Industries / Medical billing bureaus and specialist rooms
More accounts cleared. Same billing team.
A theatre list becomes an account only after your team has matched the anaesthetic record, MBS items, fund cover, gap arrangement and consent. We embed with billing staff, learn the workarounds in your practice software, and put AI on the routine checks and chasing. The practitioner keeps the billing judgement; your people get the exceptions with the evidence beside them.
Where your team's week goes.
Theatre lists arrive
Lists from hospitals and surgeons' rooms become tomorrow's accounts. Staff match the patient, facility, treating doctor and planned procedure, then pick up changes to the list.
Cover and gap are checked
The team checks Medicare and fund details, the proposed known-gap or no-gap arrangement, and whether the patient has the right fee estimate and informed financial consent before the procedure.
The clinical record comes back
After theatre, staff chase the operation report and anaesthetic record. Start and end times, ASA status and any claimed modifier have to be supported by what the clinician recorded.
The account is built
The billing officer brings together the date of service, provider number for that location, procedure and anaesthesia items, MBS explanatory notes, fees and payer. DVA and workers compensation accounts follow their own route.
Claims go out
In-patient medical claims go through ECLIPSE where appropriate; other Medicare accounts use the practice's Medicare Online workflow. Staff watch the claim status and deal with anything returned for correction.
Returns and debtors are worked
An accepted claim still needs its remittance matched to the account. Underpayments, rejected lines, patient gaps and third-party debtors sit in queues until someone gets the right answer and closes them.
The cases that eat the time.
Most of the work goes smoothly. These are the ones that come back to someone's desk, and they're where a case engine earns its keep.
The anaesthetic clock is incomplete
The record shows an 08:42 start, but the end-time field is blank when the RVG time item is being prepared.
Theatre list and operation report differ
The list says one procedure; the signed report describes an additional procedure that needs the surgeon's item decision.
A modifier has no supporting note
An ASA 3 physical-status modifier is on the draft account, but the anaesthetic record does not document that status.
The gap no longer matches the quote
The draft known-gap account differs from the estimate given before theatre, so staff stop to check the fee and patient communication.
Fund details do not line up
The membership number on the booking does not match the fund response, even though the patient's name does.
ECLIPSE returns a rejection
An in-patient claim comes back with a patient-matching reason code; staff compare the response with the hospital and fund records.
A different payer needs evidence
A NSW workers compensation account arrives without the insurer approval that this treatment would need, unless an exemption applies.
A balance stays open
The fund remittance is lower than the account and the patient gap is still unpaid, so neither the short payment nor the debtor can be closed by guesswork.
What stays with your people.
Billing staff can prepare and query the account. The practitioner is legally responsible for Medicare services billed under their name or provider number, even when someone else enters the claim.
What service is claimed
The surgeon or anaesthetist confirms the service, item and any clinically based modifier against the record and the MBS notes. An engine can point to a mismatch; it cannot supply missing clinical evidence.
The fee and the patient's gap
The practitioner sets the fee and decides whether to use a fund gap arrangement. Staff handle the estimate and consent conversation with the patient under the practice's process; a changed account goes back for review.
Disputes and corrections
Billing staff investigate a rejection or short payment with Medicare, the fund or insurer. A disputed item, changed clinical account or write-off goes to the person your practice has authorised to decide it.
What we'd measure together.
Before anything is built, we measure how your cases move today. Every change is measured against that, on your own cases.
Accounts finished per staff hour
Completed accounts against billing time, with the case mix recorded so a run of simple claims does not hide harder work.
First-pass claim acceptance
The share of lodged claims accepted without a correction, split by ECLIPSE, Medicare Online and payer.
Time to a ready account
From date of service to an account ready for release, including the wait for missing records or practitioner answers.
Exceptions and open balances
Minutes spent resolving each returned claim, short payment or debtor, and how long balances stay open.
Works alongside what you already use
- Genie
- Gentu
- Zedmed
- Clinic to Cloud
- ECLIPSE
- Medicare Online
Questions billing bureaus and specialist rooms ask us.
☛We already use Genie. What would you add?+
Genie already builds and sends ECLIPSE claims. We would sit with your billing team to find the work around it: checking theatre records against draft items, chasing missing times or consent, and pulling the right evidence into a rejection queue. We would test one bounded case type alongside Genie before asking you to change a workflow.
☛Will it pick the MBS item and lodge the claim?+
It can prepare a proposed account and show the source record and MBS note used for a check. The practitioner remains responsible for the item claimed under their provider number. We would agree who reviews and releases claims in your practice; an uncertain item or missing clinical detail stops for that person.
☛What happens to our patient and billing data?+
Bring a made-up example to the free session, not patient records. Before any real data is used, we would agree the purpose, minimum fields, access, processors, hosting, retention and deletion in writing with your practice. We can start with synthetic or properly de-identified samples. We would not assume a particular data location or put health information into a public AI chat tool.
☛Can you handle DVA and workers comp accounts too?+
Yes, as separate account routes to map with your staff. A DVA claim and a NSW workers compensation invoice do not use one set of Medicare gap rules. For workers compensation, we would check the relevant insurer approval or exemption and the current SIRA fee order before preparing a query for your team.
☛What happens in the free 30-minute session?+
Bring the billing lead and walk us through one account, from theatre list to remittance or rejection. We will ask where the record arrives, which software holds the account, who can decide a disputed item and what your team chases twice. We will tell you where a small test might be useful and where it would not.
Find out how much of your caseload could run itself.
Start with a free 30-minute session. We'll learn how your cases arrive and tell you honestly how much could run on its own, and what that could mean for your growth.