Resources
Billing basics for Medicare and the health funds
What you need to bill Medicare and the health funds for private patients, in the order you need it.
How billing works
- 1How private inpatient billing worksWho 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.
- 2Billing outpatientsHow 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.
What a claim needs
- 1The essential elements of a claimThe six elements FreshClaim uses to build every ECLIPSE claim: patient identity, referral, provider, item numbers, item specifics and assignment of benefit.
- 2How to register new provider numbers for billingStep-by-step guide to registering provider numbers for medical billing: PRODA, health fund registration, and everything you need to start claiming.
- 3Adding referral informationMedicare 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.
- 4Assignment of benefitMedicare 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.
- 5Informed financial consentWhat informed financial consent requires of Australian specialists, where the obligation comes from, what to put in writing, and how gap schemes treat it.