Assignment Task 1 on HLTADM004 Manage Health Billing and Accounting System


Assignment Brief:

  • Topic: Manage Health Billing and Accounting System – LA020462 – HLTADM004 – Assignment 1)
  • Document Type: Assignment Help (any type)
  • Subject: Other
  • Number of Words: As Per Requirement
  • Citation/Referencing Style: As Per Requirement


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Question 1

Briefly describe the regulatory and legislative requirements for billing covering a health care business.

Medicare:As per the Health Insurance Act 1973 since the 1st of February 1984, an eligible person may assign their right to Medicare Benefits direct to the practitioner as payment for medical services received. In turn, the practitioner accepts the assignments as full payment of the medical expenses incurred in respect of the service provided to the eligible patient.


The department of Human Services will only pay for service which are accepted by the Medicare Benefit Schedule (MBS) as per relevant profession, and as medically necessary for the treatment of the patient. Any incorrect billing under Medicare may result in the financial, administrative, and legal consequences for the claiming practitioner.


For a practitioner or the health service provider to be able to accept and receive direct payments from the department of Human Services the patient needs to have a current and valid Medicare Card Number and the Medical Officer will need to be issued with a Medicare Provider Number. This provider number is used to identify the health professional and the practice location for which medical services are being claimed. Without this, no medical services provided by the practitioner will be paid for by Medicare.


Private Billing: First and foremost, as detailed in the AMA Code of Ethics Brochure 2004 (Editorially Revised 2006. Revised 2016), health professionals are obligated to ensure that financial or other interests are secondary to their primary duty to serve patients’ interests. Financial and other interests should not compromise, or be perceived to compromise, a practitioner’s judgement, capacity to serve patient’s’ interests, or the community’s trust in the integrity of the medical profession.


Ultimately the requirements of private billing in a medical setting are to report income and GST to the Australian Taxation Department (ATO).


If you have access to a workplace then, discuss the regulatory and legislative requirements for billing for your business?


Question 2


a).  List all the payment options a medical practice has when requesting payment for services rendered (for e.g., Medicare).



  • Bulk – Billing
  • DVA direct billing


Private Billing


Patient to Pay

  • Cash
  • Eftpos/credit card
  • Cheque


Third Party

  • Insurance
  • Employer
  • HiCaps
  • Worker


Government Funding & Grants


           Incentive Payments

  • PIP
  • PINP
  • Concession Card Holder (10991)


    • Small Business Grants
    • Scholarships
    • Subsidy Schemes


b).  List all equipment required to enable a health care business to invoice and payment for services rendered


Accounting Software (HIC) for Medicare Direct Claiming Electronic Medical Record (EMR) – Linking the claim with consultation notes for auditing purposes. Ease of establishing correct billing according to professional medical services provided.



To enable online Claiming direct to Medicare



Printing of receipts/invoices


Till & Cash Draw

Cash Handling to accommodate those who wish to pay via cash


Eftpos Machine

To accept visa/credit payments


HiCaps Machine

Direct payment from health insurance providers


Question 3

List at least three barriers related to financial matters which may prevent patients from accessing practice services, as well as a strategy for overcoming each of the barriers you have identified.


Barrier Strategy for overcoming barrier
Medicare expire, invalid or incorrect card number – patient does not have card in their possession.



Register the healthcare center for ‘health professionals online service’ (HPOS). Which gives authorized access (site certificate) to a database that is then able to verify the patients Medicare Card details instantly online, given that certain criteria are met.

Nowadays, most if not all medical accounting software has a ‘Verify Medicare’ function. This will verify current Medicare card details, update expiry dates, notify of invalid details or any minor errors is data entry. To link certificate to the software enables the staff to utilize this function.

Patient cannot afford payment at time of consultation.


In hoping that the reception staff advised the patient of the practice consultation fees prior to the patient attending the appointment the choice of what to do in this situation lies with the practice manager and/or the senior medical officer (SMO). Options to immediately receive payment would be to offer a discounted price, patient to pay the ‘Gap’ or to direct bill. The gap payment is simply the patient to pay the difference between private fees and bulk billing fee.


e.g. – Private consult fee = $65.00,

– Bulk billing fee = $35.00,

– $65.00 – $35.00 = $30.00 Gap

-Patient to pay $30.00

Alternatively, offer the patient a 28- day invoice or a repayment plan. These options may result in debt recovery later in the future.

Patient requires a consultation but is hesitant due to the private fees of the practice.


Staff to advise the patient of the practice fees, standard fees structure to be visible in the waiting area and advertising material. Also, staff can explain the Medicare rebate amounts (out of pocket expense) and gap etc.


Question 4

Why it is important for a health care business to have a clearly stated policy regarding cash flow and viability of the practice?


