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 in scenarios where you might perform the same procedure at multiple locations on a patient. 

In the case of these kinds of complex procedures and items, you will need to include additional details in the overrides for an item. To view the over-rides for an item, simply click on the flag icon to the left of the item number. 

The overrides window contains a number of different options; which of these are required will depend on the particular items you are billing. 

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 full benefit should be paid on each service (rather than being reduced using 100/50/25). 

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:

Separate Sites: The 'Separate 'Sites' override should be used to indicate that, while the item descriptions would usually cover the same service, multiple independent services were done on different locations on the body.

Not Related: Specific to care plan items (mainly used by GP's & 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 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