Health Fund Claiming - Gap Cover

There are three ways to claim from a Health Fund in Bp VIP.net:

• No Gap
• Known Gap
• Gap Cover.

This method of Health Fund billing differs from the previous two in that the fee to the doctor is specified by the doctor. The Fee Scaler used is dependent on the practice, but it is usually the Private or Pensioner fee scalers which are set and updated by the practice. The Subsidy used is the Medicare Schedule (or Base fee), of which, the Health Fund pays 25% of the subsidy and Medicare pays 75%. The payment returned to the practice is in one payment of the Schedule fee by Medicare who bill the Health Fund for the 25% portion… independent of the payment process to the practice.

1. Bill the appointment.



2. Enter Private or Pensioner in the Fee Scaler field. Generally, this is left as the default Fee Scaler for the patient as set in the patient’s demographics screen (F3).
3. Enter Schedule into the Subsidiser field.
4. Enter the patient’s Health Fund into the 1. Less Redirection to field.
5. Ensure that Redirect Amount is set to Subsidy (x).

Your system configuration should automatically set this as a default. If not, please contact the support team for help in setting this as a default.

6. Press the Pay (F6) button to pay the patient gap.

The Payment screen will pop up to pay the patient gap.



7. Tag the invoice to be paid.

NOTE  The Gap amount will show as what is owing.

8. Enter the amount to be paid next to the payment method under the Acct Credit column.
9. Check Medicare Authorised.
10. Press the Medicare button.
11. The In-Patient Medical Claims screen will pop up.



12. Check all details are correct.
13. Press Send Claim button to send the Known Gap claim.

 

Last modified: 28 June 2022