The medical billing process helps healthcare providers get paid for the services they provide. It starts with recording patient details and ends with receiving payment from Medicare, a health fund, or the patient. Each step needs to be correct to avoid delays or rejected claims. For individual practitioners, understanding how this process works can make billing easier to manage. It also helps keep records in order and makes it easier to track payments.
1. Collecting Patient Information
The first step in the billing process is collecting accurate patient information. This includes the patient’s full name, date of birth, Medicare number, address, and contact details. It is of utmost importance that these records match what is stored with Medicare or the private health fund. If there is a mismatch, such as a spelling error in the name or an outdated Medicare number, the claim may be rejected or delayed. For this reason, it’s helpful to ask patients to confirm their details at each visit.
Regularly checking and updating records helps prevent problems later on. This is especially important for new patients or those who have not attended for a long time. If a patient has recently changed their name, address, or Medicare details, this should be updated before billing. Having correct and complete information at the start sets a strong foundation for the rest of the billing process. It also helps reduce the need for follow-up or resubmission of the claim.
2. Recording the Service Provided
After the appointment, the healthcare provider should record what took place during the visit. This includes the reason the patient came in, what service was provided, and whether any procedures were done. Writing this down clearly helps when choosing the correct item number for billing. It also provides support if Medicare or a health fund asks for more details later.
The notes should be accurate and reflect what actually happened during the consultation. This helps other healthcare providers understand the care given if the patient returns or sees another practitioner. Including the time spent, any findings, and advice given can be useful for both medical and billing purposes. Keeping clear and detailed records also helps if the billing is reviewed or audited later.
3. Assigning the Correct Item Number
Each medical service that can be billed has its own item number listed in the Medicare Benefits Schedule (MBS). Choosing the correct item number is important because it tells Medicare what service was provided and how much can be claimed. If the wrong item number is used, the claim might be delayed, paid at the wrong rate, or not paid at all.
To avoid these problems, it is helpful to check the most recent version of the MBS. Some item numbers have specific rules, such as how long the service must take or how often it can be billed. Understanding these rules helps make sure the claim is valid. Taking a few extra minutes to confirm the right item number can prevent rework and delays later on.
4. Preparing and Submitting the Claim
Once the service has been provided and the correct item number chosen, the next step is to prepare the claim. This means entering the patient’s details, the item number, and the date the service took place. The claim is then sent to Medicare, a private health fund, or the patient, depending on how the billing is set up. Most clinics now use electronic systems to submit claims, which helps save time and reduce paperwork.
It is best to send claims as soon as possible after the service. Waiting too long can lead to delays in payment or missed deadlines. Sending claims promptly also helps keep track of which services have been billed and which still need to be submitted. A simple and organised process can make this task easier and help keep payments coming in on time.
5. Payment and Reconciliation
After the claim is submitted, payment is made by Medicare, a health fund, or the patient, depending on who is responsible. Electronic claims are usually paid faster than paper claims, but the time can still vary. Once the payment is received, it’s important to check that the amount matches what was billed.
This process is called reconciliation. It means comparing the amount paid with what was expected for each service. If there are missing payments or differences in the amounts, these should be checked and followed up quickly. Keeping clear records of payments helps make sure that nothing is missed and that all services are billed correctly. This supports good financial management for the practice.
6. Following Up on Rejected or Unpaid Claims
Sometimes, a claim might be rejected or not paid. This can happen for several reasons, such as incorrect patient details, the wrong item number, or when the service is not covered by Medicare or the health fund. When this occurs, the billing team usually receives a message or report explaining the issue.
It’s important to review this information carefully, correct any errors, and resubmit the claim as soon as possible. In some cases, extra documents or notes may be needed to support the claim. Regular checks for unpaid or rejected claims can help reduce delays and prevent loss of income. Having a clear process in place to track and follow up on these claims can make the task easier to manage.
7. Keeping Records and Monitoring Claims
Keeping clear records of submitted, paid, and unpaid claims is an important part of the billing process. Simple logs or tracking systems can help identify issues, such as claims that are often rejected or services that are not paid in full. Noticing these patterns early can help improve billing and reduce mistakes in the future.
Regularly checking claim records also helps make sure that no services are missed or forgotten. It supports routine reviews of billing activity and can be useful for meeting reporting or tax requirements. Staying organised with claim records helps healthcare providers keep billing accurate, up to date, and easier to manage over time. This can support both business operations and patient services.
Why Choose Medbill for Medical Billing Services in Australia
Medbill has been supporting healthcare providers across Australia since 2008. The company works with individual practitioners, specialists, and healthcare facilities to manage billing tasks in line with Medicare and private health fund rules. Their experience covers a wide range of specialties and billing systems used in both public and private settings.
The team handles the full billing process, including claim preparation, submission, and follow-up on unpaid claims. They stay up to date with changes to Medicare item numbers and billing guidelines, helping reduce common errors and support accurate claim management. By managing these tasks, healthcare professionals have more time to focus on patient care.
With over $1 billion in claims processed, Medbill brings extensive knowledge of medical billing in Australia. Their services are designed to support faster payments, reduce the number of rejected claims, and promote consistent billing practices. This helps maintain steady income and supports compliance with relevant standards.
