1 ProBills Australia Nationwide Invoicing Services 21 March 2011
2 Thank you for requesting information on ProBills Australia (PBA). This information folder is designed to give you a detailed understanding of what PBA offers, and how the PBA system works. The folder has been broken up into the following sections to make it easier for you to locate information. The contents of each section are listed below: Section 1. Introduction Billing System Mechanics Section 2: Section 3: Section 4: Section 5: Section 6: Services Offered Account Formats Data Transmission Other Administrative Matters Debt Collection Agencies With Whom We Have Established a Working Relationship Section 7: Section 8: PBA Fees and Charges PBA Staff Information and Contact Details Account Examples No Gap registration forms for various health funds Forms associated with the provision of fee estimates Example of the PBA patient-billing sheet DVA Claim for Treatment Services vouchers (plastic envelope1) PBA item number booklet and PBA Business Card (plastic envelope 1) A copy of the ASA Anaesthesia and You brochure (plastic envelope 1) Having read the information provided here, please do not hesitate to call PBA if there are aspects of the service you are unsure of, or points you wish to clarify.
3 INTRODUCTION PBA was established to provide a billing service for medical specialists who would otherwise have to bill patients themselves, in addition to fulfilling their primary professional responsibilities. Currently we support more than 290 clients Australia wide, and process in excess of 6000 accounts per month on their behalf. PBA s services are ideally suited to specialists who: a. operate in a sole practice environment and currently manage their own billing, b. are engaged in locum employment involving constant change of locale, c. have just left a practice where staff used to perform the billing tasks, or d. are considering establishing partnerships or practices, but wish to avoid employing full time office staff specifically to deal with billing activities. PBA is also well placed to offer a temporary billing service to specialists whose circumstances are such that a permanent service is not appropriate or required at this point in time. From a client s point of view, the use of PBA as their billing agent attracts the following advantages: a. The saving of time and money. Considerable time and effort is required to set up a billing system, whether computerised or manual. Computerized systems can also be expensive. Similarly, the time involved in producing accounts, preparing the banking, issuing receipts, and dealing with account problems can be considerable. (All this involves the allocation by the specialist of resources to tasks that are not central to their profession). b. Use of an intermediary with a number of years experience in specialist billing who can deal with most account matters raised by a patient. c. Easy access by patients to fee quotations prior to admission to hospital. d. Access to practice data, without the need to extract it personally.
4 BILLING SYSTEM MECHANICS PBA uses the relational database Microsoft Access to operate its billing service. While it is not necessary to understand the details of the database structure in depth, knowledge of the basic set up may be of interest to you. Being a relational database, information concerning accounts is stored in a number of different tables, rather than in a single one (as would be the case if a spreadsheet, or a flat database, was used). For the billing system PBA uses three primary tables, one which holds biographical information about account recipients (name, address, type of account etc); one which holds details of the service(s) provided to them; and one which records payments made by the recipients. Each PBA client is allocated an exclusive source database (known as the client database) containing these three tables. Should a client decide to terminate the use of PBA these three tables would be converted to text delimited files and returned to the client. This would allow the client to include that data in a relational database system of their own, or read the data in each table using any computer programme that can read DOS based text files.
5 SERVICES OFFERED (With the exception of the Comprehensive Fee Estimate Service all services listed in this section are covered by the basic account fees listed in Section 7) PBA offers the client the following services: Account distribution: Initial patient accounts are produced and dispatched on behalf of the client. The accounts are based on information provided to PBA by the client. The PBA system is designed to minimize the work required of the client in order to provide the necessary information. The mechanics of the transfer of information is dealt with in detail in a later section. Payments and receipts: All payments received for a client are entered into the client database. This transaction automatically generates a fully itemized receipt that is dispatched to the patient. Patients can pay by cheque, money order or credit card, or by electronic funds transfer (EFT) to a special PBA bank account. If necessary they can also lodge a payment over the counter at an ANZ branch in their locality. All credit card transactions attract a processing fee of 1.2%, which is added to the fee paid by the patient. This processing fee is retained by PBA to help offset the cost of providing patients with access to a credit card payment facility. The PBA system is structured in such a way that all cheques/money order payments made by patients, Medicare, the private health funds, and other organizations are drawn in favour of the client, not PBA. Credit card and EFT payments however, are made to PBA. These funds are then transferred to the client on the first business day after banking, by direct electronic transfer from the PBA account. Comprehensive documentation of all credit card payment activity is included as part of each banking report. In some instances clients have pre-existing arrangements that allow patients to pay accounts in person, at a surgeon s rooms for example. If this is the case, and the client wishes it to continue, PBA will make arrangements to enable that occur. Payments received directly by the client can also be readily entered into the PBA system as remote payments.
