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REJECTED MEDICARE CLAIMS / BAD DEBTS

Discussion in 'Australia' started by surfboy, Dec 1, 2015.

  1. surfboy

    surfboy Active Member


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    Hi everyone,

    I bulk bill at one of my surgeries.

    The problem is, coming towards the end of the year, some patients have used up their CDM entitlement at other allied health professionals, e.g. physio or dietitian.

    I go to bulk bill the claim, and the claim rejects.

    I am then left to chase the $52.95 from the patient. I am getting resistance from some patients with respect to paying. Some of the older patients can't remember visiting other allied professionals and deny using their entitlement of 5 visits elsewhere, and then become aggressive when I have asked for payment. On said yesterday "Surely it isn't my responsibility to chase up Medicare!"

    My stock standard response has been for them to phone Medicare to see where they have used their 5 visits, and that they have an account outstanding of $52.95 to me.

    Surely others must be experiencing this problem. - What has been your approach to debt collection ???

    Many thanks
    SB
     
  2. jos

    jos Active Member

    Like I have said before - don't bulk bill, make them pay up front then let them claim their and deal with Medicare. It really annoys me that there is this 'free' mentality about healthcare- nothing is 'free' in this world.

    I have found over the years that the doctor will send them to the diabetes educator in their clinic then claim one EPC visit, with the patient being unaware that it is coming out of their quota.
    then they jump up and down when they don't get their 5th rebate with me.....but at least I have been paid for my work :) and funnily enough, they often produce a private health insurance card to claim.....
     
  3. JAYNES

    JAYNES Active Member

    We were having the same problem, get your reception or your self to check online with medicare it well tell you if they have any visits left, we usally do this day before they are due to come in. Call medicare they will tell you how you can check online.
    jaynes
     
  4. surfboy

    surfboy Active Member

    Thanks heaps Jayne. - Is it relatively easy to use the Medicare online site to check these details? I think it is through HPOS? Many thanks.
    Very frustrating!
     
  5. Paul Bowles

    Paul Bowles Well-Known Member

    This has and always will be a Medicare issue. Hss happened to us previously and is the reason we refuse to claim or bulk bill. Have had lengthy meetings with Medicare on the phone about the issue, explaining the problems. There is no way as a practitioner that you can reliably tell how many visits a patient has left. You must at all times have to rely on the ability of Medicare to update their systems which is fraught with problems.

    Our solution has been to get the patient to pay for the consult upfront and give them the paperwork so they can claim from medicare.
     
  6. JAYNES

    JAYNES Active Member

    Hi surfboy
    you have to contact medicare they well help you they help us.
    yes last message is right you can not see how many visits they have left but it will tell you if they have used all visits for that year.
    hope this helps
    jaynes
     
  7. williac

    williac Active Member

    Surfboy,

    The mistake your making is Bulk Billing in the first place. The Medicare EPC/CDM program was NEVER intended to be a bulk billed service. It was always meant to keep the out of pocket expense to the patient the same/similar as seeking care via the public system. Remember when this program was started the aim was to ease lengthy public waiting times - especially for high risk patients. Community health and hospital outpatient podiatry services are not free. There is always a small fee payed by the patient. People - check your HICAPS print outs. The scheduled fee (10962) is 62.25. This is the MINUMUM the government are telling us to charge for our service. The rebate to the patient is 52.95. This tells you there is meant to be a gap. You are cheating yourself out of 9.30 each consultation. Systematic bulk billing is ultimately eroding our professional autonomy - leaving many podiatrists reliant and ultimately subservient to the referral whims of GP's. It also sets a price precedence across the community. I have seen over the past 10 years this Medicare program as the primary cause of the decline in professional relationships in the podiatry landscape. Contemporaries becoming business enemies. Price wars between clinics - undercutting via bulk billing to win patients and curry GP favour. Companies moving into a dozen GP clinics without the staff to provide adequate service delivery and pressuring the doctors (or nursing staff who do the team care arrangements anyway) to refer in-house at the expense established local clinics etc etc. If we are to be a truly independent profession self reliance and a modern professional fee structure is imperative to our future. Discounting your service will not be viable long term. The costs of running a practice goes up every year. The BULK BILLING fee does not. It has not been raised for years. Be good at what you do. Be invested in your patients and your long term goals will have a far better chance of being fruitful.

    Regards,

    Chris Williams.
     
  8. Paul Bowles

    Paul Bowles Well-Known Member

    Jaynes you are ignoring a fundamental point of issue here - you are relying on MEDICARE to have their system up to date prior to you deciding whether or not you provide treatment or not - and hoping they have got it correct.

    This is a crazy solution to the problem as it only leaves you with two possible outcomes: 1) Pt can claim Medicare rebate 2) Pt can't claim Medicare rebate

    So the conundrum ensues. Pt "X" a Diabetic with vascular disease is in your waiting room or scheduled for an appointment and you check the medicare site wasting your staffs valuable time and resources. Pt "X" has used all their visits for the year.

