Surgical Assistant Billing Guide
2. Register with the Appropriate Organisations
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Medicare
It is essential to obtain a Medicare Provider Number for each hospital where you work as an assistant surgeon. The Provider Number enables you to claim benefits from Medicare. The health funds generally won't pay their contribution unless you have a Provider Number.
Usually you need a different Provider Number for each location where you wish to claim Medicare benefits. You need to have your Provider Number(s) before you start assisting, so it should be the first thing you do when you decide you're going to undertake surgical assisting.
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Health Funds' Gap Cover Schemes
It is prudent to register for Gap Cover with the major Health Funds even if you don't intend to use Gap Cover to bill your patients. Registering for Gap Cover does not commit you to using Gap Cover for every case, it simply gives you that option if you choose on a per-procedure basis. Assistant surgeons who usually charge a gap for their services will still inevitably want to charge no-gap for the occasional patient; in these cases using Gap Cover will result in a payment of 20-50% above the Medical Benefits Schedule fee without the patient incurring an out-of-pocket cost.
You must register with each health fund to use their Gap Cover product; the exception being the smaller health funds that are part of the Australian Health Service Alliance (AHSA). You register once with the AHSA and this automatically registers you with all AHSA funds; a great time saver.
The major health funds/organisations with which you should register are:
- Medibank Private (includes AHM)
- BUPA
- Australian Health Service Alliance (AHSA)
- HCF
- NIB
- GMHBA
- HBF
- Mildura Health Fund
- Cessnock District Health Benefit Fund
- Latrobe Health Services
- St Lukes Health
- Australian Defence Forces Health Services (provided by BUPA)
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Workers' Compensation
Each state/territory has its own major workers' compensation organisation:
State/Territory Workers' Comp. Organisation ACT WorkCover ACT NSW Workcover NSW NT NT WorkSafe QLD WorkCover QLD SA ReturnToWorkSA Tas WorkCover Tasmania Vic WorkSafe Victoria WA WorkCover WA
You should contact the main Workers' Compensation organisation in your state for details on how to register with them as a medical services provider.
Some large companies run their own workers' compensation scheme for their employees (self-insurers) instead of using the major State Insurer. In general, you do not need to register with these companies beforehand; simply send your account to the self-insurance division of the company. Ask the surgeon for details: address, claim no. and claims officer/contact person.
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Medicare/DVA Electronic Funds Transfer Registration
You can register your bank account details with Medicare for payments from Medicare or the DVA. You can download the form for Provider Registration for EFT Payments from the Medicare website.
For most funds you can download a Gap Cover registration form from their website, otherwise you can request a form be sent to you.