Medicare Safety Net

This article explains the Medicare Safety Net and how to apply this in Clinic to Cloud. Calculating the Medicare Safety Net for eligible patients will mean that you are able to accurately communicate medical costs to patients. You will have the option of selecting this new rebate option when creating fee estimates or billing patients. 

The following areas will be covered:

Please note: Medicare does not provide Clinic to Cloud with information related to patient eligibility of the Medicare Safety Net, due to patient privacy regulations. The patient is informed of their eligibility directly from Medicare.

 

What is the Medicare Safety Net?

The Medicare Safety Net is a government initiative that is subsided by our national health care system. The scheme has been designed to provide additional financial relief to patients, with high medical costs, by reducing their out-of-pocket costs after a threshold has been reached within a calendar year.

This only applies to Private Out-Patient services, also referred to as out-of-hospital services, such as consultations and medical tests.

There are two types: Original Medicare Safety Net (OMSN) + Extended Medicare Safety Net (EMSN), and both workflows are available within Clinic to Cloud. 

 

The Original Medicare Safety Net (OMSN) 

The Original Medicare Safety Net (OMSN) increases the patients’ Medicare rebate from 85% of the Medicare Benefits Schedule (MBS) fee to 100% of the MBS fee for any out-of-hospital service, once the annual threshold amount has been met. In 2020, the threshold for OMSN is $477.90.

  • The amount that accrues to the threshold is the difference between the Schedule Fee and the Medicare Rebate.
  • This threshold is indexed annually on 1 January, in line with the Consumer Price Index (September quarter).

 

The Extended Medicare Safety Net (EMSN)

Extended Medicare Safety Net (EMSN) benefits are paid in addition, to the standard Medicare rebate and any benefit received by way of the OMSN.
Under the EMSN, once the annual threshold ($2169.20 for singles, & $692.20 for concession card holders) is met, Medicare will pay up to 80% of the future out-of-pocket costs for the remainder of that calendar year.

  • The amount that accrues to the threshold is the difference between the Private Fee and the Medicare Rebate.
  • Only certain items numbers contribute to the EMSN.
  • For certain item numbers, there is an upper limit on the amount of benefit that can be paid under the EMSN which is called the EMSN Benefit Cap.
  • Furthermore, different calculation rules apply in the following scenarios, (1) Item Numbers where the Schedule Fee is a Derived Fee, (2) Item Numbers where Multiple Operations Rules apply.

 

Calculating the Medicare Safety Net in Clinic to Cloud

Invoice/Fee Estimate

1. Create a Private, Out-Patient invoice or fee estimate.

2. Search the item by item number or description. If this item number has an EMSN cap, this will show when searching for the item or when searching by description. 

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3. Consult with the patient as to whether they have reached the Medicare Safety Net. If they are eligible, select the Apply Safety Net Rebate toggle.  

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4. Select the OMSN or the EMSN as required. When you select this the Total Medicare & Safety Net Rebates will show the total of the Medicare Rebate and Safety Net amount. 

5. Click Add Item.

6. If Invoicing: You can now take payment from the patient and submit the claim to Medicare on behalf of the patient. Medicare will then confirm the patient eligibility and the rebate will be paid directly to the patient. 

7. If you need to print the invoice/fee estimate for the patient, the rebate information will show on the printout. This ensures that the patient is provided with the correct out of pocket costs. 

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Message to Receptionist

1. When you are ready to send the billing information to the reception team from a consult, select the Finish Consult icon.

2. Select out-patient and private.

3. Search your item by item number or description and select the item number. If this item number has an EMSN cap, this will show when searching for the item or when searching by description. 

4. Consult with the patient and if they are eligible choose the Apply Safety Net Rebate toggle. 

5. Select the OMSN or the EMSN as required. When you select this the Total Medicare & Safety Net Rebate will show the total of the Medicare Rebate and Safety Net amount. 

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6. Enter any notes for the receptionist and select Send & Close or Send & Stay depending on if you have finished entering all notes in the consult. (Find out more about finishing your consult here.)

7. The reception team can then raise the invoice and the billing information will be prefilled. 

 

Operation Report

1. Select the appointment once and click on the Operation Report icon or if in consult, select the Operation Report icon. 

2. Select Add Billing Items if you need to update or change any item numbers for this procedure.

3. Search your item by item number or description and select the item number. If this item number has an EMSN cap, this will show when searching for the item or when searching by description. 

4. Consult with the patient and if they are eligible choose the Apply Safety Net Rebate toggle. 

5. Select the OMSN or the EMSN as required. When you select this the Total Medicare & Safety Net Rebate will show the total of the Medicare Rebate and Safety Net amount. 

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6. Save the Operation Report. 

7. When the invoice is raised post-procedure, this billing information will be pre-filled into the invoice. 

Note: The Medicare Safety Net only applies to an Operation Report where the Out-Patient Fee Estimate is linked to an appointment. 

 

Further Reading

 

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