Video: Setting Up Medicare (AU) Claiming

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Video Tutorial Transcript

Registering Your Medicare Location ID

00:41 So, we will start with, um, registering you with a new location ID. To do that, we will go into the tools menu. So, we are unfolding the tools menu and selecting Medicare. Here on this page, all you need to do is apply for a Medicare Location ID. So this ID is your software ID that you will be using for registering with Medicare Australia to start claiming through your Zanda account. So click here to apply and give the system a few seconds to generate your software location ID. Sometimes it is also called a minor location ID.

01:25 So your Medicare location ID for your Zanda account is generated here. You can see it here. Starts with P, W, D, and some digits. So all you need to do is to use this location ID when you are registering for Medicare. To do that, you just need to click this link to open the PDF form, HW-027. Uh, this is a Medicare application form to, uh, link your provider details with your Zanda Location ID. Uh, so all you need to do is complete this form and email, uh, the completed PDF file to Medicare services.

02:06 All the information will be provided in this form for you. Now that you submitted the Medicare registration form with your new location ID, To, um, Medicare.

Configuring Medicare as an Insurer

02:20 It's time to set up your account so that it shows all the right numbers and provide the numbers and so on, uh, on the invoices when you are submitting them to Medicare through Zanda. 02:31 And we will start with going to the settings menu. And here in the payments category, let's, uh, select insurers. If you registered your account as an Australian account, you should already see that Medicare Australia has been added to your account as an insurer by default. 02:51 But anyway, let us click on this card just to see what the settings are on this end. So here you will see the insurer name is Medicare. 03:01 Type should be Medicare Australia for the integration to work correctly. Uh, and then you obviously want to show this, uh, insurer information on invoice, so let's have this on. 03:13 And text on invoice. It will be showing on your invoices next to the treating clinician's number. So, uh, you will see the name provided by the name of the practitioner. 03:27 And below it will say Medicare provider number and then the practitioners number will show or set that number just a few seconds later. 03:37 If you for any reason don't want this additional text on invoice, you can remove it now or have a look at your invoice layout and then you will be able to come back to these settings and remove or update this text on invoice if necessary. 03:53 But for now, let us add leave anything as this. And close this form. So this way you edit or make sure that Medicare is existing as an insurer in your Zanda account.

Adding Practitioner Medicare Provider Numbers

04:09 The next step would be to add your practitioner or practitioners, uh, provide numbers for Medicare in their practitioner profiles. To do that, let's jump back to the settings menu. 04:21 And in the team category, let's select practitioners. And then you click on the practitioner name, whose provider number you are going to add. 04:31 While in the practitioner profile, let us go into the insurers menu. And here again, by default, if you register as an Australian account, you will see those default insurers already added. 04:46 Or if you don't see it here, you will just be able to click add insurers and then fill this form out. 04:54 So, let me click on the form that has been pre-created for me. Here again, let's ensure that we have Medicare selected as insurer. 05:04 And the service type would depend on the type of the profession of your practitioner. Um, just make sure that if you are registering for, uh, or setting up for Medicare, um, please select specialist and allied health for most of the professions, um, that are using the end of for, um, Medicare integration 05:26 . Uh, otherwise, if you are a general practitioner or your practitioner is a general practitioner, you can select general practitioner. But here I will select specialist and allied health. 05:39 Then, uh, you should need to enter the practitioner's provider number, as it has been registered, uh, by Medicare. Uh, the next two fields, pay your provider number and pay your provider name. 05:53 In most cases, you can just ignore those fields. They can, they only need to be filled in if the money paid by Medicare should be directed into a different bank account. 06:05 Um, so if you hover over this field, it will, uh, explain you how this field should be used. So it's for use only if the provider being paid is different from the service provider. 06:19 Um, it could be if, um, the, the chief psychologist, for example, in the practice has all the, um, Medicare payments streamlined into their bank account and then, uh, This money I used to pay out to service providers, but as I said in most cases, these two fields can just be ignored. 06:43 Uh, and then if, uh, you or your practitioner are registered with Medicare to provide services from more than one location, and therefore you or the practitioner would have, uh, different provider numbers for each of those locations, you will be able to select that location here. 07:02 Or if a practitioner can use the same provider number for all the locations that are created in your Zanda account, you can select all. 07:11 Uh, then the next field is the default for all clients. If you have this switch on, what this means when a new client is added to your Zende account as a client profile and this practitioner is made their primary practitioner, then this client will have Medicare fields added to their profile by default 07:32 for you or for them to add their Medicare number. So this is what this switch does and if you want The majority of your clients who are registering with this practitioner to have Medicare information showing on their file by default, just turn this switch on and click save. 07:53 Now, if you want to have, or if your provider has more than one practitioner has more than one Medicare provider numbers, you will just add them all here to be used with different locations. 08:07 So, for example, let's have Medicare. Uh, again, specialist and allied health for Medicare, the provider number will be different in this case. 08:16 Just enter an example, provide a number. Uh, and then in this case, you can just select which location this provider number is registered for. 08:26 You can have multiple ensures default for all clients, so the system won't allow you to save, uh, the second default ensures, so this will be turned off and just click save. 08:38 It is important to add all existing Medicare provider numbers for each practitioner and have them linked to the correct provider number locations. 08:49 What this means is when you create an appointment in one of those locations, the practitioner provider details will be filled in from these settings automatically, and it means that the claim will go to Medicare successfully from the first time, rather than you having to fix update, provide a number 09:09 of data provided in detail, and so on later on. So, just quickly to recap. If your practitioner has more than one provider numbers, they have registered for practicing from different locations. 09:21 Add them all here as separate Medicare insurers for each location and for each provider number that they have registered. From here, let us now go and add Medicare items as services so that you can add them to your invoices.

