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Document last updated on: 25/01/2024

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Software as a Service Cloud Practice Management

Special Note regarding User Guides

Patient Billing - Medicare Patient Claims - SAAS Desktop

Overview

Medicare Patient Claims

Ensure that you have select a Patient Account for Private.

If required you can Add a new Patient Account or Modify the existing Patient Account (this will also be dependant on standard procedures with your Practice).

Once you have entered the billing details - there are three available options for a Medicare Patient Claim.

You can [Print Invoice] for a standard Invoice.

You can click [Pay Now] to pay all or part of the Invoice amount,

If no payment is being made at this time - just click [Continue]

Pay Now

Payment details can be entered now, and a receipt printed if required. This example is a fully paid invoice.

Details of the Payment and Receipting process are covered in a separate User Guide.

[Continue]

The Medicare Online Billing screen is now shown.

Here there are two options presented for a Medicare Patient Claim.

Start Claim Process

This will send the claim now. No 'batching' is required.

As you are always online - we recommend this method. The response times from Medicare are normally no more than a couple of seconds.

Save Patient Voucher for later claim

This option allows patient Vouchers to be saved but not yet processed for Medicare claims. Vouchers added at a later time, later date, can subsequently be processed in a single claim.

Patient Claim Payment Instructions

Before sending the claim to Medicare - you will be prompted to enter the Payment Instructions including any temporary address and banking details.

Details of the Patient Claim Payment Instructions process are covered in a separate User Guide.

After any required patient claim payment instructions have been entered - the claim will be transmitted to Medicare.

Note that Patient Claims is a "real-time" process. If there are no issue - the claim will be paid - and the process is complete.

However - if there are any issues - you will receive a notification screen similar to the example shown here.

In this example - the claim has been marked with a status of MEDICARE_PENDABLE

The "Pendable" (MEDICARE_PENDABLE) status - just means that you have the option of referring the claim to a Medicare operator.

If you refer the claim to a Medicare operator - then the claim will has a status of "Pended" (MEDICARE_PENDED)

If you receive this notification screen, please carefully review any understand the issue before taking any action.

Firstly, click on View Detailed Response (see below)

In this example - the View Detailed Response screen (Patient Claim Response from Medicare) - shows that a claim for an Item 23 has an error code 9632 - Duplicate of service already paid. If not duplicate resubmit with appropriate indication.

The notification screen presents three options:

Refer Claim to Medicare Operator
Go Back to the Patient Billing screen and resolve the issues
Cancel Claim

Refer Claim to Medicare Operator

The claim will be referred to the Medicare operator for manual processing

Go Back to the Patient Billing screen and resolve the issues

You can go back to the billing screen and resolve any issues (e.g. in this case - use the Medicare Online Overrides facility set indicate that the service in not a duplicate (Not Duplicate Service - NDS)

Cancel Claim

Cancel the claim (e.g. it is a duplicate - the claim has been duplicated)

In this example - Refer Claim to Medicare Operator was selected.

The claim is then resubmitted to Medicare as a PENDED claim.