6 Banking: Banking occurs once a week. Each client receives a weekly banking report which details payments we have processed during the preceding week. Information includes the date account was sent, account status, mode of payment, dates of reminder notices etc. If no banking occurs for a client a banking report is not produced. To provide the banking service PBA requires the following account information: a. name of the bank, b. the branch name and BSB number, c. account number, and d. name of the account. Access to the client s account is limited to deposit action only. Follow-up of unpaid accounts: NB As a matter of course all follow-up action for accounts sent to patients is by mail, or . On the basis of past experience we do not contact patients by telephone to discuss unpaid accounts, and they have not been factored into the cost of our service to clients. Based on our current practices, an analysis of bad debt statistics across our entire client base reveals a bad debt rate of just over 1%. It is our belief that this rate would not be greatly improved by the use of telephone calls. Experience also shows that the best time to make phone calls to patients is after 5:00pm. Prior to that time most calls are generally put through to answering machines or message banks, and we rarely get a call back response. If however a client particularly wants us to ring a patient a call charge will be levied. PBA s system allows you to set a default period for the terms of the account (that period before we commence overdue notice action) and, where applicable, the discount period; and then vary them for specific accounts. This means you can set as your defaults the term period for your accounts to 40 days, and the discount period to 30. These values would be used for all your accounts unless you specifically wanted to increase or decrease them for a particular patient. For example, one of your patients may be heading off overseas (never to return) sometime after their operation. In this instance you may want to set the terms of the account to 14 days, rather than the usual 40 so that follow-up of non-payment occurs sooner.
7 On the other hand, you may be aware that a particular patient is to be in a situation where payment within the normal period may not be possible, so you could extend the discount period to 60 days and the account terms to 70, to allow them additional time. One important thing to take into account when setting these values is the fact that, at the present time, it can take up to 5 weeks for Medicare and a health fund to process a patient s claim and send them the cheques for forwarding on to you. This means that if you set a discount period to only one or two weeks you are advantaging patients who can afford to pay up front, while disadvantaging those who need to claim from Medicare and their health fund before paying. The PBA defaults for these periods are 40 days for the account terms, and 30 days for the discount period. You are asked to set these periods in the Application Form. Depending on the type of account used various overdue notices may be dispatched. Non discount accounts: 1. First reminder on expiry of the account terms period. 2. Second reminder 14 days, or as soon as practicable after the first reminder. 3. Debt recovery action see below: a. debt recovery warning letter, b. debt recovery action, 7 days after warning letter. Accounts using a discount for early payment: 1. Friendly reminder automatically produced by the system ten days prior to the expiry of the discount period if no payment has been received (e.g. 20 days after the account is sent if the discount period is set to 30 days). It warns the patient that they only have a limited period of time left to avail themselves of the discount period. 2. First reminder - on expiry of the account terms period (discount fee is disabled and the account is set to the full fee). 3. Second reminder 14 days, or as soon as practicable after the first reminder. 4. Debt recovery action see below: a. debt recovery warning letter, b. debt recovery action, 7 days after warning letter.
