Manually:

(As an alternative to a patient visiting a Medicare office, there is a trial currently of Medicare kiosks in selected pharmacies, eg at Kyogle, comprising a computer touch-screen into which the patient enters bill information. It prints out a statement that the pharmacy posts into the HIC on behalf of the patient. On receipt of the statement, the HIC completes the processing of the claim and electronically transfers the payment into the patients bank account).

b) Patient does not pay, but takes account to a Medicare office (or uses a kiosk), with the HIC mailing a cheque to the patients address, the cheque being made payable to the practitioner. The patient must get the cheque to the practice somehow.

c) Patient does not pay, the practice instead bulk-bills. The patient signs a voucher which the practice batches with other vouchers and posts to the HIC for payment.

d) Same as (a), patient pays in full, but uses an EFTPOS terminal in the practice to electronically transfer funds from their bank account directly into the practitioners/practices bank account. The patient then takes the receipt to a Medicare office for a refund of 85% of the Schedule fee.

Example systems, these are all small machines similar to those seen in shops, eg Woolworths, petrol stations etc.:

• Optus HealthPoint with Commonwealth Bank Comm2000 system included
• Commonwealth Bank Comm2000
• National Australia Bank Flexipay.

e) Same as (c), the practice bulk-bills, but submits claims to HIC electronically using the HIC Medclaims system.

Example systems:

• Optus HealthPoint only, a small machine similar to those seen in shops, eg Woolworths, petrol stations etc.;
• Numerous practice management computer programs (software) that includes the Medclaims function, eg:
• PracSoft by Harvest Software Solutions, Brisbane.
• MediDesk by MIMS Data Systems, Canberra.

• An automatically-printed Summary sheet is posted manually to the HIC to validate the electronic claim.
• A one-off payment of $500 is made by the HIC to a practice that participates in the Medclaims system.
• If the practice uses electronic prescription writing, then the script pads required for it are free for Medclaims participating practices (normally $150/10,000 script sheets).
• There are no transmission costs to the practice, these are paid by the HIC to the telecommunications company engaged to link the practice to the HIC.
• The practice must pay for the computer equipment (hardware and software) that has the Medclaims function.
• There is no facility available at the moment for non-bulk-bill patients to electronically claim Medicare from anywhere. Systems to enable patients to claim Medicare whilst at a practice are either being trialled or are envisioned. More electronic services are envisioned in the near future.

Electronic Medicare Claims using Medclaims

For a country practice like Kyogle, manual processing takes from 1-4 weeks, perhaps 6 weeks. Electronic is supposed to take two working days, but actually takes about one week (a summary paper record of electronically submitted claims must be posted to the HIC for their verification purposes before funds are electronically transferred into the practitioner/practice bank account, so allowance must be made for the posting time to Sydney).

2. (Source: 1. Pamela Lubrano, Electronic Commerce NSW/ACT, HIC, ph conversation with MD 8/12/98. 2. Info Pack MEDCLAIMS Pamela posted to NRDGP).

NRDGP has the Info Pack MEDCLAIMS and video Medclaims: is your practice switched on? (11 mins) about the range of electronic services available. The video may be borrowed and copies of the Info Pack material are available, just contact NRDGP.

MedClaims allows only for direct-bill (bulk-billing) patients. The ACT Coordinated Care trial is trialling Medicare claims for non-bulk-billed patients. There are a range of electronic services that Medicare will be providing in the future.

Medclaims Approved Software Suppliers List available from NRDGP or HIC.

Medclaims Approved Communication Suppliers List available from NRDGP or HIC.

alternatively, can use a dedicated system, eg Optus HealthPoint: HealthPoint Medicare-card-swipe unit
(costs $500 up front, no fees for 1 year, thereafter $20/month)

Practice needs	Example
phone line	any phone line
installation and configuring unit	Optus staff
staff trained in terminal usage	Optus staff

(minimal required, much less than the computer option, as HealthPoint is a self-contained system).

EFTPOS

OPTUS HealthPoint

Brochure available from NRDGP, HIC or Optus.

• HealthPoint allows a practice to use Medclaims, plus other options.
• does Medclaims
• DVA cards recognised so can process DVA
• Immunisation can be processed, in participating states.
• Pathology and Radiology results can be electronically obtained (downloaded)
• blurb sheet says will interface with a computer.
• f you choose to also sign up as a Commonwealth Bank Comm2000 EFTPOS terminal (Bank charges a fee, see below), then it does standard EFTPOS at the practice Front Desk for paying patients to direct debit their bank accounts (debit card) or for them to use their credit cards.

If the HealthPoint unit is also set up as a Commonwealth Bank EFTPOS terminal (using Comm2000), patients with a debit, credit or charge card can pay their bill (just like shopping at Woolworths or the local petrol station).

HealthPoint can be an alternative to buying a computer in order to use Medclaims. There will be minimal training and staff time needed to run the system, as opposed to a computer which the staff must learn to use and maintain. It may be seen as a minimal setup for electronic billing, and an attractive alternative for practices not wishing to go the full computerisation path.

The downside is that the potential benefits of a computer for general administrative management are not available. If a practice is envisioning practice management and clinical computerisation, then the HealthPoint system is probably no the best path to take. If a practice wants an EFTPOS terminal, then there are a range of options available, eg Commonwealth Bank Comm2000 system or National Australia Bank Flexipay system.

An alternative may be to install both the HealthPoint and a computer. Then the laser printer can be used for the computer (a laser printer costs about $500 minimum for a small capacity unit, but generally about the $1000 mark in round figures). HealthPoint however costs $20/month after the first year. This requires further research regarding relative cost advantages.

Mentors as at April 1999:

Solo-GP practices
Yamba Medical Centre
Dr David HOPE
YAMBA
ph 6646-2085 solo-GP
Got Healthpoint late 98. Like it very much - saves work and quicker payment.

Dr West's Surgery
Dr David WEST CASINO
ph 6662 1166
solo-GP
Got Healtpoint in April 99, will start using it in May 99.

Multi-GP practices

Lennox Head Medical Centre
Drs Leanne Corbett, Gerry Hughes, Chris Mitchell, Susan Page, Ann Staughton, Robert Watson.
Admin: David Sandercock (Manager).
Got Healthpoint about Feb 99.

• free installation, very small unit taking up little space.
• Merchant Service Fee is 0-4% of transactions, plus $25/month access fee.
• 24-hour Customer Help Desk.
• accepts all major debit cards (cheque or savings account).
• Mastercard, Visa, Bankcard credit cards.
• American Express, Diners, JCB charge cards.
• call costs paid by the Bank.

Known Users in NRDGP
Alstonville Clinic. A Dr and a receptionist both seemed very happy with it. Dr said profitable, receptionist said saves a lot of time in paperwork etc.)

National Australia Bank FlexiPay EFTPOS

Known Users in NRDGP
Dr Cathryn Amey, Riverside Family Practice, Casino.

Personal Computer (PC) programs (software)

• PracSoft
• MediDesk.

Disclaimer

Mark Dowling, Program Officer, Information Management/Information Technology Program