Medicare Online Overrides

On occasion you may need to provide additional information alongside the items you submit for a claim.

This may include things like:

• specifying the side on which a procedure was performed,
• indicating that an item wasn't part of normal aftercare,
• or scenarios where you might perform the same procedure at multiple locations on a patient. 

Add an item override

1. Add an item to the invoice.
2. Click the + plus icon to the left of the item.
   
3. The overrides window will open.
4. Select the appropriate override(s).
5. Press Save.

If an item has overrides applied to it, the + icon will be replaced by an edit  icon.

Overrides window

The overrides window contains a number of different options. 

Override types

With the introduction of Medicare Webservices, the ways in which Medicare choose to verify overrides, specifically restrictive overrides, has been updated. The three overrides below can be used for all claim types:

Not Duplicate Service: When billing an item more than once you need to indicate to Medicare this was purposeful using the Not Duplicate Service override so they know that two separate instances of the same item were indeed done (e.g. attendances at different times, biopsies taken at different physical locations, x-rays of separate limbs and not for comparison purposes). 

Not Multiple Procedure: The multiple procedure rule is used when billing multiple items within the same attendance to recognise the efficiency to the provider. The Not Multiple Procedure override should be used if the services were legitimately independent, even though they were done during the same attendance, to indicate to Medicare that the full benefit should be paid on each service (rather than being reduced using the 100/50/25 MPR scale). 

Not Normal Aftercare: Services provided in the time period following a procedure are classified as aftercare and, in the case of lots of surgical procedures, the benefit for expected aftercare is included in the procedural item fee. If an item is unrelated to the previous attendance (i.e. patient has complications or secondary unrelated issues), it should be marked as Not Normal Aftercare so Medicare knows it is payable.

Restrictive overrides

Please note: with the introduction of Medicare Webservices, restrictive overrides listed below are only able to be used for Patient Claims. If they are used for any other claim type, you will receive an error message and will be unable to send the claim: Restrictive Override Code must only be set when billing type is Private. For any other claim type, the standard override types above can be used in conjunction with any service text you require.

Separate Sites: The Separate Sites override should be used to indicate that multiple independent services were done on different locations on the body.

Not Related: Specific to care plan items (mainly used by GPs & Allied Health). Used to indicate that an item is not related to the current care plan / cycle of care. This could be something like a separate service (e.g. mole check) provided at the same attendance as a care plan service (e.g consultation).

Not for Comparison: Services done for comparison purposes are usually not payable so you need to indicate to Medicare that there was a separate clinical need for each item. Often used in conjunction with the Not Duplicate Service override and only relevant for radiology / diagnostic services.

Service text

Service Time: Enter a time here in 24-hour standard if the item requires a time of service.

Service Text: Enter additional information relevant to the item here; for example the side the item was performed on. Below are some acceptable abbreviations for service text.

Further information

Medicare Multi-Item Billing Guide

Medicare Online & ECLIPSE Data Elements Guide

Medicare Aftercare or Post-Operative Treatment Guide