Once you have done some billings, you may notice that payments have come back for a lower amount, or perhaps you have received no payment at all!

Identifying batches with issues

The easiest way to spot if a batch had an issue, is to simply look at the Paid column. If you see any amount in Red, then some action will be required.

We can see in the image above, that we have two batches that are partially paid (Less than what we claimed). We also have two batches that are just Rejected ($0.00 Paid).

Dealing with the Batches

First, double click on the batch to view inside. You can also right click and select View Batch Details if you prefer.

Once you can see a list of patients within a batch, the thing to keep an eye out for is an icon in the Issue column.

You may have one, or multiple patients with an issue. Any patient with a Rejection or Partial Payment will have the above icon.

Viewing the Rejection Reason

Now that we have identified which patient(s) have an issue. It’s time to see what the issue actually is.

Again, lets double click on a patient, or using the right click menu, select View Items.

In the above case, this is a fairly easy rejection to identify the issue. We have the error code 2001 No Hospital Claim (PEA). From this we can deduce that the hospital has not submitted their invoice yet, and as such we cannot be paid. Our options are to just wait and try to resubmit, or you could confirm with the hospital when they are sending their claim.

One of the most common issues is that you have been paid a different amount to what you claimed. This could happen for a number of reasons such as:

• Fee Changes by Medicare/Health Funds
• Doctors agreement with a fund
• Old date of Service

To amend this, simply right click on the item and select Edit. Alternatively use the hotkey ‘E’. Then just alter the Charge inc GST to be equal to the Payable amount, as shown above.

Contacts

Not all rejections will be as simple as the ones above. In a case where you are not sure what a rejection reason means, or why something has not been paid, it is best to contact the organisation who rejected it.

We have a complete list of phone and email for medicare and the health funds.

If needing referrals applies to your discipline, read on to learn how to create new referring doctors on your FYDO system; and how to create referrals on patient records.

Start off by opening a patient’s record. Below is an example of a patient record, with the referral section highlighted.

Notice that the data fields on the record are greyed out and you cannot commit any changes. This is because you are not in edit mode and therefore cannot make any edits. 

So click on the Edit button to continue.

You will now be able to make edits to this record, scroll down to the Referring Details section.

If the referring doctor has never been entered into your FYDO system, click on the blue ADD REFERRING DOCTOR button to add a NEW referring doctor.

This will present you with the below screen, where the main data fields are highlighted. So go ahead and fill this in along with any other additional information you’d like to store about this referring doctor.

Note: this only needs to be done once per referring doctor. 

Referring doctor ‘Type’

• GP: by default, GP referrals have a referral period of 12 months
• Specialist: by default, Specialist referrals have a referral period of 3 months

If the referring doctor has already been entered into FYDO as a referrer, you will be able to search for them by clicking on the search box pictured below. You may search by the doctor’s first or last name. 

Next, enter the Referral Date and you’re done! This is the minimum data set for adding a referral to a patient’s record. 

Notes on other data fields in ‘Referring Details’

• Period: this is how many months the referral is valid for. It may be overwritten by the user, at their discretion
• First consult: if the first Date of Service is after the Referral Date, you may enter the date of service into this field so that the Referral Period is calculated from this date, rather than the referral date
• Referral to: this is which provider the referral is for. If left blank, upon billing it will get linked to that provider; 
• Site Referral (global): allows this referral to be used by any provider rather than one specific provider. 

That’s it! You’ve added a new referring doctor to your FYDO system and created a referral on a patient’s record. Click on the green Save button on the top right corner of the patient record to save your changes.

Made a mistake when creating the referral? No problem. Read on to see how to edit or delete referrals.

Start off by opening a patient’s record. Below is an example of the referral section of a patient’s record.

• Add another referral: FYDO allows you to have multiple referrals for a given patient. Use this button to add another referral
• Edit referral: this button allows you to make changes to any of the data fields of a given referral
• Delete this referral: this button will remove the referral
• Active: untick this checkbox to make the referral inactive

If you have not submitted an OEC yet, please see our guide found here

To find your OEC, first access the Documents from that patients record.

You will see a list of all the recorded documents for this patient. The OEC’s that were returned will have the Name and Type of OEC. Select one to view a preview. These documents can be printed or saved as needed, but will always be kept here within the patient record.

The first part of your OEC contains some patient information, as well as the Medicare and Fund status on the check. It will also show the Explanation, on our OEC below we can see that the patient is eligible, but subject to conditions:

Health Fund Assessment

The next part of the OEC details exactly what the patient is eligible for. We can see any Excess or Co Payments, as well as a description of each of what the patients cover is limited to.
Any Excess shown here will be automatically updated in the Appointments screen for this patient.