For maintain profitability, sustainability, and longevity of the business. Ultimately the policy gives structures to be able to pay off debts via the achieved revenue of the business. Revenue that is raised by the selling of goods and/or services.


What is The Practice Incentives Program (PIP)? Name few Australian government supported and special payment schemes or practice payment schemes that need to be considered while developing or implementing the medical billing system.


The PIP is financial incentive for medical clinics aimed and designed to support quality and continuity of care, improve access medical services, and improve health outcomes for patients. There are of course criterial that needs to be met to qualify for this incentive’s payments, along with ongoing reporting requirements.


c).  Research and name at least two commonly used billing and accounting system in a health care business. Also name three billing technologies that support a practice’s billing and payment system.


= Billing and Accounting System.


Bank Link


HIC Software for Medicare (genie, practsoft, best practice)


= Billing technologies






Question 5


What is the debt tolerance levels that a health care business accepts?


The business should identify what level of debt it will tolerate at any one time. Deciding what will be the debt tolerance of the business owner’s responsibility. Strategies should be considered when the possibility of a debt arises to prevent debt at all. These strategies include:


  • Credit policy for all patients
  • Payment options for all patients
  • Clear and explicit terms of trade/business
  • Internal cash flow management, that is banking and cash handling
  • Discounting policies


a).  List the possible debt recovery strategies for a health care business.

A debt recovery policy should be in place for the business to prevent conflict between the business and the patient. The staff member that is attempting to recover the debt will be able to follow and use this procedure as a guideline to follow to retain the best client – business relationship and of course recovering the debt.

  • Communication via electronic media – telephone, email
  • Issue overdue notices via reminder letters and invoices
  • Consequences of legal actions
  • Use of collection companies
  • Removal of credit
  • Legal action


b).  Most of the health care business follows the practice of sending generic debt recovery letters to the same party multiple times, do you think is effective or not? Explain your answer.


When a debt recovery policy and procedure is being created/updated with in a health centre there are a few recovery options to consider. Such as Phone call, Letter, Referral to a debt collection agency, legal action etc. When auditing the debtors list weekly or monthly these recovery strategies should be analysed whether the time frame of the debt is appropriate. For example, if the debt is 7 days overdue, this hardly warrants the need for legal action or if the debt is 90 days overdue a letter is to be sent.


Sending a letter in the post multiple times with not response or reply is rather a waste of resources and staff time. So, in saying that, all ‘return to sender’ (RTS) mail that is received needs to be documental within the patient’s Personal information file. When an individual need to be contacted regarding a debt, it can be quickly identified if any mail has been recently RTS.


Consideration also needs to be taken in relation to the specific details of the debt. For example, if the debt is for a standard consultation and there are a few failed attempts to contact the debtor for payment, would it be more efficient and productive to direct bill this account to Medicare and have the debt paid with in a 48hr period. Things that need to be considered would be the time factor in recovering a minor debt, costs in doing so e.g., Postage, phone calls etc. Although if the debt is for a rather significant amount for example $500.00 for travel vaccines (which Medicare do not cover this cost) the recovery of these monies is paramount.


Reflective Essay Task 2 – HLTADM004 Manage Health Billing and Accounting System


TASK 2: Reflective essay


This is a self-reflection task in which you mustprovide a descriptive analysis of established billing and/or accounting systems, processes, or guidelines within a health care business.  Word limit at least 1000 words.


Task information:


a).  The following assignment need not focus on any one practice, organisation, or business.


b).  If you are currently employed in a health care business then you may structure your responses using examples from that employment; or you may respond using experiences from a previous employment, or a combination of one or more.


c).  If you are not employed, then you can research a health care business of your choice to respond to each of the below headings and may use examples from personal and/or social experiences as relevant to the assessment task. (You can choose any practice you usually go to or any other you are familiar with)


d).  Please contact your teaching section if you are unsure of how to research an organisation to complete this assignment task.


You may use each of these as a suggested heading within your essay.


Name and description of the health care practice


First Care Medical Centre – Bradbury & Adora Fertility – Sydney




I have chosen 2 health care practices for my reflective essay. They are First Care Medical Centre – Bradbury and Adora Fertility – Sydney. I will be providing a descriptive analysis of established billing and/or accounting systems. Processes or guidelines for them. They are a general practice service based in Bradbury, NSW and a fertility clinic based in Sydney, NSW.


First Care has a team of doctors, nurses, pathologist, podiatrist, physiotherapist, and dietitian. Adora


List different payment options that a business offers clients for their ease of payment and accessibility


Payment Options


First Care are mainly bulk billed, however, have some services that are not covered by Medicare. For a patient without a valid Medicare card, the standard consultation fee is $65 (weekdays) or $75 (weekend and public holidays).