8 No Gap, Workers Compensation and Third Party Accounts PBA employs 3 staff members whose sole task is the follow up of un-paid, or under paid No Gap, workers compensation or third party accounts. In developing this role the current incumbents have established a very close and effective working relationship with key staff within most of the health funds. Reminder notices and debt processing can be deferred or delayed to accommodate nonpayment due to circumstances beyond the patient s control, or in response to a plea of hardship etc. All overdue notices are structured as an invoice accompanied by a letter. The content of the letters varies depending on which notice is being sent. The Second Reminder clearly draws the patient s attention to the fact that formal debt recovery will be the next step if the account remains unpaid, and in most instances there is no need for further action. Examples of the overdue notices and final warning letter are included in Section 8 of this folder. To initiate formal debt recovery PBA provides clients with a list of debt defaulters, and details of their account. This report is typically generated on a monthly basis. The client then returns the list to PBA indicating the required action [e.g. forward to a debt collector /write off]. If formal debt collection action is requested PBA will then send a final letter to the patient advising them of that instruction, along with request they contact PBA to either pay the account or discuss the situation. They are given seven days to respond. If no response is forthcoming debt recovery action is then initiated. Section 6 provides you with a list of debt collection agencies we have established links with. When the time comes you can consult this list as part of the process of deciding which agency to use. Please note that we derive no financial benefit or commission from any of these agencies, and have no preference for which agency you decide to use. Should you already have an established relationship with a debt recovery agency we will liaise with them whenever required, as part of our service package to you. As noted above the debt reports are normally generated on a monthly basis. Our system records the date each report is sent to the client. If, after 6 months (i.e. inclusion on six
9 consecutive reports), we have had no direction from a client about what to do with a particular patient, the account for that patient is closed. Should a client decide they want to pursue such an account it is a simple matter to reopen it. Reports to the client: In addition to the banking report, other reports on activities associated with a client s practice can be produced on request. As a matter of course a report is dispatched at the end of each month/quarter (depending on a client s BAS reporting cycle) detailing the number of accounts that were dispatched during the month, fees charged, average gaps, hourly rates etc. The report also provides a record of any GST payments they have received from patients. The report is accompanied by a PBA Tax Invoice that provides the client with a record of the fees they have paid PBA for the month. The Invoice shows the GST collected from them by PBA. Other reports can be requested on either a one off basis, or as a regular event. These could include monthly, quarterly or annual reports detailing accounts printed, payments made, dates of overdue notices, account status, etc. A series of existing reports provide information on various aspects a client s practice. These can be requested as a regular series, or on the basis of a one off series. A Report and Messaging Request Form, listing the standard series of reports, is enclosed that enables you to specify what reports you would like, what frequency you would like us to send them to you, and by what means. It is also easy to access information on issues such as patient ratios for surgeons/hospitals, the rates of payment defaulters for individual surgeons/hospitals, counts of particular types of surgery, the age distribution of a client s patient population, income derived from each surgeon etc. All that is required for such reports is a written or verbal request detailing the study s requirements. Report Transmission: The preferred method of conveying reports to clients is via . It allows reports to be received immediately they have been generated, rather than having to wait for them to move through the traditional mail system. It is also useful for those clients who prefer to file reports on their computer, rather than as hard copies in binders. PBA creates a PDF file of the reports so clients will need a PDF reader (eg Adobe Acrobat Reader) to view/print out their reports from their computer.
10 Having said this, we can generate hard copy reports and mail them to you via Australia Post. The Application Form includes a page that allows you to specify how you wish to receive your reports. As part of the report series PBA creates a Deposit Report detailing all payments we have processed on your behalf that is specifically provided for your accountant or bookkeeper all patient names etc have been removed. If you so desire we can create an package that contains this special deposit report, a copy of the Bank Reconciliation Report and a copy of our invoice to you (Referred to as the Accountant pack ). This can then be ed to you as a separate message (so you can easily forward it on to your bookkeeper or accountant) or, with your authority, we can organise to that package directly to your bookkeeper/accountant automatically whenever we generate reports for you. Provision is made in the Application Form for you to indicate what you would prefer. Telephone support for account inquiries: PBA provides a FreeCall number that allows patients from anywhere in Australia free access to advice/information regarding their account. Security: PBA adopts a rigorous approach to the security of all aspects of the business. All client databases are backed up to several different locations every five minutes during the working day and at the conclusion of each day s business the databases are backed up to three separate drives, two of which are taken off-site each night. All cheques and cash are secured in a Chubb fireproof safe. Should a problem occur at the PBA premises that rendered the office unfit for use (an important consideration given that we are located directly above three restaurants) we have the capacity to transfer the day to day running of the business to another location with minimal disruption. Fee Estimates (normally only for anaesthetists): PBA can also provide patients with estimates of what fee they could reasonably expect for an anaesthetic by a particular client. If patients do require an estimate they need to obtain a detailed description of the proposed surgery, so that we are in a position to select the appropriate item number(s); and an estimate
11 of the duration of surgery. It is important to note that in providing an estimate we are not in a position to factor in such things as modifiers and therapeutic or diagnostic services that may be included in the final account. All patients receiving an estimate are advised of this possibility, and also of the impact a variation in the actual anaesthetic time may have on the actual fee charged. If a client wishes to make this service available for their patients they will need to supply PBA with default unit fee values for the full fee, and the discount fee if applicable. In general it is recommended that the fee used as the default for this service is set at the higher end of the range of fees the client uses - this will mean that any variations between the estimate and the actual fee will tend to be in the patient s favour. Clients will also have to provide their surgeons with our contact details (please give them our FreeCall number) so that the patients can contact us prior to admission. COMPREHENSIVE FEE ESTIMATE SERVICE (ANAESTHETISTS ONLY). attracts an additional loading on top of the standard account fee see Section 7]. [This service In order to ensure that patients are given an estimate of fees prior to admission to hospital PBA staff proactively liaise with surgeon s rooms to obtain advance information on patients scheduled for surgery on particular lists. A record is created in our system and staff then contact the patients and provide them with both a verbal (over the telephone) and written fee estimate and the Anaesthesia and You brochure. This process removes problems associated with us having to rely firstly, on surgeon s rooms providing patients with our contact details etc. and secondly, on patients acting on that information and contacting us. Particular attention is paid to what health fund a patient belongs to so that we can, if required by the client, provide fee information in such a way as to allow patients to access Known Gap cover.