Just below the excess and co payment information, you will find the final details of the OEC. The fund will detail the members cover and the description will mention services that are excluded. There is also space for Benefit Limitations and Exclusions, if your OEC shows the patient as not having cover, these fields will detail what the exclusions are and why the patient is not covered.

Finally, there is a field for any Other Services that were checked, such as Prosthesis items.

Ready to bill through the Patient Claims billing channel? Follow along to learn how.

Need to learn more about Patient Claims first? Click here for more.

To get started, from the Patient Record, we are going to click on the Bill Patient button.

You can also use the hotkey ‘B’!

This will take you to the Clinical Billing page, where you’ll need to select the:

• Location: the location where the service took place. If you only have one, it will be defaulted
• Practitioner: the practitioner who performed the service. If you only have one, it will be defaulted
• DOS: date of service
• Bill Type: Patient Claims
• Type: ‘Store & Forward’, or ‘Real Time’ – more on this below

Store & Forward vs Real Time

The primary difference between these two types of Patient Claims is that:

• With Real Time, your invoices are sent to Medicare in real time, as they are created. That is, they do not go into a batch that you then manually send off at the end of the day. They do end up in a batch however.
• Whereas with Store & Forward, invoices enter a batch for later transmission. This is how all other Bill Types such as Eclipse, Medicare, and DVA behave. 

Some things to note about Real Time

• Should you need to delete an invoice after creating it, you have until the close of business that day to delete it, via the software. This is called ‘Same Day Delete’
• However, if you realise you need to delete an invoice the next day or later, you will now need to contact Medicare and ask them to delete/ ignore the invoice on their end
  • If you realise you need to delete an invoice and it has already been paid, again, you will need to contact Medicare and process a refund.

Referrals

The last step before we can begin billing is to enter any needed referral information. If this does not apply to you, click on Add Items and proceed to the next section.

Otherwise, simply fill out the Referral section as seen below. If you only have one referring doctor for this patient, they will be automatically selected here (provided it has not expired).

Once you are done with the above segments, click on the green Add Items button in the bottom left corner of your screen.

You will arrive at the Clinic Billing page. Here we can see a brief overview of previous information for the patient, and where we can bill an invoice.

It is as easy as typing in the item you need and selecting it. There are two different ways to search for the item as shown below:

• Search for the item number itself.
• Search for a word in the description. This can either be at the start, or anywhere within the description!

Notice that for Patient Claims, the Date of Service (DOS) can be changed in an invoice.

Applying Payment

Once you have added all your desired items, you can add payments captured from the patient onto the invoice using the Add Payment button.

This will present you with a pop-up to enter the payment information. The total invoice amount will be prefilled in the Amount field. 

So, you may simply allocate the payment type and hit save as below:

Once you have entered all your items and payments as desired, click on the Review Charges button to proceed to the final page of billing.

Clinic Review Charges

You may notice that this page looks nearly identical to the previous Clinic Billing page. The only real difference is that you can no longer add or change items, and there are additional buttons at the bottom.

You will also be able to see the Total Charges for the items you have billed like so:

Lets go over the options on this screen:

Edit Item And Charges: Realised you have made a mistake? click this button to go back to the previous page and fix it up!

Cancel: Cancel out of this billing. This will take you back to the Patient Screen.

Save: Save this invoice, send it to the Claiming Medical section, ready to send. 

If Save & Print is selected, it will also be printed.

You’re all done! You have successfully billed a Patient Claims invoice. Now, head over to ‘Claiming Medical’ and send it off. 

Not sure how to send off your claims? Click here for more on Claiming Medical.

In a nutshell 

Patient claims is where the practice sends off the patient’s claim on their behalf so that they can receive their medicare rebate 1-2 business days later. The patient could pay in full, partially, or nothing at all.

You would use this claiming channel when the practitioner charges above the medicare schedule. You would not use this claiming channel if you are happy to receive the medicare/bulk bill amount. 

This claiming channel is useful because whilst it would be easier to bulk bill the patient, and then charge a copayment, this is illegal.

Patient Claims is desirable for the practice because: 

• The practice may be paid in full, on the spot
• The practice decides what they would like to charge
• Multiple dates of service per invoice supported
• May avoid the 90 day scheme, more on this below

90 day scheme

When an unpaid or partially paid claim is sent to medicare, the patient receives a Pay Doctor Via Claimant (PDVC) cheque and they are expected to forward this cheque to the practitioner. 

