Charges for Medicare Non-eligible patients presenting for ...



Canberra Hospital and Health Services Operational PolicyCharges for Medicare Non-Eligible patients presenting for outpatient treatment and/or procedures Policy StatementAll Medicare non-eligible patients who present for outpatient treatment and/or procedures are responsible for the cost of that treatment/procedure. The patient and/or a guarantor must complete and sign the Non-Admitted – Estimate of Cost and Agreement to Pay form (available on the Clinical Forms Register) to formalise this agreement and commitment to payment before treatment commences.Patients who do not have a Medicare card or number are considered non-eligible. PurposeTo ensure the costs of Canberra Hospital and Health Service (CHHS) outpatient treatment/procedures of Medicare non-eligible patients are met by the patient and/or their guarantor. ScopeThis document applies to patients that are non-eligible for Medicare seeking outpatient treatment and/or procedures provided by or on behalf of ACT Health.Outpatient treatment and/or procedures can include but are not limited to:Radiation Oncology ChemotherapyOphthalmology procedures (injections etc)Angiography proceduresGastroenterology Procedures Respiratory Procedures, andNon Admitted surgical/interventional type procedures.This document applies to staff working within their scope of practice:Clerical staffMedical OfficersNurses and Midwives, andStudents under direct supervision.Exclusions: This document does not apply to consultation only visits or inpatient episodes.This document also does not apply to patients classified as Medicare ineligible asylum seekers, for this cohort please refer to the Public health services to Medicare ineligible asylum seekers Policy. Roles & ResponsibilitiesPatient and/or Guarantor is responsible for payment of services, including contacting the patient’s health insurance fund to check the level of cover if applicable.Administrative staff are required to identify Medicare non-eligible patients when a referral is received and alert the proposed treating clinician.Treating clinician is responsible for contacting the revenue data team by emailing CHHSBilling@.au for the fee estimate for Medicare non-eligible patients. The treating clinician must provide the Medicare Benefit Schedule (MBS) numbers associated with the patient’s treatment/procedure to the revenue team to inform the fee estimate.The treating clinician must discuss the fees with the patient and obtain the patient or the guarantor’s signature on the form before treatment commences. Copies of the signed form must be provided to:the patient and/or guarantor, and Revenue Data.The original should be kept with the patient’s clinical record. If the Non-Admitted – Estimate of Cost and Agreement to Pay form is not signed, the clinician must seek approval from their Executive Director before commencing any procedure and/or treatment. Revenue data team are required to provide the fee calculation based on the information provided by the clinician. The revenue data team will complete the fee estimate information in the Non-Admitted – Estimate of Cost and Agreement to Pay form and send the form to the clinician within 2 working days from the initial request. A copy of the Medicare Non Eligible or Ineligible Patient Service Fees information sheet must be provided to the clinician at the same time.Executive Directors are responsible for considering any request for treatment to commence without a signed Non-Admitted- Estimate of Cost and Agreement to pay form for Medicare non-eligible patients. They are also responsible for ensuring that clinicians adhere to this policy and escalating to the Deputy Director-General, Canberra Hospital and Health Services any situations where this does not occur.Related Policies, Procedures, Guidelines and LegislationPoliciesPublic health services to Medicare ineligible asylum seekers policyProceduresACT Health Medicare Number and Funding Source and Collection procedure LegislationHealth (Fees) Determination current version; updated annually.Health Act 1993Search TermsNon-eligible, non eligible, ineligible, outpatient, estimate, fees, agreement, pay, Medicare, overseas patient, guarantor, non-admitted, non admitted. AttachmentsDisclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Date AmendedSection AmendedApproved ByEg: 17 August 2014Section 1ED/CHHSPC Chair ................
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