Private billing opportunity

Review your potential earnings if you were to privately bill items you bulk-billed and understand the impact of this on your practice billings

Within our Bulk billing metric in the Past clinic metrics cabinet, we have added a new tab called Private billing opportunity.

This page will provide you with an overview of the potential private billings from the bulk-billed invoices in the selected time frame. This is calculated by comparing the average private billing gap to the bulk-billing incentive for each of your practitioners.

For example, a standard 23 consult is currently worth $39.75 in benefits from Medicare. If your practice chose to charge privately for this, say $75 - the difference is the private billings gap, in this case, it would be $35.25.

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To navigate to this metric, go to Past Clinic Metrics > Billings tab > Percentage of total billings bulk billed >  

Now select the Private billing opportunity tab.

 

The sections included in this article relating to Private billing opportunity are: 

• Private billing opportunity 
• Calculating your Private billings gap
• Calculating your Private billing opportunity
• List of bulk-billed invoices
  
• List of patients bulk-billed

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Private billing opportunity

Before we begin deep diving into this amazing metric, we will give you a little bit more context that shows how we calculate what your Private billing opportunity is.

The first thing you will see on this page, are some calculation steps:

 

If you need a little more information, keep reading below for examples of these calculation steps. 

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Calculating your Private billings gap

Your private billing opportunity is linked to what we call your Private billings gap. Your private billings gap is essentially the difference between what the MBS rebate usually is, and what your practice privately charges.

 

 

It is worth bearing in mind that the above example is for a 23 only, so when we calculate your average private billings gap - we are looking at all the Medicare items you privately charge at your practice for all Practitioners and the difference between those private fees and the MBS rebate available for them. This calculation does not include DVA or custom item numbers (as there is no MBS benefit for these). 

This can also vary by Practitioner. You do have the ability to filter these metrics, by selecting specific items and Practitioners in the filters. Or you can see the comparisons in the charts available on this screen.

For more information about our Private billings gap metric, please click here. 

 

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Calculating your Private billing opportunity

Now that we have started to understand what your Private billings gap is and how it is calculated, let's start thinking about the opportunity that can be made if you chose to move away from bulk-billing Medicare items to a more private model.

To move from a bulk or mixed billing practice to a fully private billing practice, there will be a difference in how to bill your patients. Instead of relying on a benefits-only fee from Medicare, you would pass an additional fee to the patient to cover these services, from which the patient will then receive a rebate. 

In Cubiko, we are able to see which services are being bulk-billed, and any bulk-billing incentives that are being co-billed in the invoice. Cubiko will then look at the difference between your bulk-billing incentive and your private billings gap, to then calculate your private billing opportunity.

 

 

Remember, these are just working examples, they are designed to show you how you could begin the transition to private billing.

Your private billing opportunity will show a dollar amount, for the chosen time frame. It will also show the number of items bulk-billed, where the average practice gap exceeds the amount received from Medicare for a bulk-billed service. 

 

The goal of these metrics is to support our customers to:

• understand the impact of moving to mixed/private billing may have,
• dive deeper into the invoices that are getting bulk-billed, and
• explain the benefits to your Practitioners.

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List of Bulk-billed invoices

This table details the invoices that were bulk-billed in the selected time frame. You can filter this table by Practitioner, bulk-billing eligibility or MBS item to see how much each patient has been bulk-billed, and what could have been billed if they were charged private fees.

In this table you will see each bulk-billed invoice during the selected time frame, with the following breakdown per invoice:

• Invoice ID
• Patient
• Practitioner   
• Items billed
• Amount bulk-billed 
• Bulk-billed incentives
• Average private gap 
• # Items billed
• Private billing opportunity

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List of patients bulk billed

This table details the patients who have been bulk-billed in the selected timeframe. You can filter this table by Practitioner, bulk-billing eligibility or MBS/DVA item to see how much each patient has been bulk-billed. 

 

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