Myth Busting, Medical Billing, The Private Practice magazine


Navigating the medical billing maze can be maddening, but dispelling five common beliefs helps to make sense of the system, writes Margaret Faux.

1. Simplified billing is simple
This is possibly the greatest misnomer in medical history. Simplified billing otherwise known as no-gap claiming, relates to inpatient services and is a system whereby the patient’s health fund contributes an amount above the Medicare schedule fee. It may sound simple but every fund has different fee schedules. There are different rates in different states and claims are regularly rejected for seemingly absurd reasons are no reason at all.

Put simply, simplified billing requires a dedicated person spending significant time each week on the phone chasing up rejected and incorrectly processed claims. So, if you don’t have many arrears from your no-gap claiming, then your billing staff are doing an excellent job!

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