Adora bulk bill all eligible fertility related services covered by Medicare. Out-of- pocket costs are for services not covered by Medicare and include day hospital and anaesthetist fees. Out-of-pocket expenses are typically under $1000 per cycle and will normally be far less for individuals with private health insurance.


List common payment barriers and flexible options provided by practice to best address those barriers


 Common Payment Barriers and Flexible Options


One payment barrier, especially for Adora would be that the patient cannot afford lump sum at time of consultation; in which a payment plan can be offered. Another barrier that both practices can face is the patient does not understand how the health billing system works. They would require explaining to the patient how it works, offering to help with the paperwork and sending them to Medicare.


Name and provide detailsof a practice’s billing and accounting software/system that support the billing and payment system


Billing and Accounting Software/System and Collecting Billing Data

Pracsoft assists medical practices in managing their appointments, billing, reporting, and Medicare Online Claiming efficiently. Pracsoft is developed and sold by Health Communication Network (HCN), Australia’s market leader in the clinical and practice management software industry.


Integrated EFTPOS terminals. Send transaction information directly from PracSoft to your EFTPOS terminal without the need to re-key, resulting in faster, easier payments. With the integrated solution there are no more data entry errors and you also benefit from online real-time reporting


If you do not have access to the health workplace, you can do the internet search and get sample of billing record or can develop an invoice that can be generated from the software being used in the practice.


Recording a Visit: Bulk Bill


For practices offering bulk billing, at the conclusion of the consultation you will be required to record the services


Offered, and submit the claim to Medicare for the practice to get paid.


  1. From the Waiting Room, select the patient record.
  2. Click Visit or press F5 on the keyboard
  3. Confirm the consultation details including: time/date, practitioner, and location.
  4. If not selected, choose Bulk Bill from the Invoice to drop-down list.
  5. Add the Service details by inserting the Item No, and then pressing the Tab key to populate the service description and calculate the fee amount
  6. If appropriate, click Add to record any other Item Numbers to claim. Note: If the practitioner is registered to receive the Medicare Plus or Medicare Plus -Rural incentive payment, the corresponding item number will be automatically applied to the visit where applicable
  7. Click Voucher to print a Bulk Bill Assignment Advice (DB4 form)
  8. After billing, the patient will be automatically removed from the Waiting Room list and their linked appointment status flagged as ‘Gone’


Explain how this system will collect billing data, provide a sample record of billing or invoice document.Provide a sample debt recovery policy or procedure you use within a business, if you do not have one, what you would develop that would cover debt recovery. How do you monitor and adjust these policies for continuous improvement?


For e.g., including processes would you put in place to recover outstanding debts from patients who have now deceased?


Provide sources of information that a practice deals with on the subsidy payments


What systems has been put in place to ensure that doctors are complying with MBS requirements or charging correct item number to gain the Practice Incentive Payment (PIP).


Provide sample reports that provide information regarding the cash position and/or cash flow of a health care business
Debt recovery and policy procedure


The sample debt recovery policy I will be using is Pacific Smiles Group (PSG) debt recovery policy. The policy and procedures include an introduction and principals for the policy, communication guidelines, payment, and collection practices and general procedure of collection.


The introduction and principals would include the businesses commitment to financial assistance to patients who cannot pay for part or all the care they receive.


That patient should be treated with respect and compassion and that patients should be expected to contribute to the cost of their care based upon their individual ability to pay.


The business will adhere to the following communication guidelines:


  1. Staff will treat patients with courtesy, confidentiality, and cultural sensitivity.
  2. PSG will strive to communicate clearly that emergency services will be

provided without regard to ability to pay.

  1. All new patients are told on payment options/fees structure on joining the practice, and details are displayed clearly in the waiting room and in the practice newsletter
  1. Patients will be informed about their financial responsibilities, the potential financial obligation they may incur their obligations for completing eligibility documentation, and the practice’s bill collection policies
  1. Patients will be informed that they may apply or reapply for financial assistance before during or after care or after collection agency assignments if their situation changes
  1. Reception staff can assist patients in determining if they are eligible for private and government sponsored programs whenever appropriate
  1. Communication to the public regarding financial assistance will be posted in visible locations throughout the practice with instructions on how to apply or obtain further information
  1. Practice will respond promptly to patients’ questions about their bills and requests for financial assistance.


The business will adhere to the following payment and collection practices:


Financial Assistance policies will be applied to patients in a fair and consistent manner.


  • For those patients that have insurance, the practice will attempt to collect
  • the co-payment, coinsurance, or deductible at the time of service to ensure
  • statements sent to patients contain accurate patient responsibility
  • Encourage patients to pay at the time of the visit and email them the
  • requisite payment information before the day of consultation.
  • PSG will work with patients to establish a reasonable payment plan.
  • Payment plans will be interest free




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