Resources
Background reading for claiming and setting up to work privately.
Start with a claim from service to payment, then the basics of billing Medicare and the health funds, then the rules for your specialty.
Start here
Inpatient medical billing, from service to payment
The six steps of an inpatient claim, who pays, what ECLIPSE covers and where income is lost, with links to each detailed guide.
Billing basics
Billing Medicare and the health funds: provider numbers, who pays, what a claim needs, assignment of benefit and referrals.
How private inpatient billing works
Who pays a private inpatient's medical bill: Medicare's 75%, the fund's 25% or more under its gap scheme, and the patient. No gap, known gap and basic cover.
Billing outpatients
How FreshClaim bills outpatients: bulk bill at 2.85% + GST, or invoice the patient at 5% + GST and lodge a pay-patient claim so Medicare refunds them.
The essential elements of a claim
The six elements FreshClaim uses to build every ECLIPSE claim: patient identity, referral, provider, item numbers, item specifics and assignment of benefit.
How to register new provider numbers for billing
Step-by-step guide to registering provider numbers for medical billing: PRODA, health fund registration, and everything you need to start claiming.
Adding referral information
Medicare referral rules for hospital claims: when you need one, how long each lasts, the in-hospital override, what if it’s missing. Printable quick reference.
Assignment of benefit
Medicare assignment of benefit from 1 July 2026: when you need an AoB, what the agreement records, pre- and post-service, and how to put it in place.
Informed financial consent
What informed financial consent requires of Australian specialists, where the obligation comes from, what to put in writing, and how gap schemes treat it.
Specialty billing guides
The billing rules for anaesthetists, physicians and surgical assistants.
How to bill for anaesthetic services in Australia
Anaesthetic billing step by step: base item, time units, ASA and age modifiers, after-hours loading, and what Medicare and each fund pay. Worked examples.
A new physician's guide to inpatient billing
Setting up for private inpatient consulting: provider numbers, gap cover, ECLIPSE, MBS items 110 to 133, costs, pitfalls and choosing billing support.
Surgical assistant billing
How a surgical assistant fee is worked out under the Multiple Operation Rule, what Medicare and the fund pay, and how to choose no-gap or known-gap.
Surgical assistants and the Multiple Operation Rule
The surgical assistant fee under the Multiple Operation Rule: items 51300 and 51303, the rule applied twice, the threshold trap, worked examples at 2026 fees.
Item reference: 51300 and 51303
Surgical assistant items 51300, 51303, 51306 and 51309 in plain terms: which one to claim, what each pays at 1 July 2026 and what the claim needs.
Choosing a billing service
When to outsource your billing, and how to compare what it costs.
When to outsource inpatient billing
The signs it's time to outsource inpatient billing, what a specialist billing service takes off your team, and how to compare the cost in Australia.