Online to submit bulk bill and patient claims.

Allied health professionals include:

Aboriginal Health Workers
audiologists
chiropodists
chiropractors
dentists
dental specialists, non-Medical Benefits, Dental Practitioners, Advisory Committee
diabetes educators
dieticians
endodontists
exercise physiologists
mental health workers
occupational therapists
oral medical and pathology practitioners
orthodontists
osteopaths
physiotherapists
podiatrists
psychologists
prosthodontists
paedodontists
periodontists
social workers
speech pathologists

Patients' bank account details

The patient simply swipes their Medicare and EFTPOS cards through your EFTPOS terminal and the information is automatically sent. You are not required to collect a patient's bank account details.

Patient privacy

Patient privacy is protected. All information sent via EFTPOS is encrypted and sent through a secure network. As part of the accreditation agreement for Medicare Easyclaim, financial institutions are not permitted to collect, store or use any health claiming information.

Helpful tip when using Medicare Easyclaim

allied health professionals must ensure they have a Medicare provider or registration number before transmitting claims
for a patient to assign their benefit for bulk bill claims, it is a legal requirement to press OK on the EFTPOS terminal, or to sign an approved DB4 form if the EFTPOS terminal system is unavailable
bulk bill claims transmitted and assessed for payment by 5:30 pm Australian Eastern Standard Time will be paid in 2-3 working days for health professionals who have bank details registered with us
health professionals need to have their bank account details lodged with us to receive bulk bill payments
a general practitioner (GP) consultation and a diagnostic item or items can be transmitted in 1 claim, as long as the items are non-referred or requested services, and the servicing provider is qualified to perform those services
if the EFTPOS terminal times out or there is a communication failure, the practice should issue an account or account receipt to the patient or claimant to receive their benefit through Medicare Online, by phone or at a Medicare Service Centre
the AP override code, not duplicate service am-pm, is not required for Concession Entitlement Verification (CEV) items. For example, when claiming item 23 and CEV item 10990, it is not necessary to use the override code of AP for the CEV item
the AP override code should only be used when claiming a 2nd visit using the same item number for a patient on the same day, for example, item 23 is rendered twice on the same date of service at separate visits

Items not accepted through Medicare Easyclaim

in-hospital items
Australian Immunisation Register information
bulk bill claims more than 2 years from date of service
patient claims more than 2 years from date of service
time-duration-dependent items
notional charges, for example, a health professional has raised a total charge to cover a group of services
patient claims for pathology items, except Group 9 items
bulk bill pathology items that are self-deemed or Rule 3 exemptions
patient claims and bulk bill claims with non-standard referrals
items where the charge exceeds $9,999.99
GP multiple attendance items, for example, Medical Benefits Schedule (MBS) item 24, 35, etc
separate sites override, unless the item is listed under Restrictive override code in the 'General terms explained' list below
assisted reproductive technology services
claims requiring text

These items may be claimed through Medicare Online, by phone or at a Medicare service centre.

SaaS Web Setup and Configuration

Set the default Billing Mode

Default Opertor Mode set for General Practice usng Tyro Easyclaim as the default Medicare channel

Tyro Easyclaim - Bulk Billing

The Billing Process is identical regardless of the Medicare channel (Medicare Online and Medicare Easyclaim).

Note that the Medicare Online channel is always available with SaaS Medical Systems.

Also refer to the Medicare Online User Guide (which covers some aspects of Billing in more detail). The Medicare Easyclaim User Guide will point out differences in the workflow.

For an approved Bulk Billed claim:

Consultation details are entered in the Billing screen

The claim is transmitted in real time to Medicare Australia

A response will come back from Medicare asking “Do you accept the claim for $XX.XX?”

This question prompts practice staff to check to make sure that the number looks correct. If it doesn’t look correct, they can select ‘NO’, go back into the billing screen and add to/amend the item number/s. The practice staff press ‘YES’ to accept the claim.