12 ACCOUNT FORMATS All PBA accounts are printed using A4 size paper. For all private patients, defined by PBA as those who are going to claim from a private health fund and/or Medicare, the account generally consists of two pages. Our web site contains a detailed explanation of fees so each account includes an invitation to the patient to either log on to the site, or call our office on the FreeCall number should they require details on how the account fee has been arrived at. PBA s aim is to make the billing process as simple as possible for our clients. If a client has a pre-existing way of formulating the account fees, which does not match one of the built-in account structures, we will make the necessary changes to include it. The system also allows for variation of account structure for individual patients within the same batch. To speed up data entry PBA uses, wherever possible, a set of account format defaults. These are loaded each time a new account is entered onto the system. The defaults usually take the form of a dollar unit value for the discount and full fee or a specified gap above the Schedule Fee (anaesthetists), or a percentage mark-up on the Schedule Fee (other specialities). Whilst these defaults are loaded for each new patient, they can be easily changed for a particular patient if required. A section on the Application Form asks client to nominate their defaults. The most common account format in use involves a discount/full fee structure, determined by the use of different unit values for the discount and full fee (anaesthetists); or percentages above the Schedule Fee (other specialities). It may interest you to know that the use of a discount/full fee structure significantly speeds up payments and reduces the need for follow-up action. A recent study of PBA clients matched two clients located in the same area, with roughly the same number of patients, but differing in the fact that one used a discount/full fee format, while the other offered only a single fee. In the twelve month period studied 152 patients from the client offering the flat fee required contact with one or more overdue notices, while only 34 patients from the Discount/Full Fee client had to be contacted. Another common format involves the client specifying a loading to be added to the Schedule Fee (i.e. a gap payment) e.g. a client might indicate a fee of S/F +$200 for a patient. This format can also be used with the Medicare Rebate being set as the fee base e.g. Rebate +$50.00.
13 Some clients set up the fee by specifying a full fee, and then indicating a percentage deduction for the discount fee, e.g. $ less 10% for early payment ; while others go the other way and ask, for example, for a fee to be calculated on the basis of a discount fee of $300.00, with a 20% loading for the full fee (late payment penalty). Occasionally a client will opt to use an hourly rate for a fee so, for example, we may be requested to produce an account with a fee based on an hourly rate of $ The bottom line is that, so long as a client can clearly indicate what sort of fee is to be used, or how it is to be arrived at, we can adjust our system to achieve the desired result. Workers Compensation The payment schedules used by workers compensation insurers vary from state to state. In New South Wales, Northern Territory, Tasmania, Western Australia, and the Australian Capital Territory insurers remunerate doctors using the AMA List of Fees. In Victoria, South Australia, and Queensland, insurers calculate their reimbursements using the MBS Schedule of Fees as a guide. Department of Veterans Affairs (DVA) DVA accounts are calculated using the fee schedules specified by that department. Cosmetic Surgery Accounts Generally cosmetic surgery account fees are based on the AMA List of Fees, and include GST. On those occasions where a mix of cosmetic (Medicare ineligible) and Medicare eligible surgery occurs PBA will produce two separate invoices, one covering the surgery the patient is able to claim a rebate for, and another for the non-claimable, and GST attracting component. Anaesthetists please note that for these types of invoices we need to know how much time is to be allocated to each type of surgery. Also note that in order to maximise the rebate claimable by the patient we normally include services such as the pre-anaesthetic consultation, arterial lines, post-operative pain management etc on the invoice that is eligible for a rebate. Other GST Accounts In some instances accounts for services that are deemed medically necessary (and therefore, in normal circumstances, not liable to a GST) do attract a GST. The most common reason for this is that the service provided was done so as part of a contract between the client and a
