Resubmit or adjust Medicare patient claims

It may occur that you have accidentally sent off a Patient Claim with incorrect details on it, resulting in a rejection from Medicare. Alternatively, a patient may advise you that they have not received their rebate from Medicare.

• Because of the one-way nature of patient claims, it is not possible to reclaim items like you can reclaim items on bulk bill, DVA or health fund claims. 
  
  
• Instead it is necessary to refund and cancel out the original invoice, then recreate it.
• In the event that you have charged incorrect items or submitted the claim against a different patient in error, you should contact Medicare's eBusiness Service Centre on 1800 700 199 as soon as possible and ask that they cancel the claim on their end.
• If you have been advised by the patient that Medicare rejected the claim, and you wish to resubmit it on the patient's behalf, it will be necessary to zero out the original invoice, and then recreate and re-claim the invoice from scratch.  

Note: as outlined in the instructions below, it is very important that you change the Payment Date when refunding and re-receipting an invoice, to ensure that your banking is not out.

Refund the original invoice

1. Open the Patient's file to their Account tab and select the invoice.
2. Note down the Service Date of any items on the invoice.
3. Click on the Payment Summary drop down to expand the Payment Summary table.
4. Note down the Payment Date and Method.
   
5. Click the Refund button above the invoice preview.
6. In the Invoice Refund window, change the Payment Date to match the date that the patient originally paid for this invoice (as shown in the Payment Summary).
7. Change the Payment Source to match the payment method (as shown in the Payment Summary).
   
8. Process a Full Refund for the invoice.

Cancel the original invoice balance

1. Open the invoice.
2. Click on the Adjust icon  to the far right of each item. 
3. Adjust the item fee down to $0.
   
4. Save the adjustment.
5. Repeat the above steps for all items on the invoice.
6. Save out of the invoice.

Recreate the new invoice

1. Select Add > Invoice.
2. Recreate the original invoice which was sent as a Patient Claim.
3. Ensure that you amend the item(s) Service Date to match the original date of service.
4. Select Pay & Claim.
5. Change the Payment Date to match the original date of payment.
6. Select the Payment Source which matches the original receipt's payment source (as noted down from the Payment Summary earlier).
7. Process a Receipt for this invoice.
8. In the Paid Patient Claim Information window, select the appropriate options and then click Claim.

Once complete, the original invoice will be nullified and the new invoice will be sent to Medicare as a new Patient Claim.

Quick reference

To correct and resubmit a patient claim:

1. Refund the payment against the original invoice, ensuring the Payment Date (and Payment Source) match the details of the original receipt.
2. Open the invoice and adjust all the item fees down to $0.
3. Create a new invoice and set the item Service Date to match the original invoice.
4. Select Pay & Claim and process a receipt, ensuring the payment details match those of the original payment.
5. Submit the claim to Medicare as prompted.