Other Helpful Information

Informed Financial Consent (IFC)

Informed Financial Consent (IFC) works best when doctors, hospitals and Health Funds work together to provide information to patients about the costs associated with treatment, and the Medicare and Private Health Insurance benefits payable, prior to admission to hospital.

Providing for Informed Financial Consent for patients is sound, ethical, professional practice. Ultimately it is also good business practice and will result in fewer disputes over accounts, lower debt recovery costs and fewer bad debts.

The AMA and Federal Government have both put strong emphasis on the need for Informed Financial Consent for private patients. To find more information about AMA’s position statement on IFC go to: http://ama.com.au/node/5091

When should Informed Financial Consent (IFC) be issued to my patients?

When you are charging a gap/co-payment to your patients or when an account will be issued directly to your patient. So your patient is aware of his/her responsibility prior to the service being provided.

IFC is not required when your claim is submitted under a No Gap Scheme. It is recommended that patient eligibility be confirmed prior to the procedure.

Patients must agree and sign the Informed Financial Consent prior to the procedure.

What is the difference between No Gap, Known Gap Scheme and Patient Account?

No Gap process:

• One account submitted directly to the Health Fund;
• The doctor charges the Commonwealth Medical Benefits Schedule (CMBS) fee, or
• The doctor and the Private Health Fund (either directly or via a private hospital) have an arrangement/agreement for payment above or at the CMBS fee and the doctor charges the agreed fee, e.g. Medical Purchaser Provider Agreement (MPPA) or
• The doctor uses an existing Private Health Fund ‘product’ (such as HCF’s Medicover Arrangement or NIB’s MediGap Scheme) and does not charge the patient an additional amount;
• Informed Financial Consent not required;
• No Gap claims are submitted directly to the Health Fund. The Health Fund forwards the claim eletronically to Medicare for the 75% (of CMBS) in-patinet benefit. The patient does not get any account making it a streamlined process with accounts being finalised by the Health Fund. We encourage No-Gap billing where possible for private patients as there is no out-of-pocket charge to the patient.

You will be paid:

• 75% of the CMBS fee from Medicare, and
• 25% of the CMBS fee from the Private Health Fund, and
• Any agreed premium above the CMBS fee from the Private Health Fund.
• No Gap accounts are paid in full by Health Fund/ Medicare at No Gap rates.

‘Known gap’ simplified medical billing occurs when the patient has a gap to pay and there has been an Informed Financial Consent process between the doctor and the patient.

Known Gap process:

• ‘Doctor Claim’ issues one account to the Health Fund, and the Health Fund submits the claim eletronically to Medicare for the 75% (of CMBS) in-patient benefitt;
• A second account to the patient for the balance (i.e. the previously agreed ‘gap’ charge);
• Informed Financial Consent required.

You will be paid:

• 75% of the CMBS fee from Medicare, and
• 25% of the CMBS fee from the Private Health Fund, and
• any agreed amount above the CMBS fee from the Health Fund (if using  medical gap schemes such as HBA’s Ezyclaim or Medibank Private’s GapCover), and
• the balance (i.e. the previously agreed ‘gap’ charge) from the patient. The co-payment is electronically deposited into your nominated bank account depending on the time it takes to recover it from your patient.

Recovery of the agreed gap charge for Known Gap claims can sometimes be a slow process. If this is the process you prefer we recommend payment of your agreed gap charge to be collected up front from the patient prior to the service being provided.

Once we recover the agreed gap charge from your patient we will deposit it into your nominated bank account.

Accounts are issued directly to the patient and can be charged at No Gap or Known Gap rates depending on the agreement between you and your patient/s. In this situation Informed Financial Consent should be issued so the patient is aware of any payments due by them prior to the service being provided.

Patient Account Claiming process:

• Patients can pay the account up front and take the receipt to Medicare and their Health Fund; or
• Take the unpaid account to Medicare and their Health Fund, collect the respective rebate payable from them and post it to the provider. In this process the provider receives payment by cheque;
• Informed Financial Consent required.

Recovery of patient accounts payment can sometimes be a slow process. If this is the process you prefer we recommend payment of your accounts be collected up front prior to the service being provided. Once we recover the payment from your patient we will deposit it into your nominated bank account.

Important Information on how you can help us to provide a better service to you

1. Ensure that you have an active Medicare provider number;
2. Let us know if you have a new Medicare provider number;
3. Provide all patient details (Medicare card number and reference, Health Fund name and membership number, hospital UR number, date of birth, referral doctor etc) – as required on our medical billing service form;
4. Provide us with contact details so that we can request clinical notes where required. Your response will impact on our ability to recover payment for rejected claims;
5. If you receive any cheques or benefit statements from Medicare or Private Health Funds, please forward these to us so that we can finalise your claims for reconciliation purposes and ensure that our records are up to date.

You can notify us of the above by email, fax or mail. For cheque payments we require the following information:

• Total amount paid;
• Cheque number;
• Name of Patient;
• Name of Health Fund that issued cheque, or
• email, fax or mail the statement which covers all the above.