14 third party, for example, a regular list at a military hospital. It is important that in these cases the client clearly indicates to PBA that a GST is to be applied. No Gap Accounts. PBA has in place the necessary account formats and fee tables to process No Gap accounts for submission directly to the various health funds from any state or territory. Known Gap Accounts (typically for anaesthetists only) Known Gap accounts involve two documents. The first is a No Gap account that is sent to the fund for their contribution, and a gap/co-payment account to the patient for their contribution. The fee for the co-payment account can be calculated using either the client s default fee settings, or as a gap specified by the client. Please note that for AHSA funds there is an upper limit of $400 per item number. If the gap payable by a member of those funds exceeds that limit they will not have access to the Known Gap scheme. Medibank Private has set a limit of a total gap of $ If the gap exceeds that amount we cannot use the Known Gap format. Anaesthetic Consultations (17610), Epidural Infusions (18216 and 18219) In the Medicare MBS these, and a number of other consultation and regional nerve block items are not included in the MBS RVG, and therefore do not have units allocated to them. To help simplify the operation of our system PBA assigns unit values to each of these services for the purposes of calculating discount and full fees that differ from either the Rebate or the Schedule Fee. The table below shows the unit values attached to each number. The unit values have been obtained by rounding up, to the nearest whole number, the figure arrived at by dividing the listed Schedule Fee for the service by the dollar value for one MBS anaesthetic unit.
15 Number Units Allocated for each additional 15 minutes exceeding 1 hr of attendance for each additional 15 minutes exceeding 1 hr of attendance
16 DATA TRANSMISSION For PBA to process the accounts the information needs to be sent to our office in Canberra. This can be achieved by the use of the postal service, by fax, or by . It is strongly recommended that photocopies are made of all data dispatched to PBA in case the originals are lost en route. When we receive a batch of accounts we always acknowledge receipt either by an SMS message to the client s mobile, or by return (if the accounts have been ed to us). All accounts received into the office are scanned into the computer system for future reference. For fax or mail transmission PBA has designed a series of billing sheets for your use. Examples of the various billing sheets available are included in Section 9 and include two versions for anaesthetists (Type A = 4 patients per page, Type B = 1 patient per page), a version for ICU, and one other for all other clients. We will supply hardcopy versions on request, and we can also provide PDF versions via that you can save and print off as required. Please note that it is not mandatory that you use our sheets, but it is certainly preferred. In general, the information required by PBA for account production is no more than would be needed for accounts to be produced by the clients themselves. The information required includes: a. The title, name, address of the patient; and the name and address of the account recipient if the account is not going to the patient (e.g. to the patient s parent, employer or to some other organization with the exception of DVA accounts the DVA address details are already to hand). b. Name of the hospital and surgeon. c. Medicare numbers, health fund details and membership numbers, DVA/workers compensation/third party claim numbers, or military service numbers where appropriate. d. Telephone number (if available) of the patient
17 e. The type of account the client wishes the patient to receive. f. The date and a brief description of the surgical procedure/anaesthetic service undertaken. g. All MBS anaesthetic item number(s) or AMA/ASA item codes to be included in the account. It is the client s responsibility to select and list the item number to be used to generate the fee. h. (ICU only) Details of the ICU services provided to the patient. N.B. If a blood transfusion has been performed, particularly on the first ICU day, it is essential that the time of the ICU transfusion is provided, otherwise there is a good chance the Medicare will reject it if a transfusion has also occurred during surgery prior to admission to ICU. We recommend that transfusion times are listed for all such services during a patient s admission to ICU i. The start and finish time for the anaesthetic; and consultations if more than one is conducted (anaesthetists only). j. Referral details including referring doctor, date of referral and duration of referral (Anaesthetists where only a consultation occurs. Surgeons and physicians for all services) Generally the information for points (a) and (b) are provided by the hospital via stickers that can be attached to the billing sheet. Please note that it is important to ensure that both the surgeon/referring doctor and the hospital are clearly identified for each account. We are aware that from time to time the information will not be available until after the surgery date. In these instances we will chase up the required information however, should a client persistently leave of critical information that requires us to contact surgeons, hospitals or the clients themselves on a regular basis, the decision may be made to charge a phone call fee for each call we have to make in order to process the accounts. Patient Numbers. On the PBA system the patient numbers are determined by the date of surgery. All a PBA client need provide is the date of surgery. The PBA system will then generate the patient number. For your information the number system used by PBA involves a 9-digit number. The first digit is a 2 (to overcome data sequencing problems associated with the new millennium).