• The cheque will be in the the doctor’s name, so the patient cannot bank this money
• The 90 day scheme is a measure in place to redirect the funds directly into the doctor’s bank account, in the event that the cheque is not banked by the doctor within 90 days
• However, this is only eligible for gps and specialists, and is not applicable to allied health practitioners

Eligible health professionals

Ineligible practitioners

Allied health professionals, optometrists and dentists aren’t eligible to participate in the scheme.

Want to learn more about the 90 day scheme? Click here to read more. 

Important note: for this billing channel, you will send claims, assuming they will get paid as no communications are sent back. This is owing to a Medicare limitation that only allows for one-way communication. That is, you can send claims but will not receive any:

• Exception statements, or
• Payment statements

Medicare Easyclaim

Easyclaim is another billing alternative for bulk billing and patient claims. It may be a stand-alone process via an EFTPOS machine or integrated into your billing software.

Note: FYDO does not currently support Easyclaim

Key features

• The patient receives their Medicare rebate almost immediately into their bank account
• No additional bank transaction fees. However, standard EFTPOS charges still apply
• May be used for bulk billing and patient claims
• Single payment made to practitioner’s nominated bank account for bulk billed claims within 2-3 working days
• Concession verification – instant confirmation of patients’ concessional status
• Available to all allied health professionals

Want to learn more about Medicare Easyclaim? Click here to learn more.

Ready to bill through the Patient Claims billing channel? Click here to learn how.

Disclaimer: Altura Health recommends periodically checking these settings to ensure they are correct. Your fees will not update if these settings are incorrect. You are responsible for maintaining and ensuring these fees are set up correctly.

Tired of updating your Health Fund Fees every time a change occurs?

If Fydo is setup correctly, your health fund fees will automatically be updated! Simply follow this quick 5 minute guide, and never worry about your fees again!

First, lets head to Settings, found on the bottom left hand side of Fydo.

Then select Fee Levels, found underneath Fee Management

Fee Levels

You will now arrive at the Fee Levels settings. This page displays all of the current Fee Levels within Fydo, and lets you edit them as needed.

Now, lets select Edit from the top right hand corner of the page.

To setup automatic fee updates, we just need to change a few settings for each health fund.

• Fund
• State (If Applicable)
• Fee Type (If Applicable)

Fund – This is a simple one, simply select the corresponding fund from the list. In the above case, I selected HCF for both of my HCF fee levels, AHS for my Alliance (AHSA) fee level and MPL for my Medibank Private level.

State – This will only apply to Alliance (AHSA), BUPA and GU Health. Select the state you require fees for. In the above case, I opted for the NSW fees.

Fee Type – This will only apply to HCF and HBF. Simply select if you need the No Gap or the Known Gap fees. In the above case, I have a fee level for both, though you may only have one.

Once you have completed the above, click the Save button.

All done! You can now rest easy, while we take care of the rest. Your Health Fund fees will automatically update as soon as we have the latest fees, usually every 2-3 months.

Disclaimer: ACSS recommends periodically checking these settings to ensure they are correct. Your fees will not update if these settings are incorrect. You are responsible for maintaining and ensuring these fees are set up correctly.

You can find the fees that Fydo will import here.

There are two main ways to perform an Online Eligibility Check (OEC) for a patient.

Patient Record

Simply go the patient’s record and under the ‘More Actions‘ select Eligibility Check (OEC)

Appointments

You can also access the OEC from Appointments (Hospital appointment), simply right click on an appointment and select OEC.

You can also use the handy hotkey: O

OEC Request

The next step is the fill out the required fields in the OEC request.

Patient Details

The patient details will be automatically filled in by information taken from the patients record such as Name, Fund, DOB, Membership Number, Medicare Number and Gender.

Eligibility Check

Like the Patient Details, the Eligibility Check fields are also pre filled from the patient record/booking. Things such as the Admission Date, Hospital, Provider Number and Surgeon/Doctor.
The most common type of check you will be running will be Fund Only.

Items

The final part of the OEC is to select the Illness Code or MBS Items to check. There are also Protheses items available to check. While the list of Illness Code’s is comprehensive, it is generally more accurate to check if the patient is eligible for the items you will be billing.

Now that the OEC is filled out, click OK to run it and we can take a look at the results.

To find out how to see the OEC results see our wiki page here

Medicare & DVA

Health Funds

Start off by opening the patient in question’s record and hit the Accounts button.

This button reveals a patient’s billing/ treatment history where each line is an invoice: 

So from here, simply right click on the desired invoice to be printed and select Print Invoice. This will produce a PDF file of the invoice, which you may print or store/ send electronically.

If selecting Print Invoice presents you with the below message, this means you do not have an invoice template for the type of invoice you are attempting to print,

So, click here to view our guide on how to upload an invoice template.