Clinic Billing Leakage Quick Scan

Clinic Billing Leakage Quick Scan

Revenue leakage affects the majority of Australian healthcare practices, yet many providers are unaware of where their losses occur. This quick scan checklist helps you systematically identify the most common billing leakage points across your practice operations. Work through each section and note any areas where your current processes may be falling short.

### Consultation Billing Accuracy

- [ ] GPs consistently select the correct MBS item level for each consultation (Levels A through D) - [ ] Longer consultations are billed at the appropriate higher item number, not defaulted to standard items - [ ] After-hours consultations are billed using after-hours item numbers where eligible - [ ] Urgent after-hours attendances are claimed at the correct urgent item rate - [ ] Telehealth consultations are billed using the correct telehealth-specific MBS items - [ ] Home visit and residential aged care facility visits are billed at appropriate item numbers

### Chronic Disease Management Items

- [ ] Eligible patients have current GP Management Plans (item 721) - [ ] Team Care Arrangements (item 723) are completed for patients with multidisciplinary needs - [ ] GP Management Plan reviews (item 732) are completed at appropriate intervals - [ ] Contribution to multidisciplinary care plans by allied health is billed (items 10950-10970) - [ ] Mental health treatment plans (item 2715) are initiated for eligible patients - [ ] Diabetes cycle of care annual claims are lodged for registered patients

### Health Assessment Items

- [ ] 45-49 year old health assessments (item 701) are offered proactively - [ ] 75+ health assessments (item 705) are completed annually for eligible patients - [ ] Aboriginal and Torres Strait Islander health assessments (item 715) are actively promoted - [ ] Refugee and humanitarian entrant health assessments are claimed where applicable - [ ] Health assessment items are not being missed due to lack of recall systems

### Claims Processing

- [ ] Claims are submitted within two days of service - [ ] Rejected claims are investigated and resubmitted within five business days - [ ] Medicare, DVA, and private health fund reconciliation is completed weekly - [ ] Batch claims are reviewed for errors before submission - [ ] A designated staff member is responsible for claims follow-up

### Patient Payments

- [ ] Outstanding patient co-payments are collected at time of service - [ ] Aged patient debts are followed up within 30 days - [ ] Payment policies are clearly communicated to patients before consultations - [ ] EFTPOS and online payment options are available and functioning - [ ] Failed payment transactions are followed up promptly

### Procedural and Incentive Items

- [ ] Minor procedures are billed separately where MBS rules permit - [ ] Practice Incentive Program (PIP) payments are claimed in all eligible categories - [ ] Wound care and chronic wound management items are utilised appropriately - [ ] Immunisation incentive payments are claimed for all eligible vaccinations - [ ] Bulk billing incentive payments are correctly applied

### System and Process Checks

- [ ] Practice management software is configured to prompt for appropriate item numbers - [ ] Billing reports are reviewed monthly by practice management - [ ] New MBS item numbers and changes are communicated to all clinicians within 30 days - [ ] Staff billing training is conducted at least annually - [ ] An external billing audit has been conducted within the past two years

Interpreting Your Results

If you have identified three or more unchecked items across multiple sections, your practice likely has significant billing leakage. Each unchecked item represents a potential revenue loss that compounds over weeks and months.

Next Steps

Complete Health Partners offers a comprehensive Revenue Diagnostic that goes beyond this checklist to quantify your actual losses and develop a targeted recovery plan. Contact us to arrange a confidential review.

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*This checklist provides general guidance and should be used alongside current MBS and Medicare guidelines. Always verify item eligibility against official Department of Health resources.*