Ease Into Easyclaim

Introduction

Announced by Prime Minister John Howard on the 13th of August 2006, Medicare Easyclaim (formerly known as Electronic Medicare Claiming) is a new patient payment system developed by Medicare Australia for Specialist and General Practice.

Set to be introduced in "the second half of 2007", the system will utilise the EFTPOS network for the transmission of data from practices to Medicare Australia and participating financial institutions.

How Does It Work?

Medicare Easyclaim has been designed as a stand-alone system and doesn’t require practice software or a computer to operate. Instead, receptionists will use the practice’s EFTPOS terminal to process claims.

In its proposed form, there are three billing scenarios where Medicare Easyclaim can be used:

Bulk Bill Claims

Following the consultation:

  1. The patients Medicare card is swiped through the EFTPOS terminal by the receptionist.
  2. The item number/s, provider number and cost of the consultation are entered into the EFTPOS terminal by the receptionist.
  3. The EFTPOS terminal sends a claim to Medicare Australia.
  4. Medicare Australia sends back an approval message to the EFTPOS terminal.
  5. The patient is then asked to press "OK" on the EFTPOS terminal to allocate the Medicare Australia payment to the doctor.
  6. The EFTPOS terminal will print a receipt for patient.

This completes the transaction and no further information or paperwork needs to be provided to Medicare Australia. Payment from Medicare Australia should arrive in the practice’s nominated bank account by the next business day.

Privately Billed Patients

Where the account is paid following the consultation:

  1. The practice presents the patient with an invoice.
  2. The patient pays for the consultation with cash, cheque, debit card or credit card.
  3. The receptionist then swipes the patient’s Medicare card through the EFTPOS terminal.
  4. The item number/s, provider number and cost of the consultation are entered into the EFTPOS terminal by the receptionist.
  5. The EFTPOS terminal sends a claim to Medicare Australia.
  6. Medicare Australia sends back an approval message to the EFTPOS terminal.
  7. The patient’s debit card is swiped through the EFTPOS terminal.
  8. The patient enters their pin number and specifies whether they would prefer the money to be paid into their savings or cheque account.
  9. The EFTPOS terminal prints a receipt and the money is transferred into the patient’s bank account.

Unpaid Accounts

For unpaid accounts, the following procedures will apply:

  1. The patients Medicare card is swiped.

  2. The item number/s, provider number and cost of the consultation are entered into the EFTPOS terminal by the receptionist.
  3. The EFTPOS terminal sends a claim to Medicare Australia.
  4. A cheque is sent from Medicare Australia to the patient who then brings it back to the practice.

Benefits

The benefits of the Easyclaim system as purported by Medicare Australia are:

  1. Other than the patient’s receipt, there is no paperwork generated with bulk bill claims.
  2. Payment for bulk bill services will usually arrive on the next working day.
  3. Concession entitlements for bulk bill claims are verified in real time.
  4. Via the EFTPOS terminal, practices can request ‘pay doctor via claimant’ cheques for unpaid accounts, providing greater certainty the claim has been made.
  5. Participating practices will be providing a service that 84% of patients who "usually pay" for medical services say they want.

EASYCLAIM Q&A

As with any new system, there is the potential for confusion amongst practices as they adopt Medicare Easyclaim. To assist practices to better understand the new Medicare initiative, the rest of this article is devoted to answering a number of questions that have been raised since Medicare Easyclaim was first proposed.

Why is Easyclaim being introduced?

Medicare Australia has stated that Easyclaim is designed to provide greater convenience to patients and doctors than existing systems currently provide.

According to Medicare Australia, up to 80,000 people per day visit a Medicare office to claim their rebate. Medicare Easyclaim promises to make their lives simpler, especially if they are currently attending a practice that doesn’t use the private patient claiming features of Medicare Online Claiming.

Which peak bodies did Medicare Australia consult with during the development of Easyclaim?

The AMA originally proposed an EFTPOS-based system around three years ago and has been working with the relevant Ministers and the Department of Human Services throughout the development of Easyclaim. In addition, the AMA has had onging consultation with various financial institutions during the development of their product offerings.

How much will Easyclaim cost?

There is no direct cost levied on practices for transactions processed using the new system.

How Easyclaim will affect overall practice efficiency remains to be seen. It is likely that indirect additional costs or cost reductions will vary widely and be largely dependent on the current billing arrangements of practices.

Financial institutions are paid 23 cents per transaction by Medicare Australia, one aspect of the system that has caused some consternation amongst practice software developers and proponents of gap billing.

Which banks are signed up to provide Easyclaim services?

At the time of writing, the Commonwealth Bank, National Australia Bank and Tyro (formerly Money Switch) have signed contracts with Medicare Australia.

The Commonwealth Bank have badged their Easyclaim solution as "MediClear" and have included information about their services on their website.

Who and what is Tyro?

Tyro is a relatively new financial institution, specialising in payment solutions for merchants (including practices). Tyro operates under a recently created financial licence, specialising in electronic payment related services (i.e. credit, debit and EFTPOS transaction factilities).

What options are available to my practice if our EFTPOS supplier doesn’t offer Easyclaim functionality?

In the first instance, Practices are advised to contact their financial institution and ask whether they have plans to become a Medicare Easyclaim certified partner.

Practices should also speak to their practice software developer to discern whether they have plans to integrate with any financial institutions, and if so, which one/s.

