Bill Medicare for Chiropractic Services in Australia

If you own chiropractic practice in Australia, then you’ve most likely considered offering bulk billing or Medicare rebates for clients. But maybe you haven’t got around to doing the research because, at first glance, the requirements for getting set up can seem overwhelming.

Fear not! Once you know how to bill Medicare for chiropractic services, a whole new target market will open up to you. People who are in need of your services but were previously unable to afford them will now be able to get a referral from their GP and get up to five sessions at no (or little) cost.

Looking for help on how to bill Medicare for chiropractic services in the US? We’ve got you covered.

Across Australia, 86% of all Medicare claims are bulk billed (meaning that there is no client co-payment). However, the percentage of bulk bill claims for allied health professionals like chiropractors is closer to 65%. This suggests that the rates offered to allied health providers are possibly below the value of the services, but it is still a good opportunity for chiropractors who have the capacity to take on more clients. Even if you decide against bulk billing, you still have the option to offer Medicare rebates with a gap fee.

Ready to find out how to get set up and start claiming from Medicare Australia? Read on! We’re going to cover how to get set up, what requirements you need to fulfill, what conditions are treatable, and how to submit claims.

1. Get Set Up with Medicare in Australia

Before you can accept Medicare clients, you need to be registered. It’s a simple five-step process that is quick to do and will allow you to offer bulk billing or Medicare rebates with a “gap fee”.

Step 1 – Apply for Your Medicare Provider Number

As a chiropractor in Australia, you are considered an allied health practitioner. Therefore, in order to claim Medicare benefits, you will need to get approval for an initial Medicare provider number.

Step 2 – Register for the Healthcare Identifiers Service

The national HI Service uses unique numbers to match healthcare providers to individuals. As a registered chiropractor with the Australian Health Practitioner Regulation Agency (AHPRA), you’ll automatically be assigned a healthcare identifier.

Step 3 – Register for Digital Health

Governments across Australia are working towards a unified online system that manages health information electronically. Once you have a Healthcare Identifier, you can choose to be involved in digital health.

Step 4 – Check Your Eligibility

In order to be able to provide medical services that qualify for a Medicare benefit, you need to:

Have current registration with the Medical Board of Australia;
Have a current Medicare provider number for the practice providing the services;
Meet the eligibility requirements set out in the Health Insurance Act 1973.

Step 5 – Register for HPOS

The Health Professional Online Services connects you as the practitioner to Medicare services which will allow you to:

Update your practice details with Medicare;
Change your location;
Submit claims online;
Access the Practice Incentives Program.

2. Medicare Requirements

Once you are registered with Medicare in Australia, you can take on Medicare clients. But, in order to be able to claim from Medicare, your client will need to have a referral from a general practitioner under Medicare’s Chronic Disease Management program.

A chiropractor is limited to five bulk-billed chiropractic consultations per client per calendar year provided that:

The client has not used their chiropractic benefits elsewhere;
The client has been suffering from a chronic musculoskeletal condition (longer than six months);
The client’s doctor has determined that they meet the eligibility criteria;
The doctor has completed Medicare forms 721 and 723;
The client is not an admitted patient of a hospital;
The service is provided individually and in-person;
The treatment lasts for a minimum of 20 minutes;
You provide a written report to the referring medical practitioner.

3. Treatable Conditions Under Medicare in Australia

Doctors can refer their clients to chiropractors who bulk bill or accept Medicare along with gap fees for the treatment of musculoskeletal injuries. This includes:

Spinal pain in the neck, middle back, and lumbar spine;
Headaches and migraines;
Sciatica, disc conditions, and nerve pain;
Pregnancy-related back pain;
Whiplash;
Sports injuries;
Vertigo and dizziness;
Muscle spasms and stiffness;
Arthritis and other degenerative conditions.

4. Claiming from Medicare in Australia

The process of how to bill Medicare for chiropractic services has been streamlined significantly through Medicare Easyclaim. This is a Medicare Australia initiative that allows your clients to lodge their claims and receive rebates through a HICAPS terminal at your practice. It can be used for bulk bills and patient claims (including CDM).

As a chiropractor, you are classified as an allied health provider, which means that you can only claim under a CDM plan if the referring general practitioner has established and subsequently activated the plan with Medicare Australia.

Reimbursement will depend on how the account was settled:

Medicare rebates are paid directly into your client’s cheque or savings account.
Bulk bill claims are paid into your account within two to three days if you have your EFT details registered with Medicare Australia (cheque payments take longer).

Patient Claims

There are three payment types that can be submitted through Medicare Easyclaim and will depend on how you have agreed with the client for the settlement of their account. The three choices are:

Fully paid account – when a patient has paid their account in full, payment from Medicare will be made to the client’s nominated bank account. The payment is initiated when the client swipes their EFTPOS card.
Part paid account – where the patient has contributed towards the settlement of the account. If Medicare benefits are assessed as payable, a statement and/or cheque in the name of your practice will be forwarded to the client’s address, who will then forward it to you. If no benefit is assessed as payable, the client will receive a statement only.
Unpaid account, if the account has not been paid, Medicare will follow the same process as for a part-paid account.

