Medicare Bulk Billing Incentives

For eligible patients, Helix automatically adds Medicare billing incentive items to a service for a consult.

Before you begin

Eligible patients are those who are either under 16 years of age, or have a valid concession card, such as a Centrelink or Seniors Card.

About this task

Different incentives apply depending on the Modified Monash Category in which your centre is located. Select either your centre's category, MM1-7 to automatically apply incentive items added by Services Australia on 1 November 2023, or specify a default bulk billing incentive item. For more information, see Modified Monash Model. To find your centre's MM category, see Health Workforce Locator.

Procedure

To define the Medicare billing incentive item added for eligible patients:
  1. Select User iconuser > Settings iconSettings.
  2. Select Centre > Centre Settings.
  3. For your centre, hover the mouse over your centre name and click Edit iconEdit.
  4. In the Centre Management window, select the Billing tab.
  5. From the Default billing type list, select Medicare or DVA.
  6. To set bulk billing incentives, either:
    • From the Modified Monash Category list, select the category for your centre, for example MM1 - Metropolitan areas. Incentive items are automatically added for eligible patients to all eligible bulk billing items, for example, 75870 is added for items 23, 36, 44, 123.
    • In the Custom Default Bulk Billing Incentive Item No field, enter the number of the billing incentive item that you want applied for relevant Medicare or DVA items for eligible patients. For example, 75870.
  7. If required, add default incentive items which are automatically included for other billing types:
    • Default First Available Item No
    • Default First Available After Hours Item No
    • Workers Comp First Available Item No
    • Workers Comp First Available After Hours Item No
    • Workers Comp First Visit Additional Item No
    • Credit Card Surcharge Item No
  8. Click Save.

Results

Medicare incentive items are automatically added to any visit with any healthcare practitioner that meets the following conditions:
  • Billing type of Medicare or DVA
  • Patient is under 16 years of age or has a valid concession card included in their patient details
  • Patient has a valid Medicare or DVA card
  • There is no referral attached

First available and workers compensation incentive items are automatically added to any eligible visit with any healthcare practitioner.

If a patient is registered with MyMedicare and this is recorded in Helix, additional incentives may be available. For more information, see Regular centre.


Example Medicare incentive billing