Tag: bulk billing

Bulk Billing Claims trick
By Veronica Scoot

Bulk Billing Claims trick

Here is a great little trick for your bulk billing claims in Genie. Please note that this is only for FULLY REJECTED claims.

When a claim has been fully rejected, when retrieving your reports it causes a popup that says the Payment report is not available. You end up with claims that look something like this:

Part of correcting these claims typically involves removing items from the batch and deleting the exception resulting in an empty claim, or deleting the claim altogether. This is not very useful should you need to make investigations down the track. But, since I really don’t encourage you to delete anything in Genie, you do have another option that will keep the exceptions report intact, and still deal with your claim appropriately.

Whether you intend to write off the rejected items with a credit or correct and resubmit, you will remove the item/s from the claim. When you do this, my suggestion is to NOT to delete the exception when prompted. Instead, once all the items have been removed double-click the empty claim, and tick it as finalised.

This moves it to the finalised status where the empty claim will still have full access to the Exceptions Report and the Processing and Transmission Text. This is very useful if you ever need to look back historically to see why an item was rejected.

Very nice and tidy, with all the reports preserved. Give it a try!

Cracking the Medicare Error code 432
By Veronica Scoot

Cracking the Medicare Error code 432

Eureka! Thanks to the lovely ladies at Medicare and Medibank Private I have finally worked out the meaning of that elusive Error “432 – Not multi-op – more information required to pay benefit”.

If you are like me and many of my sites, occasionally you get a Medicare claim error either in the bulk billing or via ECLIPSE that you just can’t work out how to resolve. I have had some people say you need to send a report, and others just write it off. But it has all been guesswork…until today. Several people in Medicare claims had never even heard of the error and that never inspires confidence.

So what is the problem? When you see the 432 “not multi-op” error it means that for some reason the services for the procedure have been split and potentially paid separately. This might occur because a diagnostic item has been billed separately to its procedural items, or it might occur because one procedure item was claimed and then a second claim has been sent containing an item that should have been the first (100%) item on the account under the Multiple Item Rule. It might also arise because the health fund has, for some reason, split the items when they sent them to Medicare for approval. To put it another way, it means that Medicare have already paid an item that would have been paid at a lower rate (per the multiple item rule) had they received all the items together, so they can’t just pay on the extra item/s without adjusting the already paid item.

And the solution? The new item/s either need to be

Differentiated as having occurred separately. i.e. If the service/s were performed as two unique procedures, then they need to be differentiated by TIME in the item service text and by using the “not multiple procedure” Medicare override.  In this case, the items will be paid as a separate procedure.

OR

Reconciled as having occurred together. i.e. Medicare need to know that the items were performed together and Medicare will need to perform an adjustment of the already paid item. This is done using a single form – the Medicare HW023 form for Simplified Billing or ECLIPSE
adjustment or the Medicare DB018 form for a correction to a bulk billed claim. Complete the form with as much detail as possible, attach the correct invoice with ALL the items performed, and send it to Medicare for processing. They will either make a top up payment or request reimbursement. Make sure you specify clearly and exactly what you want them to do, otherwise they will send the form back for correction. And if in doubt, call Medicare for advice.

How can you avoid this error arising?

Ensure you have ALL the services to bill before you start, and put everything on the one invoice/claim. Simples! 🙂

I love learning new things. Have a great day – I am off to reconcile some more billing…