Access to Medicare Billings

I don’t have access to my practice’s software and my practice manager is only giving me a printout of weekly billings totals. I am concerned about the accuracy of my billings but my practice manager has told me not to worry because they will sort out any problems. Is this reasonable? Can I request to see all my Medicare Billings and how frequently can I do this?

It is critically important that you have visibility over all Medicare item numbers that are billed to your provider number. As you are partly liable for any errors/incorrect claims, you must be able to see what has been billed in your name.

Also, billings totals may well be different to your Medicare item number records, depending on how your practice bills.

According to the NTCER, clause 14.7:

“As the billing doctor is responsible for any incorrect billing practices, it is recommended
that registrars review their list of patient billings on a regular basis to protect
themselves from inadvertent breaches of Medicare legislation. Employers shall
cooperate in this process, providing prompt access to lists of patient billings and
associated documentation and records.”

And clause 15.3:

“The employer will provide the registrar with billing or receipts information as
appropriate. Information on billings or receipts shall be made available to the registrar
at a frequency no less than that available to other employed doctors in the same
practice.
Where there are no other employed doctors in the same practice, information as to
billings or receipts will be made available to the registrar at a reasonable frequency,
by mutual agreement between the practice and the registrar.”

In the case where Medicare rejects an item number, and the practice manager makes an adjustment on your behalf, you must have provision to check and correct the item numbers. Failing to do so puts you at risk of Medicare Audit and Professional Services Review, and if incorrect item numbers have been submitted, you are liable to pay a portion of them back.

Depending on what software the practice uses, it is likely that generating daily reports on billings is possible. Speaking with the practice manager or your training provider to have information on billings and receipts made available more frequently is advised.