Surgical Assistant Billing Guide
1. Overview of How to Claim Fees
There are several ways to receive a fee for surgical assisting:
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The surgeon pays you directly.
The surgeon claims the assistant's fee on your behalf and pays you directly. This arrangement is usually determined by the surgeon and you may not have a choice if they insist on doing it this way. You can use EasyAssist to make sure you're receiving at least as much as if you were billing for yourself. Note that you may have to pay GST on your earnings if the surgeon pays you directly for your services (check with your accountant), whereas there is no GST if you receive your fee via the other methods below.
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You bill the patient directly.
You can bill the patient directly by sending them an invoice detailing your services and fees due. This is generally not an option if the patient is covered by some sort of compensation insurance, or the procedure is covered by the Department of Veterans' Affairs (see below). Click here for more details.
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You bill the health insurer directly.
Most private health insurance funds have an option to use a Gap Cover scheme. You send your invoice directly to the health fund, and they pay you by electronic funds transfer or cheque. Most Gap Cover schemes allow the doctor to apply it on a case-by-case basis, so the doctor is not "locked into Gap Cover" (a common misconception). Note that you must adhere to the health fund's Gap Cover schedule of fees and billing procedure to ensure you receive your payment. Click here for more details about Gap Cover.
Similarly, if the patient's medical expenses are to be paid by another agency, such as Workers' Compensation or the Department of Veterans' Affairs (DVA), you usually send your invoice directly to that agency. The DVA and many Workers' Compensation schemes have their own schedule of fees to which you must adhere. Click here for more details about DVA and Workers' Compensation.
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You bill both the patient AND the health fund
Some health funds allow you to bill both the fund under their Gap Cover scheme, and also bill the patient directly for an additional amount (a patient co-payment). This is called 'Known Gap' Gap Cover. You must consult the individual funds' Gap Cover guides to see if the fund supports a 'Known Gap' Gap Cover scheme. Click here for more details.
EasyAssist includes the fees schedules for all health funds, DVA and State Workers' Compensation schemes (where available) so it's easy to calculate the correct fee for all health insurers with EasyAssist. It can even produce an Estimate of Fees where the assistant chooses to charge a gap, detailing the estimated health fund, Medicare and patient contributions to the assistant's fee.