    Do you:

    a) Tell Pt "X" a (diabetic with vascular disease and neuropathic ulceration which is why he is here to see you) - Sorry buddy Medicare says "NO" im not treating you

    OR

    b) See the patient knowing full well you have a duty of care but yu wont get the medicare rebate for it.

    Of course any morally correct and ethical practitioner is going to choose option "B".
    Where does that leave the practitioner?

    I still wonder how Podiatrists can "bulk Bill" patients getting a rebate of around $52. If you use a sterile pack of instruments APodC guidelines from a while ago (costs go UP not DOWN) state to sterilize a set of instruments costs around $22. Add to this consumables.....

    So in effect you are seeing a patient for less than $30?

    Now being pragmatic - if you are in a small clinic and have a receptionist and phones and other overheads and you dedicate 30 mins to each patient - you would be earning less than $60 per hour minus COSTS.

    I'm not sure you would be making any money. Of course you could short consult your patients to 15mins but i'm not sure even after almost 20 years of clinical practice I could thoroughly manage one of my diabetic patients in 15mins.....not without cutting serious corners anyhow!

    This argument should have been sorted by the organizations that be many many years ago....
     
  9. BEN-HUR

    BEN-HUR Well-Known Member

    I take it we are discussing the Medicare EPC program.

    We (Podiatrists) have a (important) job to do - treating lower limb conditions for the community... not (also) chasing up & worrying about entitlements, payments etc... We have enough on our plate to be not also bogged down with this stuff! Is it any wonder there is this thread (Burnout High Among Podiatrists) present on the forum.

    Shouldn't Podiatrists (in fact all entitled Allied Health providers) receive a Medicare EPC referral from the patient's G.P outlining the quotas the G.P has allocated to a Allied Health provider/service (which totals 5 visits per calendar year across the Allied Health board) i.e. 3 for Podiatry & 2 for Physio... or 5 for podiatry. If so (& the patient should/has to give you this form) I note the number of times they visit within their (patient) notes according to the allocated quota (i.e. 3 or 5 as per above example). I then inform the patient that they have received the last of the allocated EPC visits entitled for the year & state I will be writing a report back to their G.P. I'm sure such practice would/should be reasonably obvious to help avoid confusion on such above noted claim number issues.

    Another obvious practice is... DON'T BULK BILL... as well as DON'T PROVIDE A FREE SERVICE (sorry for the caps but it's important). We provide a valuable service but we (you) are not a charity (you have to make a living as well). You would also be surprised how the human psyche interprets free services - yes, usually (eventually) with disrespect (strange, albeit interesting)... which (evidently) looks to be happening in the above noted case... & has been my observation with some (not all) patients that I have been associated with under such (free service) environment (i.e. public sector).

    I (& we all should) write a report back to the referring G.P as well when a patient is on this program. Now this takes time & resources (i.e. printer, ink, paper, envelope, stamps)... in some cases it can take me nearly 30 min. to write the report... & a bit more time to post the report off. Now I sure as hell not going to provide my valuable (treatment) service for at least 30min, then carry out the above requirements of a report, as well as other associated expenses (as outlined in post # 8) for the stated amount of $52.95!

    Just yesterday I had a lady come & inquire about this program (could hardly speak English - whoops, can't mention such things these days)... wanting to know if I bulk bill & also send claim directly to Medicare (so she doesn't have to hand over any money). I said no & stated my fee & that she would then need to take receipt to Medicare to claim her entitlement. She questioned why... informed her of reasons... she sighed, rolled her eyes & walked out... I bit my tongue & went back to attending to patient.

    Then there are those who can claim on the Medicare EPC program then want to use their health fund to pay for the gap.

    Then there are others who want you to fudge the dates, item number claims etc... so they can get the most out of their health funds (but that's a different issue & another issue in itself).

    Frankly, we shouldn't have to deal with the above rubbish... in many cases it is rude & disrespectful... as well as time consuming & stressful! I have now got to the point where if patients intend/insist on pursuing such requests I advise there are other Podiatrists in the area to try such requests on.

    Hence surfboy, change your Medicare EPC billing policy... & inform your patients as to why the change (maybe put a sign in the waiting room)... reasonable people will understand... & those who choose not to... :boohoo:

    Just for interest sake... I went to the Cardiologist last week for a stress test (the treadmill kind)... was there for about 40 - 50 min. (heart performed well & she said it was "good looking" ;) )... was charged $650 (heart skipped a beat or two at that point)... received $347.55 from Medicare.
     
  10. dyfoot

    dyfoot Active Member

    When we stopped bulk billing several years ago, it saved us a lot of headaches and we got only a few complaints with the vast majority of our patients staying with us.

    Now, when asked about bulk billing, we simply state that we can't afford it and leave it at that!
     
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