International Patients & Overseas Healthcare: Billing and ePrescribing

Patients visiting or living in Australia from overseas may not have a Medicare card, but MediRecords still supports billing and ePrescribing for them. This article covers what is different when treating an international or overseas patient, including patient registration, billing, and ePrescribing when Medicare is not available.

Contents:

1. Before You Begin
2. Medicare Eligibility for Overseas Patients
3. Registering an International Patient
4. Billing an International Patient
5. ePrescribing Without a Medicare Number
6. Private and International Health Insurance
7. Common Scenarios
8. Frequently Asked Questions

Before You Begin

Before treating an international or overseas patient, confirm the following:

• Whether the patient has a Medicare card (this determines whether OPV or Medicare billing is available at all)
• Whether they hold an Individual Healthcare Identifier (IHI)
• Whether they have private or overseas health insurance (without a Medicare number, this is billed manually to the health fund and printed for the patient)
• How the consultation will be billed

The sections below explain how to confirm eligibility and complete each of these steps in MediRecords.

Medicare Eligibility for Overseas Patients

Medicare eligibility for overseas visitors depends on their visa type and, in some cases, a Reciprocal Health Care Agreement between Australia and their home country. Eligibility rules can change and vary by individual circumstances, so this should always be confirmed for each patient rather than assumed.

A Medicare number must be entered on the patient record before an Online Patient Verification (OPV) can be run, and before Medicare can be selected as a billing method on an invoice. If a patient has no Medicare card to enter, there is no Medicare number for OPV to check, and they should be treated as a private patient. See Billing an International Patient below.

Patients from countries with a Reciprocal Health Care Agreement (RHCA) may be eligible for a limited range of Medicare services. Where this applies, the patient will first need to obtain a Medicare card or number from Services Australia; only once this is entered on the patient record can it be verified via OPV. If an RHCA patient does not hold a Medicare card, bill them privately at MBS rates; they can then take their receipt to Medicare to claim a refund themselves. Coverage varies by country, see Services Australia: When Reciprocal Health Care Agreements Apply for country-specific detail.

Registering an International Patient

When creating a patient record for an international or overseas patient, the workflow is almost identical to registering any other patient:

• A Medicare number is optional and can be left blank
• Record an IHI if the patient has one
• Record private or overseas health fund details if applicable
• Complete the patient's demographic information as normal

If a patient later becomes eligible for Medicare, update their existing patient record with their Medicare details. There is no need to create a new patient record.

Billing an International Patient

If a patient has no Medicare card, bill them as a private patient in the same way as any other private billing.

For general steps on creating a private invoice, see Private Invoicing: Quick Guide.

ePrescribing Without a Medicare Number

A Medicare number is not required to ePrescribe. An Individual Healthcare Identifier (IHI) can be used instead. International patients who are not eligible for Medicare may still be eligible to obtain an IHI from Services Australia.

If the patient holds a Department of Veterans' Affairs (DVA) number, record this in the patient record as normal; it can also be used to validate ePrescribing.

To apply for an IHI, patients can use the Individual Healthcare Identifier application process on the Services Australia website.

Private and International Health Insurance

Some international patients hold overseas or international health insurance, which some Australian health funds offer alongside standard private health cover. Where a patient has private or overseas health insurance recorded, address the invoice to the health fund and print it for the patient to complete and submit themselves. This is known as manually billing the health fund.

Claims are submitted according to the requirements of the patient's insurer. MediRecords does not determine whether an overseas insurer accepts claims submitted this way.

Common Scenarios

The table below summarises how billing and ePrescribing typically apply across a few common scenarios. Always confirm eligibility for the individual patient rather than relying on the scenario alone.

Frequently Asked Questions

Can I create a patient record without a Medicare card?

Yes. A Medicare number is optional when registering an international or overseas patient.

Can I ePrescribe without Medicare?

Yes, using a validated IHI or DVA number instead.

Can I bulk bill an overseas patient?

Only if they have a Medicare number entered on their patient record and OPV confirms it is currently valid.

What if an RHCA patient doesn't have a Medicare card?

Bill them privately at MBS rates. They can take their receipt to Medicare to claim a refund themselves.

Can I submit an electronic health fund claim for an overseas patient?

Not without a Medicare number. Create a New In-Patient Invoice, bill it to "(Manual) [Fund Name]", and print it for the patient to complete and submit themselves.

Can I update a patient's Medicare details later?

Yes. If a patient later becomes Medicare eligible, update their existing patient record rather than creating a new one.

Further Reading

• Patient Identifiers: Medicare Cards & Online Patient Verification (OPV)
• Private Invoicing: Quick Guide
• Manual Invoicing: Medicare, DVA & ECLIPSE Quick Guide
• Services Australia: Medicare Eligibility
• Services Australia: Individual Healthcare Identifier
• Services Australia: When Reciprocal Health Care Agreements Apply