A small receipt is printed from the Tyro terminal explaining what item numbers are being claimed and the patient is then asked the question “Do you assign your right to benefit?” This question appears on the Tyro terminal screen, and is also mirrored in the SaaS Web screen, so that Practice staff can prompt the patient to select ‘YES’.

Once the patient presses ‘YES’ on the Tyro terminal, the claim is submitted to Medicare Australia in real time.

A second receipt is printed from the Tyro terminal for the patient, explaining that they have just assigned their right to benefit for xyz item numbers.

On the SaaS Web screen, practice staff are asked “Would you like to print a Practitioner copy?” (Medicare states that these copies do not need to be kept, so we would advise Practice staff not to print them).

For a rejected Bulk Billed claim:

Unlike patient paid/part paid/unpaid claims, bulk billed claims are not fully assessed in real-time, they are only validated e.g. is the item number etc ‘valid’. This means that Practice staff will not get real-time rejections on bulk billed claims, they will need to continue to manage exceptions on the next day, as they do with Medicare Online claims.

Bulk Bill Easyclaim

Accept Claim and Assign your right to benefit dialogue

Tyro Easyclaim - Patient Claims (Fully Paid)

Procedure for Fully Paid Patient Claims

Consultation details are entered in the Billing screen.

Payment is taken from the patient – either via integrated EFTPOS or another method – cash, cheque etc.

After payment, the patient can choose how they would like their rebate, eg:

Direct Deposit: If they have registered their bank details with Medicare, they could be paid by direct deposit from Medicare (after 1-3 days)

Cheque: They could have a cheque sent out to themfrom Medicare

Go to Medicare Office: They could askfor the invoice and take it to Medicare for their rebate

Swipe Debit Card (Easyclaim): Or they could swipe a debit card through the Tyro terminal and have the rebate in 11 seconds (no need to register bank details)

If the EFTPOS Card/Easyclaim option is selected, practice staff would press one button in the PMS and all the claim information is sent through to Medicare, including the item numbers, date of service, doctor provider number, patient’s Medicare card number (and claimant if applicable)

A response comes backfrom Medicare approving the claim:

· The EFTPOS terminal screen will read “Claim approved. Benefit $XX.XX. Swipe EFTPOS card”

· The SaaS Web screen will mirror this message.

· The patient swipes their debit card, selects their account and enters their pin.

· The Tyro terminal prints an official Medicare receipt.

· A window should appearin the PMS letting Practice staff know the details of the transaction, eg. that the claim was approved, the cost of the consultation, the amount that was paid by the patient, the amount that was rebated to the patient.

· The Medicare rebate is paid back into the patient’s bank account in 11 seconds.

· The normal invoice printed through PMS is optional – users might opt to ‘save’ this rather than printing it.

For a rejected patient paid claim:

Consultation details are entered into invoice screen in PMS

Payment is taken from the patient – either via integrated EFTPOS or another method – cash, cheque etc.

After payment, the patient can choose how they would like their rebate, eg:

Direct Deposit: If they have registered their bank details with Medicare, they could be paid by direct deposit from Medicare (after 1-3 days)

Cheque: They could have a cheque sent out to themfrom Medicare

Go to Medicare Office: They could askfor the invoice and take it to Medicare for their rebate

Swipe Debit Card: Or they couldswipe a debit card through the Tyro terminal and have the rebate in 11 seconds(no need to register bank details)

If the EFTPOSCard/Easyclaim option is selected, practice staff would press one button in the PMS and all the claim information is send through to Medicare, including the item numbers, date of service, doctor provider number, patient’s Medicare card number (and claimant if applicable)

· A response comes backfrom Medicare rejecting the claim:

· The EFTPOS terminal screen will read “NO BENEFIT PAYABLE”

· A receipt will print from the EFTPOS terminal explaining no benefit was paid.