Adding Medicare Item Numbers as Services

09:39 To do that, we will go into the settings menu. And in the billing category, let's select services. So here you have two default services that we added for the trial purposes. 09:50 You can deactivate them. Uh, and then we will add a new service for Medicare. Let's call it, for example. So it will be a Medicare standard. 10:04 Now the item number or code should be the code that you will be using for billing Medicare. So please make sure that you are creating a separate service for each item number that you will be using for cleaning. 10:20 Uh, in the description you can add the duration of the service just for as a description to show on the invoices. 10:29 So for example, 50 minutes. Plus, so it means that this is a claimable item for a service that, uh, has a duration over 50 minutes. 10:40 And now here, let us enter the exact correct duration that will transfer to your appointments, um, links. So here, for example, 55 minutes, uh, usually the Medicare claimable services will be tax exempt. 10:56 So let's select that. So for category, we haven't created them here in the trial account. This is a custom setting for use specifically. 11:04 If you provide lots of services and lots of products, you can use their categories to group them together in your reporting. 11:11 So it's okay to leave it blank. It won't affect your Medicare claiming at all. Uh, the cost also is just for your internal information. 11:20 Feel free to leave it blank, and then the price will be the price that you are, um, billing or invoicing your client. 11:28 So, for example, give it a $120. Uh, and then you can also use this location's filter to allocate this service to a specific type of location. 11:41 Again, if you have a lot of services and if you have ended up with a long list of services and you only provide some of them in one location based on their claimable codes. 11:53 For example, you can already, uh, Split them here and limit by that location, or you can leave it blank so that this item with this item code is available at all locations. 12:07 So let's save this change. And this way please add all the services for each different item number that you will be using for cleaning with Medicare. 12:19 We'll help you with streamlining your Medicare. Billing, you can also use the session packs feature that Zanda provides. Let me show you how it works and explain what it means.

Setting Up Session Packs

12:31 So let's go back to the settings, billing, uh, category and select session packs. Session packs is a way to organize a number of units you are going to provide to the client and once you've used them all the system will, uh, give you an alert that the client has just used or has been allocated the last 12:50 available session in the pack of services that have been, uh, provided to them the treatment plan they have created or the referral they have. 12:59 So let us create a session pack for the initial Medicare referral of six sessions and I will show you how to use with Zanda and Medicare claiming so that you know when the referral is about to end. 13:14 So we'll click on the Add Session Pack, give it a name. So for example, Medicare six sessions. You can leave the item code blank and just select the service or product that will go together with this session. 13:35 So, for example, Medicare standard sessions. Again, you can also leave this blank and for each invoice you are going to generate to the client using this session pack, you will be able to select a different item code if you need to use a different code while building this client and Medicare. 13:52 So the park units will be, uh, in sessions and the maximum units let's do six. Uh, and let's also charge per session using the standard price at the time of use. 14:05 Uh, and we can select sex exempt and save. Alright, so we set up our providers. We set up our services.

