Medicare Tutorial - Part 7: Bill to Patient - GAP Only

Medicare Tutorial - Part 7: Bill to Patient - GAP Only

In part seven of the Medicare Tutorial, you will learn how to process a Medicare claim using Bill to Patient - GAP payment only.

*NOTE: This process strictly relates to invoices and payments where the patient is claiming the rebate from Medicare. 
  
Bill to Patient - GAP Only means that while the patient is responsible for the payment of the whole invoice, they only initially pay for the GAP amount (balance after Medicare rebate). Once the patient claim is submitted and processed, Medicare pay the rebate amount to the practice account.

You can also bill to Head of Family with the GAP payment option.

The GAP payment option is not available for all services. GAP payments can only be processed once the claim has been submitted and then approved by Medicare. Claims for duplicate services in a single day, for example, would not be approved by Medicare for GAP payment, because claims for duplicate services (from the same clinic) do not get automatic approval, and may not be approved approved at all.

When a GAP claim is rejected by Medicare online, then the patient must pay the full invoice, using online patient claiming to apply for the rebate.

To process an invoice using Bill to Patient, navigate to the Accounts section of the patient record, and then click Invoices.



Click New Invoice to open the invoice form.


Complete the invoice with all the required details, and make sure that the Bill To field is set to Patient or Head of Family.

Adjust the Amount so it is larger than the MBS Item Rate. This will change the GAP amount.



Click the Print Medicare Claim tick-box to print a copy of the invoice with details of the rebate for the patient.

The Total is the total amount being billed to the patient, and the GAP is the actual amount they will be out-of-pocket after Medicare has refunded the amount covered under the Medicare Benefits Scheme.

Once you have completed the invoice form, click Quick Pay to reveal a set of quick payment options below.



Make sure the Online Patient Claiming tick-box is selected. Click GAP Amount and the GAP payment amount will automatically be calculated and added to the invoice.

Select the Payment Method and then click Pay and Claim to submit the claim to Medicare.



Once the claim is submitted to Medicare, it may take up to 10 or 15 seconds to process. The speed of processing claims is dependent on your internet connection, and the amount of claims being submitted to the Medicare server at that moment.

*NOTE: If you have enabled Medicare PCS (Patient Claim and Store) in your practice settings, and you process claims individually or in a nightly batch, then you will receive this message prompting you to store the message for processing later.

Once the claim has been processed, you will be returned to the patient record, where the newly created invoice will be visible in the Invoices list, where it listed as Partially Paid.



If you click the Payments tab, you will be able to see a record of the partial GAP payment of the invoice.



Lastly, if the GAP payment is not automatically approved by Medicare, you will receive a notification with a brief explanation as to why it was not approved. You will be prompted to invoice the patient for the full amount of the service, and apply for the Medicare benefit using Bill to Patient or Bill to Head of Family.

Here is an example of a notification a GAP payment was denied by Medicare, due to a duplicate claim of the same Item Code (23) on the same day.



This concludes part seven of the Medicare Tutorial.