Outsource your inpatient billing when it stops being a routine task and starts competing with everything else your team does.
The usual signs: claims wait days for someone to have time, one staff member holds all the billing knowledge, rejections and unmatched payments pile up, and billing hours grow with every new operating list. A specialist inpatient billing service takes over lodgement, rejection follow-up and reconciliation, and reports what has been billed, paid and is still outstanding.
Inpatient billing, often called private hospital billing, runs from the doctor recording the service to the payment being matched to the right patient, with rejected claims corrected and lodged again along the way.
Managing billing in-house works well for many specialists early in practice. These are the points where it usually stops working.
Procedure lists, item numbers, claim preparation, lodgement, payment follow-up and reconciliation take a growing share of the week. As inpatient activity increases, billing absorbs time that would otherwise go to patients, referrers and the doctors.
How many hours each week go to inpatient billing? If the answer is measured in days, outsourcing is worth exploring.
When billing fits around other work, claims get lodged days or weeks after the service, in batches. Payment waits by the same amount, backlogs grow and you lose sight of what is outstanding.
Delay also causes loss: a claim waiting in a pile is the one most likely to be missed altogether.
How long, on average, is it between a procedure and its claim being lodged?
In many practices, inpatient billing sits with a single experienced administrator. It works well until they take leave, reduce their hours or move on. Then fund rules, rejection fixes and the state of every open claim leave with them.
Who lodges claims when that person is away? How long would it take to train a replacement, and would claiming continue in the meantime?
Billing does not end when a claim is sent. Medicare and health fund payments arrive as single deposits covering many patients. Each one has to be matched to its claims, short payments followed up and missing payments found.
As volumes grow, this often becomes the most time-consuming billing task in the practice, and the one most likely to be left for later.
Could you say today which of last month's claims are still unpaid?
More procedures mean more claims, more payments, more reconciliation and more reporting. Billing work rises in step with activity across the whole medical practice.
An outsourced service scales with your activity, without recruiting, training and managing more billing staff.
If your theatre activity grew by a fifth next year, who would do the extra billing?
Claims fail for incorrect fund details, incompatible item numbers, missing referral information or simple transcription errors. When we tested conventional billing platforms, around 15 percent of claims failed on first submission.
Each rejection takes 5 to 30 minutes to investigate, correct and lodge again, and often needs Medicare and fund rules knowledge. The ones nobody has time to fix become aged debt.
How many rejected claims are sitting unresolved right now, and whose job is it to fix them?
Most practices know what arrived in the bank each month. Fewer can see the claims behind it: what was billed, what was paid, what is still outstanding and where the delays are.
Every attendance ends in one of four outcomes. Only the first costs you nothing beyond the fee. A good billing service reports on all four.
Could you produce this breakdown for last quarter?
A complete service takes on the whole of inpatient billing management, not just the lodgement. Your team keeps the work that needs to be done in the practice.
The quoted fee is the easiest billing cost to see. In-house billing has no fee, but it is not free. Compare both on the same basis: everything it takes to turn your work into payments.
Services that look alike on price can differ widely in what they hand back and how much of your work they get paid. Four questions show the difference.
Some services lodge claims but leave data entry and rejections with the practice. Ask exactly which tasks stay with you.
Some charge per rejection or return corrections to the practice. Ask what happens to a claim nobody can fix.
Ask for claim-level reporting you can check against your own lists, not only monthly totals.
Billed or collected? Is there a minimum per claim, a setup fee or a lock-in contract?
Most services charge a percentage of billings or collections, typically 2 to 5 percent, and some add minimum per-claim or rejection fees. FreshClaim charges 2.85% + GST of what Medicare and health funds pay through ECLIPSE, 5% + GST where the patient, TAC, WorkCover or a hospital pays, and nothing until the claim is paid.
You should gain it. Ask any service for claim-level reporting: what was lodged, when, what was paid and what is outstanding. FreshClaim shows every claim's status in the app and itemises each deposit by fund and patient.
In-house billing can work well early in practice, when volumes are low and the doctor or one staff member knows each claim. The case for outside medical billing support grows with volume, with the number of payers and when billing depends on one person.
Yes. ECLIPSE lodges the Medicare and health fund benefit. The patient's out-of-pocket amount on a known-gap claim is not part of the ECLIPSE claim, so it is invoiced to the patient separately. Check that a service handles both.
That depends on the service, which is why it is worth asking. Some return rejections to the practice or charge per correction. FreshClaim investigates, corrects and lodges them again as part of the fee, and only comes back to you for information it cannot get elsewhere.
Most health funds are ready for claims within one to two weeks.
There is no single claim volume or practice size that decides it. The point usually comes when billing stops being a routine task and becomes an operational responsibility.
If your team spends more time on revenue administration than on the patients and doctors it supports, compare what your current billing costs.
2.85% + GST of what you collect. Nothing until the claim is paid. No setup fee, no lock-in.
