Identify appointments that occurred after hours and do not have after hours billings
This metric will identify appointments that started after hours as defined by the MBS and were billed either a standard consultation item number instead of an after hours item number OR not billed an after hours item number at all (do not have any billing with the same service date as the appointment). An appointment is considered after hours if the appointment was booked to start after hours as defined by the MBS or if the corresponding visit started after hours and this visit started later than the appointment was scheduled to start.
The MBS defines an after hours consult as one that is provided:
- on a public holiday,
- on a Sunday,
- before 8 am, or after 1 pm on a Saturday, or
- before 8 am, or after 8 pm on any day other than a Saturday, Sunday or public holiday
Practice managers, the Management team, Practitioners and Doctors can use this metric to:
- Look at the potential billings earned if after hours item numbers had been billed instead of regular item numbers
- Identify a list of appointments that occurred after hours that have not been billed (do not have billing with the same service date as the appointment)
- Use this data for training purposes by identifying trends where standard appointments are being billed instead of after-hours items or billing is being missed for after hours appointments
To navigate to this metric, go to Clinic Optimisation > Billing optimisation > Operational tab > After hours appointment does not match billing.
This metric can also be found:
- In My Cubiko for your Practitioners, under the My Diary tab
- In Multisite, under the Diaries tab.
The sections included in this article are:
- Understanding the Metric and Data
- Key Components
- Using the Metric and Data in Your Practice
- Get started and Additional resources and tools
Understanding the Metric and Data
Cubiko looks for invoices raised for that patient for that day with the same doctor as the appointment. Then we check for any after hours item numbers 585, 588, 591, 594, 599, 600, 733, 737, 741, 745, 761, 762, 763, 764, 765, 766, 767, 768, 769, 772, 776, 788, 789, 5000, 5020, 5040, 5060, 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5200, 5203, 5207, 5208, 5260, 5263, 5265, 5267, 5220, 5223, 5227, 5228, 92210, 92211, 93653, 93654, 93655, 93656) and if we cannot find an invoice with one of these MBS item numbers Cubiko identifies the appointment as being an after hours appointment where the billing did not match.
Cubiko is also able to calculate a potential after hours billing opportunity. This checks for any standard consults that were billed for that appointment and compares the medicare rebate for the relevant standard consult and the equivalent after hours medicare rebate. This does not apply to the after hours appointments that have no billing.
Cubiko excludes appointments that were billed CDM item numbers as they are typically not eligible for after hours consults to be billed concurrently. CDM is any of the following item numbers (721, 723, 729, 731, 732, 92024, 92025, 92026, 92027, 92028, 92068, 92069, 92070, 92071, 92072, 229, 230, 231, 232, 233, 92055, 92056, 92057, 92058, 92059, 92099, 92100, 92101, 92102, 92103).
Key Components
You can filter these metrics by date range, practitioner and appointment type.
There are also two key checkbox filters for this metric.
The first is called "Include appointments with after hours billings" This allows you to see how many after hours items the practice is already billing.
The second is "Include batched invoices", this allows the user to see appointments that were missing after hours item numbers but have already been batched so would be hard to correct because they have already been sent to Medicare.
This can be used to see historically how many missed after hours billings there were and might highlight if the practice should be focusing on ensuring they bill after hours items in the future.
Using the Metric and Data in Your Practice
Any viewer with full access to Cubiko will have access to the Billing optimisation cabinet where this metric is located. If you wish to allocate this to a member of your team you will need to ensure they have access to the "Billing optimisation" cabinet in permission. See Setting up and managing viewers to do so.
Practitioners and Doctors can locate and use this metric in MyCubiko. Please see our article "Setting up access for Practitioners and Doctors to My Cubiko" to grant access to your Practitioners and Doctors.
1. Look at the potential billings earned if after hours item numbers had been billed instead of regular item numbers
You can filter these metrics by date range, practitioner and appointment type.
Make sure to select the "Include batched invoices" filter, which incorporates billings that have been batched with standard item numbers instead of after hours items for appointments conducted after hours. While it might be challenging to retroactively modify those already billed, this step allows you to identify potential missed billing opportunities. The system calculates the variance between the billed item and the corresponding after hours item.
To locate the number of after hours appointments and billing opportunities by practitioner, refer to the top two metrics on the page, providing a comprehensive overview of this critical information.
After hours appointments with NO billings are not included in this calculation.
2. Identify a list of appointments not yet batched that occurred after hours but billed regular numbers, that could potentially be changed to reflect the after hours item
To optimise the successful capture of appointments occurring after hours, which may have been billed with a standard item number instead of the appropriate after hours item number, we advise delaying your batch submission until the following morning. Take the opportunity to review these entries first thing each morning, ensuring the invoices are updated to accurately reflect the correct item numbers. This approach enhances accuracy and improves the efficiency of billing processes.
To view this list ensure the "Include batched invoices" filter is unticked. This filter is defaulted to be unticked. You may wish to filter down and view this for one practitioner at a time.
Use the "List of after hours appointments" table at the bottom of the page. This will show you the details of the appointments that were after hours and what items were billed to the patient.
Review these billings with the billing provider and if the appointment meets the after hours criteria, change over the billing prior to submission.
3. Identify a list of appointments that occurred after hours that have not been billed (do not have billing with the same service date as the appointment)
To capture a list of appointments that occurred after hours that have not been billed (do not have billing with the same service date as the appointment), use the List of after hours appointment table at the bottom of the page.
Sort the column "Items billed" to identify a blank row where no item has been billed for this appointment. This may show appointment books in which you do not bill from such as Nurse columns- use the "Select Practitioner" filter to select the relevant billing providers.
Review these appointments with the billing provider and if the appointment meets the after hours criteria, create an invoice.
4. Use this data for training purposes by identifying trends where standard appointments are being billed instead of after hours items or billing is being missed for after hours appointments
Use the date filters on the page to select a date range that you would like to review to capture trends where standard appointments are being billed instead of after hours items or billing is being missed for after hours appointments. Be sure to tick the filter "Include batched invoices" filter, which incorporates billings that have been batched with standard item numbers instead of after hours items for appointments conducted after hours.
Use the "Trend of after hours appointments" graph to identify days/weeks/months where you have higher potential missed billing opportunities for appointments that were after hours but billed regular standard consult item numbers and the number of after hours appointments.
TOP TIP! Use the drop-down arrow on the graph to view the trend data either broken down by day, week or month for the date range you have selected.
To get a further breakdown of these trends use the "List of after hours appointments" table at the bottom of the page to identify the time of appointments, after hours categories and appointment types:
Get started:
- Jump into Billing optimisation today and review your data under the "After hours appointment does not match billing" metric
- Ensure the relevant staff have access via viewers' permissions above to use this data
- Share the relevant areas that you would like each viewer to use in the "Using the metric and Data in your practice" sections above with relevant staff, Practitioners and Doctors to help them start actioning this data
Additional Resources and Tools:
- To view the details of the MBS items to be used for after hours attendances, click here.
- Cubiko utilises the Australian Government's Australian Public Holidays Dataset to determine the public holidays that are recognised by each state. This dataset can be accessed here