Adding Medicare Info to Client Profiles

14:16 Now let's, let me show you how to add medical information to your client profiles. Uh, let's quickly go into one of our client profiles here. 14:28 Uh, and once we are in, once we are in, uh, you will see that the Medicare fields are available on their details page. 14:40 Um, so if you set up Medicare as a default provider on the practitioner's profile for their new clients, This specific setting will automatically add a field for you on the client's details page. 14:55 And here you can enter their Medicare details and you can also use the Validate Medicare data button. You just click this button and Zanda speaks with Medicare service and validates this information for you. 15:10 If something isn't correct, the validation won't come through and you will see Uh, an error message showing you which of this data didn't validate. 15:20 But you may have a situation when you create the client profile, uh, but Medicare field is not available on the details page. 15:28 It's very easy to fix. You will go into their billing settings and click on insurance. And you will be able to add uh, Medicare as the insurance here. 15:40 The same way and uh, select Medicare as the insurance and uh, the uh, details. Of course, I'm just entering the information that is um. 15:59 Just for test, if I click Validate Medicare data, this won't validate for me, of course. Of course, let me save this just as a test. 16:08 Also, I have this default switch turned on and what this means is that if you turn this insurance as a default for the client, the system will automatically select this insurer for all the new invoices for this client after you've saved this. 16:28 Uh, insurance for, and also you can select to add this insure to all existing invoices for this client, just future data invoices or past and future invoices. 16:41 So there you go. You added Medicare details for the client on their profile. But don't go away just yet. In most cases, you will need a referral for this client to be able to claim with Medicare.

Adding Referrals to Clients

16:56 And while we are staying here, let us add this referral to the client profile. In that case, let's click on the profile folder and select referrals. 17:07 And while we are here on this page, let us click add referral. Uh, if you've already started setting up and adding referrals to your profile, you may already have some available here, so just, uh, look them up. 17:22 If you don't see the options for those referrals, you can quickly add a new referral. So let's do that. You can briefly add the, uh, business information. 17:36 So for example, the practice name, uh, the referral type. So this could be the medical practitioner or, um, a lighthouse practitioner who referred, who referred this client to you? 17:49 Let's select medical practitioner. Uh, you can also select the type of the medical practitioner. For example, in this case, I want to select GP and the provide a number, Medicare provide a number of the referring medical practitioner. 18:07 And click next. So this way we created the new referral profile and now we can add them to our client. 18:17 What else you need to do is the referral start date. You will see that on your referral letter. So for example, it was issued on the 1st of April and then you need to select the period this referral is valid for. 18:29 For example, 12 months. Also, there are two other switches that help you manage this referral. If you turn on the ease default switch, this referral will populate on this client's invoices by default. 18:43 Uh, and also if you want to show it on the invoice print, also, um, turn this on. Uh, and this means when you are sending an invoice copy to your client, the referral information will be showing on the generated invoice. 18:58 Any notes for your internal use? They won't. So that's it. We added the referral to this client. It will show on invoice prints.

Linking Session Packs to Clients

19:12 Uh, it will, it is default and the reserve referral name was there for providing number. Now, this step is optional, but because we created a session pack to be used with Medicare referrals, let's add this session pack to our client profile. 19:28 To do that, we will go into billing session packs. Click add new pack. And in the templates, let's select the Medicare 6 sessions pack we created. 19:40 And basically, that's it. We don't need to do anything else. Let's just click save the changes. So once you've created this pack, you can easily see how many, uh, services have been allocated to this client, so how many units have been added to their existing, uh, appointments, or invoices, uh, and how 20:03 many units have been used up to date. And once all the, uh, available units are allocated to the invoices, the system will give you an alert here in the tasks. 20:14 And you will see that session pack for Medicare's Excessions has been used for these, your practitioners or your admin team. 20:23 This will be a reminder that you need to contact this client and suggest that they get another referral, for example. 20:31 And also for a practitioner, this could be an indication that they need to write a report letter to the referring practitioner, because the referral has been used and you need to send the information about how the treatment has been going. 20:46 So, just once again, session packs is an optional step, but I do recommend using it with Medicare Claiming feature because it helps you to streamline, um, how this whole process works and the system will remind you when you need to ask for another referral and when you, your practitioner or you as a 21:04 practitioner, need to write a report letter to the referring practitioner. So, once we've done all of this one time, set up all providers, Uh, it is all the information for the client.

