Private Billing

If your health service operates fully or partially as a private business, enable the Private Billing module so that your health service can bill a patient privately.

If your health service operates as a private clinic, you decide what fees to charge for the services you provide, and bill the patient directly for payment in full.

Some patients may be supported in paying their medical costs by third party insurers such as Medicare, WorkCover or their Private Health fund. Once they have paid for their clinic visit, they can claim and receive the relevant patient rebates for the services received, subsidising or covering all fees charged.

Getting Started

To enable your health service to privately bill patients for services, complete the following steps:
  1. Activate the Private Billing module:
    1. Select File > System Parameters > System tab.
    2. Set Private Billing.
    3. In the confirmation window, to import your MBS Favourites into the private billing fee schedule, click Yes. You an adjust the fee schedule later.
    4. Click Save.
    5. Enter your authority code and click Save.
  2. Assign user system rights:
    1. Select File > User Groups.
    2. Select the user group to which you want to assign billing user rights.
    3. Set one or both of the following options.
      Tip: The following rights apply to both private billing and Medicare bulk billing.
      • Billing - to allow in the user group to make claims
      • Billing Administration - to allow users in the user group to administer claims
    4. Click Save.
  3. Set up at least one private billing type. See File > Reference Tables > Private Billing > Billing Type. See Billing Types for more information.
  4. For each billing type that is an organisation, there must be a record in the address book. To add organisations for private billing to the address book, select File > Address Book Maintenance. See Address Book Maintenance for more information.
  5. Set up the private billing fee schedule:
    • If you added your MBS Favourites when you activated the module, edit these records. Otherwise, add each billing item individually.
    • For each fee item, you can set a different fee for each billing type. For example, a private practice might charge $50 for a Standard Consultation to an individual and $75 for Workers Compensation because of the administrative tasks involved.
    • Link a fee item to a Medicare Benefits Schedule (MBS) item so a patient can claim a Medicare refund for the linked MBS item. For example, a Private practice short consult can be linked to MBS Item 3 - Brief Consult Level A.
    • To add and edit fee schedules, select File > Reference Tables > Private Billing > Fee Schedule. See Fee Schedule for more information.

Charging private billing

When a clinician closes a clinical record, or service details are opened from the Service Recording, the Medicare tab is displayed

To change to private billing, on the Detail tab, set Claim Type to Private. This action changes the Medicare tab to the Private tab. See Private Billing for more information.

Managing private billing

To manage private billing invoices, select File > Private Billing Administration. See Private_Billing_Administration for more information.

A private billing invoice lists all items provided for a patient encounter that relate to a payer and the balance due. The 'Payer' field identifies who is going to pay for the service, that is, the individual or organisation who is responsible for the account, who may be different to the patient or recipient of the service. For all patients over 15 years of age, the patient is the default private payer. Update this default in Patient Biographics.

Payers for organisations must be included in the Communicare Address Book.

After a payment is made for the invoice, the payment received details are also displayed.

Reports

To run reports on Private Billing Claims and Payments for any given date range, select Report > Private Billing.