Bulk Bill Invoicing, Claiming, Receipting and Resubmitting

Requirements

Provider/Entity is registered with Medicare - Pre-requisites
Provider/Entity has Bulk Bill Rate selected in Location rates for each Active Location in Utilities - Entities - Locations (Active)
Patient/Client has a valid/verified Medicare Card
If the Provider/Entity is an Allied Health Provider or a General Practitioner, a Referral is not required. This can be flagged in their settings
If the Provider/Entity is a Specialist a current Referral is required unless an override is selected
Date of Service (DOS) is not older than 6 months
DCM will not process a Bulk Bill Claim if any of the above is not correct
On transmitting the Claim, the Medicare Card is verified again based on the Date of Service (DOS)

On generating the Invoice with the Rate Bulk Bill, a button labelled Bulk Bill appears on the sidebar to select
Note the Fee equals the Benefit
- If the Billing Entity is a GP, the Fee is 100% of the Medicare Fee Schedule be it an In Room or In Hospital service
- If the Billing Entity is not a GP, the Fee is 85% of the Medicare Fee Schedule for an In Room Service and 75% of the Medicare Fee Schedule for an In Hospital Service
Right-click on the Item Description to select any Qualifiers that Medicare requires

One invoice equals one claim
Should the Claim not be transmitted from the invoice, as will be the case if feeding in from an upstream application, go to Regular Tasks - Online Claiming - Invoices not Claimed (x) and transmit/process from there

Bulk Bill Claims are paid overnight
This process can be automated
Otherwise, go to Regular Tasks - Online Claiming and select the Get All BB/DVA button on the sidebar

On getting the BB/DVA Payment details, and the Invoice is paid in full, the Invoice will be receipted, and the status of the Claim Status will change to Completed without staff involvement

Should there be a difference in what was paid to what was claimed, the Claim Status will be Reports Available
Right-click on the Claim and select Get Report for detail
Options are
- Accept Payment
- Resubmit Later
- Resubmit Now resulting in a new Claim ID
You can either use the toggle buttons at the top of the form or select from the drop down

The reason for no payment above is due to the Service being previously paid (162 Reason Code)
Accepting Payment and then selecting Complete on the sidebar will change the invoiced amount to what has been paid.
In the example above, the invoiced amount will change to $0.00
If monies have been paid, you need to Accept Payment and Complete to receipt the invoice

Right-click and Go to Client or Go to Invoice and Resolve the Issues.
- There could be a missing Qualifier, eg: Not Normal Aftercare, or
- The Referrer's Provider number is not valid. This should be highlighted on entering the Referrer details and resolved then. Know that the Provider Number must be 8 characters in length. Should it be 7, try entering a 0 at the start
The above issue is Referral/Request details not supplied
Resolve the issue and then either ...
- Resubmit Now resulting in the Claim being Resubmitted with a new Claim ID
- Resubmit Later resulting in the Claim being moved to the Claims to Resubmit section

Related to