Once the client has paid their account, you can swipe their Medicare card, follow the prompts, and then the rebate will be paid directly into their account almost immediately.

Bulk Bill Claims

A bulk bill claim arises when a client who is eligible for Medicare benefits assigns their right to the rebate to the provider (you) via the HICAPS terminal. It is considered full payment for the services and is paid into your nominated bank account. If you bulk bill, you cannot charge any additional fees or co-payments to your clients.

To reconcile your bulk bill claims, you can access the claims processing and payment reports via Medicare Australia’s Health Professional Online Services (HPOS) portal. You will need to register for a Public Key Infrastructure (PKI) individual certificate.

Get a step-by-step guide to HICAPS Medicare Easyclaim here.

FAQ on How to Bill Medicare for Chiropractic Services

What is bulk billing?

This is the term used in Australia that refers to healthcare services offered to clients at no cost. Rather than the client paying for an appointment, then applying for a partial rebate through Medicare, you, as the practice owner, will bill Medicare directly (and there are no out-of-pocket expenses for the client). The Medicare rate provided by the government then covers the payment of your client’s bill.

Can chiropractors bulk bill?

Chiropractors can bulk bill if the patient qualifies for treatment under Medicare Australia’s regulations. If the client is a green card holder, they may also qualify for access to bulk billed x-rays if you refer them to a specialist radiographic centre. Medicare green card holders that are referred to you by their GP can utilise up to 5 bulk billed sessions per calendar year.

Who is eligible for bulk billing?

As a chiropractic practice owner, you can choose who you offer bulk billing to. Some practices choose to bulk bill certain patients such as Seniors Card holders or children under the age of 16, while others may choose to bulk bill follow-up appointments. Some chiropractic practices offer bulk billing to all clients that qualify.

Clients who may be eligible for bulk billed chiropractic services include:

Health Care Card holders;
Seniors Card holders;
Age Pension pensioners;
Children under the age of 16;
Students;
Home visits and after-hours services;
All green card holders at a bulk billing practice.

Why don’t all chiropractors offer bulk billing?

Bulk billing is not a mandatory requirement in Australia, and chiropractors can decide whether they want to offer bulk billing, private billing, or a combination of the two. Some practices may choose not to offer bulk billing as the rate of remuneration might not be high enough for the services they provide. Often, if you are starting out or are a solo practitioner, bulk billing is a good way to differentiate yourself and attract clients who qualify for Medicare coverage.

What is a gap fee?

Often referred to as “the gap”, a gap fee is the difference between the practice’s fees and the Medicate rebate rate. This out of pocket amount is covered by the client and is applied to any consultation that is not covered by bulk billing.

As a chiropractor, you can set your own prices for different consultation types and treatments, while Medicare rebates are calculated according to the Medicare Fee Schedule.

If you do not bulk bill clients, each client will need to pay the full fee on the day of their consultation, and the practice will then claim on the client’s behalf. If the client has registered their bank details with Medicare, the rebate will be back in the client’s account within a few days. Alternatively, the client can claim back the rebate themselves (from a MyGov office or using Medicare’s online claim options).

What is CDM and does my client qualify?

Within Medicare, there is a scheme called Chronic Disease Management (CDM), which is available for people in Australia with chronic injuries or illnesses. The condition needs to be present for more than six months, and the proposed treatment that you offer should have a high probability of being beneficial to the patient. A client’s CDM eligibility is determined by their GP, and a referral is valid for one year from when it is issued.

These are the CDM criteria.

How can chiropractic practice management software help us submit medicare claims online?

There are a few practice management software systems that integrate with Medicare. However, unlike most, Zanda provides a direct integration completely free of charge. No need for any additional software or subscriptions as Zanda does everything for you! Submitting a Medicare patient claim or Bulk Bill is a very simple process and just takes a few clicks. All the required information is automatically included on invoices to ensure they comply with Medicare requirements.

Phew, that’s quite a lot to process but hopefully, you’ve got some clarity on how to get set up, what the requirements are, which conditions you can treat and how to go about claiming from Medicare in Australia. For chiropractors working as allied health providers, the four most important things to remember are:

To check your eligibility and confirm that you are registered with Medicare;
To get your paperwork in order before accepting a client including the referral note needed from the referring GP;
To decide under which conditions you will offer Medicare rebates or bulk billing;
To check that the referring GP has established and subsequently activated a CDM plan with Medicare Australia.

If you’ve just started your chiropractic practice, or if you’re looking for ways to grow your client base, offering Medicare rebates or bulk billing can be a great option. Maybe it’s not something that you want to offer to all your clients but, because it is not mandatory, you can customize who you offer it to, or only make it available for certain services. However you choose to approach Medicare, it’s important to make sure you’re registered with them and know how to bill Medicare for chiropractic services.

How to Bill Medicare for Chiropractic Services in Australia