· A message should appear in the PMS showing both the error code and a description of the errorcode. Eg “9632: Duplicate Service already paid. If not duplicate, resubmit with appropriate indication”.

Depending on both the rejection code and how PMS/Tyro choose to implement this, practice staff may be prompted to print a normal invoice and ask their patient to go to Medicare, or the workflow might allow the practice to attempt to resubmit the claim.

Patient Billing - with Tyro Easyclaim billing mode

The Account Billing Type is Private

The Billing Mode is Tyro Easyclaim

Enter all billing items - then select Pay Now

Patient swipes or inserts Card - and enters PIN if required

EFTPOS transaction is completed

When the EFTPOS screen is closed - the Payments and Receipts screen is redisplayed showing the Receipt Total

When Completed is clicked - the Easyclaim transaction is initiated

When the Easyclaim transaction completes - the Tyro Medicare Easyclaim screen is displayed with the response from Medicare

Click on the "Click Here To Complete" button which updates SaaS Web records.

You can now either click View Detailed Response or Close if this is not required.

Detailed Response display

Tyro Easyclaim - Patient Claims (Part Paid and UNPAID)

Procedure for Part Paid and Unpaid Claims

For an approved Part Paid claim:

Consultation claim details are entered in the Billing screen

Payment is taken from the patient for the ‘Gap’ – either via integrated EFTPOS or another method – cash, cheque etc.

After payment, the‘Cheque’ option is the only available rebate option via Easyclaim (for a cheque to be sent to the patient that is made out to the Doctor).

Practice staff would press one button in the PMS and the claim is transmitted in real-time to Medicare Australia.

A response comes back into the PMS explaining that the claim has been approved.

A ‘Lodgement’ receipt is printed from the Tyro EFTPOS device explaining that the claim was approved.

A window should appear in the PMS letting Practice staff know the details of the transaction,eg. that the claim was approved, the cost of the consultation, the amount that was paid by the patient, the amount that was rebated to the patient.

The option to print a customer copy appears in the PMS.

For a rejected Part Paid claim:

A response comes backinto the PMS saying ‘No Benefit Payable’, this message will also appear on the EFTPOS screen.

· A ‘Lodgement Receipt’is printed from the Tyro EFTPOS device explaining that “Medicare has assessedthat no benefit it payable”.

· A message should appear in the PMS showing both the error code and a description of the error code.Eg “9632: Duplicate Service already paid. If not duplicate, resubmit with appropriate indication”.

· The option to print a customer copy appears in the PMS.

For an Unpaid Claim

Patient invoice details are entered into PMS

· The option to pay at another time would be selected.

· The rebate window appears - the only rebate option is ‘Cheque’ (meaning a cheque will be sent to the patient, but it will be made out to the Doctor).

· Once this claim istransmitted, all of the Medicare claim information is sent through to Medicare and Medicare will approve the PDVC claim in real time.

· An official Medicare receipt is printed, explaining that the claim has been lodged with Medicare inreal time.

· Medicare will then post a cheque out to the patient

· The patient brings this cheque back into the surgery and usually makes a payment at the same time

Payments and Receipts - Part Paid

Pay Gap with Tyro EFTPOS

Payment is taken from the patient for the ‘Gap’. You can receipt by other methods (cash, cheque etc.)

Shown here is receipting via integrated Tyro EFTPOS.

Just click on Pay Gap with Tyro EFTPOS to start the transaction.

When approved, you can print the Customer Copy if required.

Part Paid Patient Claim - APPROVED - PDVC - Pay Doctor via Cheque

Patient Claim Response from Medicare - PDVC - Detail Display

Patient Claims - UNPAID

Account Billing Type: Private

Billing Mode: Tyro Easyclaim

If yIf you NOT receipting from the patient (and the patient is claiming from Medicare) - the UNPAID claim can be submitted. If successful, Medicare will mail a cheque to the patients registered address.

If the Billing entry is complete - just click on [Continue] to start the transaction.