Surgical Assistant Billing Guide
Billing the Patient Directly
If you want to bill the patient directly you need to provide them with an invoice detailing your services and your fees for your services. The patient then has a choice:
- They can pay you the full amount directly and then claim back their rebates from Medicare and their health fund if insured. You must provide a receipt of payment to the patient so they can do this.
- The patient can claim their rebate(s) from Medicare and their health fund before paying you. The patient will be sent cheques from Medicare and their health fund made out to you and it is their responsibility to forward the cheques on to you along with any gap payment you may have charged. It will take several weeks for the patient to receive the cheques, which means you may wait for a couple of months before you receive your payment.
When you bill a patient directly you can charge whatever fees you wish, but the patient must have informed financial consent before the procedure unless this is unavoidable, such as with some types of emergency surgery. In these cases, financial information about the Assistant's fee should be given to the patient as soon as is practical after their surgery.
If you choose to bill an insured patient directly and you don't want to charge a gap then the most you can charge is the Medical Benefits Schedule (MBS) fee for surgical assisting for the procedure. Medicare will contribute 75% of this amount and the health fund will contribute the other 25%. If the patient is uninsured then they will be liable for the 25% out of their own pocket, so if you don't wish to incur an out-of-pocket expense for your uninsured patients you should only charge them 75% of the MBS fee. EasyAssist lists both the 75% and 100% assistant fee amounts for the Medical Benefits Schedule.