Booking Appointments and Using Medicare Packs

21:19 Uh, you are now ready to start claiming with Medicare. Let me show you how to do that. Let's go to the calendar. 21:27 Uh, and create an appointment for this client. So a client, so their practitioner will be, um, so let's go to today. 21:38 That's here. Uh, so their practitioner will be Irene. Let's create an appointment. Select our client. And now here in the appointment details, let's click select a service pack or product. 21:54 Uh, and so you'll have here two different scenarios. If you're just using services, you can just select Medicare standard service with the, uh, item number. 22:05 Or if you want to use session packs for tracking the referrals and the number of services provided, you can select the session pack. 22:13 I'll do that. You'll see that the pack and the service with the item code, code has been added if at any stage you want to use a different item code, you will be able to select a different service with a different item code and, um, edit here, uh, and just save the changes. 22:32 So here you will see that the appointment was created and the invoice for Medicare, uh, is created too. Uh, and here next to the invoice information you will see this M number, uh, by clicking which you will go into the Medicare claiming page. 22:50 But before we do that, for example, if you're client, um, before we do that, let us have a look at the invoice settings and how the system populated everything using the setup we've just made. 23:05 So if we click on this pencil icon here, Uh, the invoice edit page will, uh, open and we will see all the information provided here for us. 23:17 So here, uh, we can see the location. So it's my practice location. It's available by the client. The referral has been added automatically by the system. 23:27 The right insurance has been selected by the system as well. Uh, and the item was populated as an invoice item. 23:35 Here is the code that Medicare should be able to, um, accept. And that's it. So you will see that, you can see that the system populated all the information necessary for Medicare, uh, for, uh, to process this claim. 23:51 So let's go back to the, uh, appointments settings. Uh, if you want to see what this invoice for Medicare looks like in the generated form, let's click this printer icon to have a preview. 24:06 And here at the top, you will see that it's provided by the practitioner name. Then Medicare provided a number is listed here as well. 24:14 There's also the practitioner information here at the top. And then here is the client information. It's provided to the client name, Medicare, number, and appointment date and start time. 24:26 And here on the right hand side, you will see the referral information as it has been populated also from the referral linked to this client. 24:36 And here is the items that provided the quantity, the code, and item number and description. So again, we have everything that we need to start claiming with Medicare because we've set up our account and added all the information before generating this invoice. 24:56 If you remember, or if your practitioners have different provider numbers, um, that are available in different locations, let me show you how you could do that. 25:06 Uh, so, for example, um, here, uh, the location is selected is my practice, and the provider number, uh, was populated on the invoice based on the provider number linked to this location. 25:22 Uh, if you change the location for this appointment to a different one, and let's have a look at the print. 25:32 Printed versionable will see that the provided number populated on the invoice is linked to the location that was switched to. 25:40 So again, having set up your providers, your practitioners with all their provider numbers and linking to the correct locations, um, takes away this task of manually updating this invoice, uh, the system will populate the correct, uh, appointment location and the provider number for your practitioner 26:01 that they have registered for that location. Beautiful, we are now ready to process this claim for the client. Let's click on the appointment panel, and I will show you two things that you can do.

Submitting Medicare Claims

26:16 So, uh, first of all, you can claim directly from this appointment panel, just by clicking on this M button. Or if you need to make any changes, any updates to invoice before you do that, click on this pencil icon. 26:29 Uh, do what you need to do, or you may just want to check if the referral and the insurance and the location are all selected correctly. 26:37 And once you're sure that you are ready to start with claiming, you can click on this button here, Medicare and DVA at the top. 26:46 Uh, now for Medicare, you have the options of submitting two different types of claims. Uh, patient claim or the bulk bill claim. 26:54 The bulk bill claim, let's click this one first. The bulk bill claim means that you haven't processed any payments, you haven't received any payments from the client. 27:05 For this service and you are submitting this invoice as a bulk bill claim to the, to Medicare. So there should be no payment collected on this invoice when you send it to Medicare as a bulk bill. 27:20 And just make sure that all the information you can see here is filled in. So the patient information, uh, with the Medicare information, your provider information is selected correctly, the practitioner, uh, the referral information is here. 27:36 Uh, and the service items, you have the description of service, you have the item number, the quantity and the charge amount. 27:43 Uh, and once all this is done, um, you can either save and send this later, so you can save each, um, claim as you are generating them during the day, and then at the end of the day, you can send them as a batch, to Medicare.

