Normal Billing

For doctors who may not wish to establish their own facility for patient billing, Medical Billing Service offers a comprehensive billing service. This applies to any medical billing and may include both ambulatory patients and patients in hospital. The doctor is charged a small processing fee based on recoveries.

No Gap

‘No Gap’ simplified billing occurs when:-
The doctor charges the Medicare Schedule fee
The doctor and the private health fund (either directly or via a private hospital) have an agreement for payment above the Medicare Schedule fee and the doctor charges the agreed fee.
The doctor uses an existing Private Health fund product and does not charge the patient an additional amount.

Known Gap

‘Known Gap’ simplified medical billing occurs when there has been an informed financial consent process between the doctor and the patient.

Medical Billing Service collects:-
75% of the Medicare Schedule fee from Medicare
25% of the Medicare Schedule fee from the Private Health fund.
Any agreed premium above the Medicare Schedule fee from the Private Health fund.
The balance (i.e previously agreed ‘Gap’) from the patient.
Simplified Medical Billing

​Simplified medical billing refers to billing by a licensed agency (like Medical Billing Service) for medical services, which have been provided to a patient in a private hospital and are billed on either a ‘No-Gap’ or a ‘Known-Gap’ basis. The various accounts are consolidated and billed directly to the appropriate Private Health fund and Medicare.

There may or may not be a patient co-payment (i.e ‘gap’ payment by the patient), depending on the arrangement between the doctor and the individual patient. There are thus two forms of the simplified medical billing (depending on the ‘gap’) and both are offered by Medical Billing Service.

The processing fee remains the same as for normal billing.

Our Fees

Medical Billing Service only applies a small processing fee once we have recovered the payment from the relevant paying agent or patient. This means that our revenue is dependent on Medical Billing Service successfully recovering your fees.

There is no set up cost or initial fee to commence using Medical Billing Service.

Recovery & Disbursement

As Medical Billing Service uses the Medicare Eclipse System for the majority of claims, recovery is achieved within 3-5 business days provided it is not a disputed claim. All recoveries are then reconciled with our billing system prior to being disbursed.

​Recovered funds, less our processing fee, are disbursed into your nominated bank account twice monthly. Supporting paperwork is mailed to you once the disbursement has occurred. The following documents are included for your reference:

Electronic Funds Transfer (EFT) Remittance Advice – shows the Net Recoveries deposited into your nominated bank account by Medical Billing Service.
Detailed Disbursement Report – shows itemised details of recoveries by patient.
Tax Invoice/Receipt – shows the processing fee deducted for that fortnight inc. GST.
Quarterly BAS Data Sheet – to assist you with preparing your BAS returns.
End of Financial Year Report – to assist you with preparing your Income Tax Return.
Recovery & Disbursement