Newsletter – December, 2010


This is our last newsletter for 2010. It’s been a great year for us at Synapse, expanding our services so we can offer you more ways to streamline your practice.

Our new medical transcription service, Just Your Type, was introduced early in the year and already we have doctors telling us they don’t know how they survived without it.

Synapse has also partnered with the Private Practice, a group that assists doctors with the business of being in practice. I’ve been giving talks on medical billing at their seminars and most recently spoke to the ophthalmologists and the dermatologists. At one of those talks, an issue relating to bulk billing was raised, and I’ve addressed it in the article below.

Thank you for your business, your great feedback and your good humour in 2010.

I’m looking forward to being back in touch with you in 2011 but until then, enjoy the festive season and I hope you find the time for a well-deserved holiday!

Margaret Faux

Bulk Billing Blues

Most doctors know how and when they can bulk bill. I did, however, come across a recent example of one who was unclear about some aspects of the system. I’m sure that all Synapse clients know the drill, but thought I should alert you to a practice which is an incorrect interpretation of bulk billing…

In the outpatient context, excluding workers compensation, third party and veterans, there are only two types of claims:

  • Patient claims
  • Bulk billing

There are three patient claim options. The first two involve the patient paying the full amount of the bill on the day of service so the doctor receives their due immediately. Then, once the patient is issued with a receipt, they may go to Medicare and obtain reimbursement for 85% of the schedule fee for the service and they will be out of pocket for the remainder. Some doctors offer to transmit the claim online to Medicare for their patients. In these cases, Medicare will automatically send out a cheque to the patient or deposit the rebate directly into the patient’s account.

The third patient claim option is where the doctor agrees to accept just the gap amount from their patient, foregoing immediate payment of the Medicare-covered portion of their bill. In this situation, the doctor transmits the claim to Medicare.

Patients like this option because they only pay the gap and are never out-of-pocket for the portion of their medical costs which are covered by Medicare. They also don’t have to wait in queues to reclaim their entitlement or wait for a cheque to appear.

For the doctors who have accommodated their patients, it’s much less than ideal. This is because even though they are entitled to the payment from Medicare, reimbursement will come as a cheque, made out to them, but mailed to the patient.

The doctor relies on the goodwill of the patient who, having already received their medical service, may have no need to visit the doctor again – save for the delivery of the cheque. If the cheque is not presented within 90 days, the 90 day doctor cheque scheme will automatically come into operation.

However, prior to the 90 days lapsing, some patients have managed to deposit the cheque, made out in the doctor’s name, into their own bank accounts. Clinic staff who ring Medicare enquiring about the delay are then advised that the cheque has already been presented!

Even when patients do the right thing and forward the cheque to the doctor shortly after they receive it, there has still been a couple of weeks delay before the money is in the doctor’s account, plus the administrative chore of getting it there.

It seems that a few doctors have been inadvertently issuing a separate invoice to the patient for the gap, calling it a ‘non-claimable item’ or ‘balance’, then bulk billing the claim to Medicare. Whilst this method allows for them to be paid instantly and directly by Medicare, it is inconsistent with the provisions of the MBS and the relevant legislation. Because when you bulk bill, there is no gap and no balance.

The law states that by offering bulk billing to your patient, you have waived the right to any further payment for that service other than that provided by Medicare. And whilst you are free to set your fee for your professional services, if you wish to charge a gap, then you must use one of the three patient claim options above.

And of course patients are forever putting in receipts to Medicare just to see if there is something they might yet claim on them. It wouldn’t be too hard for Medicare to marry up a ‘non-claimable item’ receipt with a bulk-billed one for questions to be raised…

We’ve got mail

Clients who have gmail accounts may have experienced delays in confirmation that we have received their files. This is due to a glitch in the server which hosts our website and we’re hoping it will be fixed up soon.

We are having no problems receiving files: if you sent it, we’ve probably got it. However, in the meantime, if you do have a gmail account and have any concerns, please login to Synapse and check the status of your file.

The Private Practice kicks off in 2011

‘Why Most Medical Practices Don’t Work and What to Do About it’ is the title of a one-day seminar being hosted by the Fintuition Institute, the group behind The Private Practice.

Even if your practice works efficiently, the seminar will likely offer some ideas about making it work better. I would encourage you or your practice manager to attend.

Michael E. Gerber, bestselling author of The E-Myth Physician, will be talking about freeing doctors from the tyranny of juggling patients, hiring, firing and the day-to-day pressure of business.

He will be joined by David O’Callaghan, senior financial adviser, who will discuss effective investment strategies for medical practitioners, and Steve Macarounas, Director of the Fintuition Institute, who will unveil their educational program for 2011

The seminar is on Saturday February 12, 2011 at the Sydney Convention Centre and costs $550. An earlybird discount of 10% applies to bookings before December 23.

Click here to book now.

Christmas closures

The Synapse office will be closed from 5pm, Thursday December 23 to 9am Tuesday January 4. However, our services will continue as follows:

Please send through your billings as usual. If you upload via the website you will continue to receive automated emails confirming receipt of your files, but your files may remain as ‘new’ and appear not to have been actioned until business resumes. If you do not use the website, we will send all confirmation emails after we re-open on January 4. We will process some billings over the break to help us to clear the backlog when business resumes and ensure that your cash flow is not interrupted for too long.

Just Your Type
This service will continue as usual throughout the Christmas period. The only minor delay may occur for transcriptions uploaded after midday on Thursday December 23. These files may be delayed until Tuesday December 28.

Reports and accounts
Like the tax office, we’re giving you a break from reports and accounts in January and will send out both December and January reports and accounts in the second week of February.

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