Pre-validation & Error Handling

28:01 Let's do that. In this case, uh, if you have any problems, any issues with this claim, uh, Zanda will do the, Free evaluation or pre-assessment of the claim and it will show you if something is missing. 28:16 So the client's date of births field cannot be empty. Uh, and if you need to fix that, or you can do is click client details. 28:26 Uh, and for example, let's enter the date of births for this client and save the changes. Now if we jump back, To the appointment, click Medicare, click Create Bulb Bill claim. 28:46 We will see that the patient date of birth has been populated, and we can try submitting this claim again. So because they clicked Save and Send later, the Bulb Bill claim has been prepared. 29:00 It has the status of prepared. It shows the invoice number that it is linked to. And again, all the claim information is listed here. 29:10 If you don't want to send this claim for any reason before it has been submitted, you will have the option to delete this claim. 29:20 So let me do that. Just for the sake of demonstration. So if we jump back to the calendar, let me show you how, what you would do, uh, if you actually collected the full payment of the client for this session. 29:35 And then you can submit this claim as a patient claim. In that case, Medicare will send the rebateable amount to the client's bank details. 29:45 So, you are paid at the time of session and then the client gets the Medicare rebate into their bank account. 29:54 So, to do that, let's collect the full payment of this invoice. So, for example, the client used the card and paid the invoice in full. 30:04 Once you've collected the payment and the invoices fully paid, we will click M again. And in this time, let's create a patient claim for this client. 30:16 Again, have a look and make sure that all the fields that are necessary are filled in correctly. That we have the claimant information, the, um, Providing information, the referral information. 30:30 Uh, it's important to see this green banner saying account is fully paid, yes. And again, let's click Save and send later just for this pre-validation. 30:40 So, that's great. The claim is ready to be submitted. Uh, and you can send it immediately. You can delete it if you don't want to send this claim before. 30:55 You sent it to Medicare. So if I click Send now, let's see what's going to happen. Uh, if there is any issue with your registration details or, uh, with any, anything with the client, uh, details you will, again, will see this warning that, um, something is not working right. 31:19 So in this case, the location is not authorized to undertake this function. It means that my location ID either haven't been registered yet because it takes about seven days for Medicare to process that HW-O27 to register, provide a number with Zanda location ID, or there may be other issues, for example 31:41 . We have a knowledge-based article that explains how to, um, how to fix. Issues based on the type of the error that you are seeing. 31:52 Obviously, this is my test account. It's not registered for real with Medicare. I'm just using it for demonstration purposes. So I won't be able to actually send this claim to Medicare.

Viewing and Managing Medicare Claims

32:04 But anyway, once it's been generated, let me show you, uh, how you can have an overview. Of the Medicare claims that you have created submitted and so on. 32:16 So to do that, we will go into the tools menu and click Medicare. And here you will see the Medicare information of your account. 32:29 So basically your location ID. Uh, and the list of claims that have been generated. If you have a long list, if you've submitted a number of claims, you can use these filters to narrow down the list of claims you want to see. 32:44 Such as by provider, by location, by the claim date, by the status of the claim, so now claims can have different statuses such as assessed, referred, rejected, warned, and so on. 32:57 Again, please have a look at our knowledge base where we have explained each status in full detail and what it means and what implications it has for you. 33:08 Uh, by the type of claim you submitted, you can submit four types of claims, bulk bill claim, patient claim, uh, and DVA paperless or DVA allied health, which is just one registration with Medicare. 33:22 Uh, you can also print out a list of your claims as a paper document, you can save it as a PDF or export into a CSV or Excel file, so use these buttons here. 33:37 Well, if you, um, Prepare your Medicare claims if you save them to send later. This is where you will be able to send all those prepared claims as a badge. 33:51 So, uh, here you will see the button badge submit all prepared claims. So, if you've been preparing them during the day and then the end of the day you are submitting all the claims you prepared in bulk, this is where you will be able to do that. 34:08 Uh, after some time, usually 24 or 48 hours, if you want to check the, um, the outcome of the claims of the bulk bill or DVA claims that you sent to Medicare, uh, you can use these two buttons, you can request the payment status report, and you can also view the payment status report after it has been requested.

