Medical billing can be quite complex and varies widely from practice to practice; as a result, billing in Zedmed is designed to be very flexible to cater for the many different billing scenarios practices need.
When billing for consults where patient has attended the clinic, it's standard practice to bill patient's from the Waiting Room. This is because it gives users a clear view of patients that have attended but not yet been billed & also populates the correct time on the Attendance Report.
For any other billing scenario, eg Eclipse billing or you need to re-create an invoice, click Bill from the Patient Details screen.
Before You Get Started
Before doing any billing, we highly recommend that you do an Online PV (Patient Verification). This checks the patient's details with Medicare and their health fund (if the patient's health fund details have been entered) and saves you getting rejections from Medicare due to incorrect details.
Click on the tabs below to display further information for each topic.
Bulk Bill Invoice
- From the Waiting Room, right click on the patient’s name then click Bill.
- Ensure the Payer is set to Medicare or DVA respectively.
- If Medicare isn’t in the Payer drop down box, click Add/Edit Payer > Add New.
- Select Medicare then set the fee type; GP Practices should select Medicare Schedule while specialist practices/ providers should select Medicare - 85%.
- Click Close to the next screen that pops up as it should display both payers
- Ensure the Doctor and Referral (if relevant) are entered.
- Ensure the date is correct, then enter the item number and press Tab on your keyboard to bring up the item information.
- If required, click Properties to enter relevant indication flags, eg 'Not Normal Aftercare' or enter time of service.
- Surgical items need to have the body part that the service was performed on eg left forearm. Enter these notes into the Notes field.
- Once all details have been entered, click Suppress.
- See the Batching article for details on how to create & transmit batches.
If your site is using Tyro, follow the steps above to create the invoice but click Easyclaim instead of Suppress. See the Tyro Easyclaim article for more information.
A Patient Claim is where the patient (or a Next of Kin account payer) pays the invoice then gets the Medicare rebate refunded to them. This can be done online through Zedmed.
- From the Waiting Room, right click on patient’s name and select Bill.
- Ensure the payer is correct (either the patient or NOK Family Member) & the correct doctor is selected.
- If the patient is under 12 years old, a parent or guardian must pay the invoice in order to receive a rebate.
- Ensure referral is attached if relevant.
- Enter service date & item number then press ‘Tab’ on your keyboard. Click ‘Add’ to enter another item number if required.
- If they are paying on the day, click ‘Quick Pay’.
- If the patient is going to take the invoice to pay at a later date, click ‘Print’.
- Enter the method of payment then click Add.
- If you are using Medicare Online and the patient would like their rebate back, click MA Online, then Send.
- If you’re using Tyro, click ‘Eftpos’ then ‘ET’ to initiate the Tyro payment. Once the payment has been taken, click ‘Easyclaim’ to initiate the rebate back into the patient’s account.
- Please note: Tyro rebates go back into the patient's account in under 1 minute, so if there's an issue with the invoice (eg the doctor wants you to charge a different item), you will need to call Medicare to fix up the claim.
- If they don’t want the rebate claimed for them, just enter the payment method, then click ‘Print’ to provide them with a receipt.
Billing a Family
If several members of a family attend the clinic on the same day, you can bill them all on the one invoice so the patient only has to make one payment. Before you can do this, you will need to set the Family Group up in the patient's record. See below for more information on setting this up
Linking members of the same family together makes billing easier.
- From the Waiting Room, right click on the head payer (person who is to pay the account) & select Bill.
- Enter the invoice details then click Family.
- Select the next family member to be billed, enter the invoice details & click Family again if there are more people to be billed. Otherwise, click Quick Pay.
- It will default to the total amount owing for all invoices. Select the method of payment, click Add then MA Online to process the rebate.
Third Party Invoice
A Third Party Invoice is when an external entity, generally insurance companies, is responsible for paying the patient's accounts. This is for things like Work Cover/ TAC claims etc or if you have to manually send an Eclipse claim to a health fund.
- From the Waiting Room, right click on the patient's name & select Bill.
- Ensure the payer is set to the Third Party payer eg EML & that the doctor is correct. If a claim has been added into the Patient Details screen with that payer linked, the claim will appear on the invoice.
- Once the invoice is complete, click either Print or Email to send the invoice to the insurance company.
- Please note: you will need to set up email invoicing if you would like to use this feature. See the Emailing Invoices article for more information on setting this up.
Eclipse is used to electronically process in & out of hospital claims.
Please note: before you start ECLIPSE billing, you must ensure you have completed all the required setup. See the ECLIPSE manual for more information.
Setting Up the Payer
- For ECLIPSE billing, the patient is always the payer.
- In the patient details screen, click Payers > Add New > Patient then click Select.
- Click Details then choose the patient’s fund from the drop down box & enter their membership number.
- Always do an Online PV to ensure the details are correct.
- Open the patient’s record in Office & do an Online PV & click ‘Bill’.
- Select the Patient as the Payer & ensure the Doctor & referral are correct.
- Ensure the ‘Refund/Gap Calculation’ is set to Fund.
- Enter the date of service, then the item number. Ensure the fee matches the patient’s health fund; if it doesn’t, drop down the Fee box & select the correct one.
- For health funds that use the AHSA fee schedule eg Australian Unity, select AHSA from the Fee drop down box.
- Click on ‘Properties’ then select the ‘Hospital/Site’. Enter time of service & any indication flags that might be relevant. Click ‘Close’.
- Click on ‘Add’ to enter any additional item numbers required.
- Click ‘ECLIPSE’ to transmit once the invoice details are complete. On the next screen, ensure that the ‘Claim Type’ is set to either Agreement or Scheme then click ‘Send’.
- If it defaults to Patient Claims, you can manually over ride it but it means that the setup for that fund in the doctor’s details is incorrect. See the ECLIPSE manual for information on how to fix this.
Multiple Operation Formula (MOF)
- When you bill a surgical item, you will get a popup asking if you want to activate MOF (multiple operation formula).
- If you click ‘Yes’ the multiple items will automatically be charged at the rate of 100%, 50%, and 25% thereafter.
After you click ‘ECLIPSE’ & the claim is transmitted, it will be assessed by Medicare & the health fund who will pay it & send the remittance advice back to Zedmed (can take up to 2 weeks). Then you will need to reconcile & receipt off your ECLIPSE claims.
Assist Surgeon Invoice
Assist doctor billing is quite complex as there are several scenarios to consider. Please see the Assist Doctor Billing article for more information.
You are able to defer an invoice in Zedmed, which is essentially a draft of that invoice. It's particularly useful if a patient has had a service eg a biopsy, & you won't know the correct item to bill until the results come back from the lab.
- From the Waiting Room, right click on the patient's name & select Bill.
- Enter the invoice details that you have at the moment then click Defer.
- Once the results come back & you have determined the correct item to bill, open the patient's file, click Bill & Yes to the popup asking if you want to work on the deferred invoice.
- Click on the item then click Change & enter the new item.
- Please note: if the invoice was created with the patient as the payer but after getting the results back you now want to bulk bill it, you will need to Re-Assign the invoice the Medicare first.
- To do this, go to Account Enquiry, highlight the invoice, select Re- Assign & select Medicare as the payer.
- When you go to change the item, you'll also need to change the fee type to the MC85% rate.
- Click Suppress then you can batch it as normal.
Deferred invoices can be found in the Debtors Report by changing the status to Deferred Only.
See the Debtor Management article for more information on this.