If it becomes apparent that your EFTPOS provider has no plans to facilitate Easyclaim transactions, your practice will have to decide whether to change financial institutions, or persist with your existing arrangements.

Is the Easyclaim system secure?

All information transmitted via the EFTPOS terminal is encrypted, and financial institutions are not permitted to store any sensitive information. Information that is stored includes a transaction identification number, the date and time of the transaction and the rebated amount paid into the patient’s account.

Prior to being certified to offer Easyclaim services, participating financial institutions need to complete an accreditation process with Medicare Australia.

This accreditation process includes a comprehensive security audit conducted by Defence Signals Directorate approved assessors to ensure that messages are carried and handled securely and in accordance with Government policy.

Will patients require a new Medicare card?

No, Medicare Easyclaim operates using existing Medicare cards. When the Access Card is released, financial institutions need to provide EFTPOS terminals capable of handling the advanced security features of the proposed card.

What if the patient forgets their Medicare card, or the EFTPOS terminal or magnetic strip on the card is faulty?

In the event that a Medicare card cannot be swiped, reception staff are able to manually enter Medicare numbers into the EFTPOS terminal.

What happens if incorrect information is entered into the EFTPOS terminal?

If an error occurs when a privately billed patient’s claim is being processed, the claim can be cancelled before the patient’s debit card is swiped and the transaction re-done.

If the error occurs after a bulk bill claim is submitted, the practice would need to contact Medicare Australia to fix the error using the dedicated practitioner help desk line.

Will this replace Online Claiming (formerly HIC Online)?

No. All Online Claiming services are going to be maintained, and practices are free to use Easyclaim concurrently with Online Claiming if they wish.

What about Department of Veterans Affairs (DVA) claims?

DVA claims cannot be transmitted using Medicare Easyclaim. According to Medicare Australia, the additional information required by DVA could not be efficiently entered into an EFTPOS terminal. Practices will continue to process DVA claims using existing lodgment methods.

Are there any mobile billing solutions available to practitioners?

All financial institutions presently signed up to deliver Easyclaim services have mobile EFTPOS terminals, however none have publicaly stated whether these devices will be compatible with Easyclaim.

Practices should contact their bank and enquire about the possibility of obtaining a mobile EFTPOS terminal suitable for Easyclaim transactions.

How will training be provided?

Given the repetitive nature of patient billing and the limited number of Easyclaim "compatible" scenarios, it shouldn’t take staff long to get up to speed on the new system. Like any new system however, there will be a learning curve for practice staff.

Medicare Australia has indicated that participating financial institutions will provide training materials and ensure the practice’s EFTPOS terminal is capable of performing Easyclaim transactions.

In addition, Medicare Australia plans to work with the relevant professional bodies to keep practices informed, and has already conducted Easyclaim forums with several state branches of the AMA.

Kathryn Conroy, the Media Officer for the Australian General Practice Network (AGPN), indicated that the 119 divisions of general practice have the capability to work closely with Medicare Australia to assist general practices to become familiar with the new system.

Ms Conroy went on to say that, "Should there be any gaps in training, general practice Medicare representatives may be able to attend Division Network GP education evenings. Representatives would be able to demonstrate how the system works. Such evenings have the potential to include live demonstrations and Q&A sessions."

How will patients be informed about Easyclaim?

A patient centric education campaign is scheduled to commence in mid August this year. Practices will also be provided with resources to pass on to patients who request information about the Easyclaim system.

Medicare Australia are promoting the fact that Easyclaim is a standalone system as a benefit, but won’t this result in double entry?

While EFTPOS keypad shortcuts will streamline the process somewhat, until practice software vendors release versions of their programs that integrate with EFTPOS terminals, double entry will be a reality for practices who adopt Medicare Easyclaim.

Fortunately, some financial institutions and practice software vendors have been collaborating to develop integrated solutions, which should streamline the process of using the Easyclaim system significantly.

At the time of writing, it is unclear which financial institutions and practice software vendors will collaborate on integrated Easyclaim solutions. Because of this uncertainty, practices are strongly advised to avoid entering into long term EFTPOS contracts which may limit their options in the future.

For more information about integrated Easyclaim solutions, refer to "Easyclaim Integration" on pp28 of this edition of Pulse+IT.

To speed things up for bulk billed transactions, am I allowed to press "OK" to complete the procedure on the patient’s behalf?

As outlined at the start of this article, having reviewed the claim information on the EFTPOS terminal screen, the patient is required to press "OK" to assign their benefit to the doctor.

Patients will be informed of this legislative requirement. If a practice is found to not follow the prescribed procedure, Medicare Australia will take steps to investigate.

How will practices reconcile Easyclaim transactions given that the EFTPOS terminal only produces receipts for the patient?

Medicare Australia is currently developing a daily report that will allow practices to reconcile the payments they receive against the claims made. This report will be made available to practices via a secure website.

Presumably once integrated solutions are released, similar fuctionality will be replicated within the practice software.

Posted in Australian eHealth

You need to log in to post comments. If you don't have a Pulse+IT website account, click here to subscribe.

Sign up for Pulse+IT eNewsletters

Sign up for Pulse+IT website access

For more information, click here.

Copyright © 2017 Pulse+IT Magazine
No content published on this website can be reproduced by any person for any reason without the prior written permission of the publisher.