Automating Bulk Bill Payment Reconciliation

34:32 You can also set up your system to automatically update the bulk build payments, so you don't have to come in and check the outcome, but the system will do this for you and allocate those bulk build payments that you received from Medicare to their corresponding invoices. 34:55 To do that, you can update these current settings here at the bottom left. So automatic bulk bill payments is disabled, so we click on that link, and we can just enable this switch, automatically allocate payments to invoices, uh, edit, and you can select the payment method you want to use for your internal 35:19 reports. So we'll use bulk bill in this case. If you are registered for DVA and if you want to use the integration, you can also enable the DVA payments. 35:31 Uh, and also use the bulk bill. For example, or you can create a new payment method for DVA payments. Um, and you will save the changes. 35:43 Let us now go back to the tools menu. Select Medicare. And here you will see that your current settings have been updated and the automatic bulk bill payments feature is enabled. 35:59 So the system will be automatically allocated the bulk bill payments, uh, that Medicare has paid out into you or your your or your practitioner bank accounts and update the relevant, um, invoices. 36:13 If you don't provide bulk billing, if you only use this integration for submitting patient claims, you won't see the outcome here on this page because Medicare will communicate directly with the client if they have any issues paying out into their bank account. 36:33 So for bowel claims, all you need to do is to see that your um, Medicare claim, bowel claim has been assessed, has received the assessed. 36:45 Studies, in this case, that it means that you've done everything correctly on your side, you've sent an invoice to Medicare and Medicare will process it and, um, transfer the, uh, rebate into the client's account.

Submitting Claims for Minors

37:04 If you or your practitioner's work with underage, uh, clients, you will need to be able to submit claims for minors to Medicare. 37:13 And this is how it's done. Uh, so first of all, let's go into the client profile. Let's say they are a minor. 37:24 So the 9-year-old, so first of all, what you will need to do is add, uh, the parent or guide guardian to them as their contact. 37:35 So let's say we have client, John. Let's say the John, uh, is their, um, Parent, who will be receiving the, um, Medicare. 37:48 Pay the invoices for the minor client and receiving Medicare rebate into their bank account. So we will link, um, this parent as a contact to the client profile. 38:00 Select their relationships, for example, father. Let us add also the contact details for the contact of the client. So we added the phone number, the email address, Please also make sure that the parents' Medicaid details have been recorded as well. 38:18 And let us save those changes. Uh, what else we need to do if all the invoices of this client, um, will be paid by their parent, and you will be using our claims for minors feature. 38:32 Let's also go to the client profile, the child profile, go into their billing settings, billing setup. And set up the invoices as build to the contact name, the parent name, uh, and save those changes. 38:49 Let us now have a look at how we would process these, um, uh, claim for minor. So let me create a new appointment for this client. 38:58 And if I now have a look at the edit page of the invoice, like the inside of the invoice, I will see that it's payable by, um, contact by the parent, not by the client. 39:10 Uh, but and the referral information is the insurance information is there, item code is there. So now, uh, All I have to do is collect the payment upfront, so let's collect the full amount and save this invoice. 39:26 So this invoice is now fully paid. It's built to the parent and now we can process this claim for minor. 39:33 Let's click Medicare and DVA. Create a patient claim. Uh, and now here we will see a difference with a regular. 39:45 Patient claims. So here the patient information is the child's information. Uh, and the claimant here is the parent and the parent information has been filled in as well. 39:56 The provide information is here, the referral information is here. Uh, all the account is fully paid, yes, we have item number for Medicare, so we are all set for processing this, um, claim as a claim for minor, and Medicare will pay out their beta amount into the parents bank account detail, uh, bank 40:18 account associated with the parents Medicare number. Well for now, thank you for watching. If you need more information, if you have any questions, please don't hesitate to use our help menu.

Getting Help

40:31 So here you can get help from our customer team if you have a quick question, or you can navigate to the knowledge base and look up articles dedicated to Medicare, where we are provided all this information in full detail. 40:46 So thank you for staying with me and I will see you another time.