Revenue Cycle Management

MBS Items Commonly Missed or Under-Utilised

One of the most significant sources of revenue leakage is the failure to bill for services that have been clinically delivered. Our audits consistently identify under-utilisation in the following MBS item categories:

Chronic Disease Management Items

• Item 721 (GP Management Plan): Many practices prepare management plans for patients with chronic conditions but fail to bill the item, or bill it less frequently than the 12-monthly cycle permits. For practices with large chronic disease populations, this can represent tens of thousands of dollars annually
• Item 723 (Team Care Arrangement): Often under-billed because the administrative steps required to coordinate with two allied health providers are perceived as too time-consuming. Streamlining the TCA workflow is one of the highest-value interventions we deliver
• Item 732 (Review of GP Management Plan or TCA): Eligible to be billed every three months, yet many practices only bill at the 12-month review or not at all. Systematic recall systems can dramatically improve utilisation

Health Assessment Items

• Item 701/703/705/707 (Health Assessments): Age-specific and condition-specific health assessments are significantly under-utilised. Item 715 (Aboriginal and Torres Strait Islander Health Assessment) is particularly under-billed despite strong clinical need and generous remuneration
• Item 699 (45-49 year old Health Assessment): A one-off item that many practices miss entirely for eligible patients

Mental Health Items

• Item 2715 (Mental Health Treatment Plan): With rising demand for mental health services, practices that do not systematically identify and bill mental health treatment plans are leaving substantial revenue unclaimed
• Item 2712 (Mental Health Consultation): Follow-up mental health consultations often billed as standard Level B or C consultations rather than the higher-value mental health-specific items

Procedural and Incentive Items

• Procedural items: Skin excisions, cryotherapy, wound management, and minor procedures are frequently under-billed, either by using the wrong item number or by failing to bill for the procedure at all when it is performed during a consultation
• PIP and WIP payments: Practice Incentives Program and Workforce Incentive Program payments are not MBS items, but they represent significant revenue that many practices fail to maximise due to incomplete reporting or failure to meet eligibility criteria
• After-hours loadings: Practices providing after-hours care often miss the applicable MBS loadings, particularly for urgent after-hours attendances and unsociable hours services

Bulk Billing vs Mixed Billing Strategies

The decision between bulk billing and mixed (private) billing is one of the most consequential financial choices a practice makes. Our consulting addresses this strategically:

Bulk Billing Considerations

• MyMedicare incentives: Under MyMedicare, practices that bulk bill registered patients receive the tripled bulk billing incentive for concessional patients, making bulk billing significantly more viable than under previous arrangements
• Patient volume dynamics: Bulk billing practices typically see higher patient volumes, which can offset lower per-consultation revenue if workflows are optimised for throughput
• Demographic alignment: In areas with high concessional patient populations, bulk billing may be the most commercially viable model when combined with chronic disease management and health assessment billing
• Workforce attraction: Some GPs prefer bulk billing practices due to reduced administrative complexity and patient billing disputes

Mixed Billing Considerations

• Revenue per consultation: Private billing generates significantly higher revenue per consultation, particularly for longer and more complex consultations
• Patient segmentation: Many successful practices adopt a mixed model, bulk billing concessional patients and children while privately billing non-concessional adults. This requires clear policies and well-trained reception staff
• Fee schedule design: Setting private fees requires careful benchmarking against local market rates, the AMA recommended fee schedule, and patient price sensitivity. We help practices design fee schedules that maximise revenue without driving patient attrition
• Gap payment management: For practices billing above the Medicare schedule fee, managing patient expectations around gap payments is critical. We develop communication materials and train reception staff on fee discussions

What We Offer

Billing Leakage Recovery

• Comprehensive billing audit analysing 12 months of consultation data against clinical activity records
• Identification of under-billed and unbilled services by clinician, item category, and location
• Analysis of item number selection accuracy benchmarked against MBS utilisation data published by Services Australia
• Gap analysis between clinical activity documented in patient records and claims actually submitted
• Retrospective recovery strategies where permissible under Medicare claiming rules

Claims Processing Improvement

• Rejection and denial root cause analysis with categorisation by rejection reason, payer, and clinician
• Automated claims submission workflow design targeting same-day lodgement
• Reconciliation processes for Medicare, DVA, private health funds, WorkCover, and CTP insurers
• Batch processing and lodgement efficiency improvements
• Real-time reporting dashboards tracking claim acceptance rates, rejection volumes, and outstanding claims by age

Debtor Management Best Practices

Aged receivables are a persistent problem for many practices, particularly those billing third-party payers. Our debtor management consulting includes:

• Structured follow-up protocols: Defining clear timelines for debtor follow-up at 30, 60, and 90 days, with escalation pathways at each stage
• Patient debt recovery: Designing communication templates and processes for recovering outstanding patient co-payments and gap fees, balancing firmness with sensitivity
• Third-party payer management: Establishing dedicated workflows for following up outstanding WorkCover, CTP, DVA, and private health fund payments, including insurer-specific escalation contacts
• Aged debt write-off policies: Developing clear criteria for when to write off uncollectable debt, ensuring decisions are documented and consistent
• Prevention strategies: Implementing upfront payment collection, deposit requirements for private billing, and real-time eligibility checks to reduce the volume of debt that enters the receivables cycle in the first place

Our Approach

1. Revenue Diagnostic: We conduct a detailed audit of your billing data, claims history, and debtor book to quantify losses and identify the root causes of leakage

2. Opportunity Mapping: Our consultants prioritise the highest-value recovery and optimisation opportunities, providing a clear dollar estimate for each intervention

3. Implementation: We work with your reception, billing, and clinical staff to embed improved processes, deliver targeted training, and configure system automations

4. Monitoring and Reporting: Dashboards and regular reviews ensure gains are sustained and new leakage is identified early. We typically conduct quarterly reviews for the first 12 months post-implementation

Expected Outcomes

• Revenue uplift: Practices typically recover 8-15% in previously lost or under-claimed revenue within the first six months
• Reduced rejections: Streamlined claims processes cut rejection rates by up to 35%
• Faster payment cycles: Improved debtor management accelerates cash flow by 15-25 days on average
• Billing confidence: Clinical and administrative teams develop greater competency in MBS item selection and documentation requirements
• Sustainable systems: The processes and reporting frameworks we establish continue to deliver value long after the engagement concludes

Get Started

Every dollar left on the table undermines the sustainability of your practice. Whether you suspect billing leakage, know your claims processes need improvement, or want to evaluate your bulk billing strategy, our revenue cycle consultants can help. Contact us for a confidential billing diagnostic and discover the revenue your practice is entitled to.