Australian medical billing dictionary
Plain-English definitions of commonly used Australian medical billing terms. Select a letter or search the page using your browser.
Assignment of benefit
A process under which a patient assigns their Medicare benefit to the practitioner, commonly used in bulk billing arrangements.
Backlog billing
Claims or billing records that have not been processed within the usual workflow and require systematic review and lodgement.
Bulk billing
A claiming arrangement where the provider accepts the Medicare benefit as full payment for an eligible service.
Claim rejection
A claim that is not accepted for payment because information, eligibility, coding or administrative requirements have not been met.
ECLIPSE
An electronic claiming channel used for eligible in-patient medical claims involving Medicare and participating private health insurers.
Gap
The difference between a provider’s fee and the combined benefits paid by Medicare and a private health insurer.
HPOS
Health Professional Online Services, a secure Services Australia channel accessed using PRODA.
Health fund registration
The provider onboarding or registration process required by a private health insurer for eligible claiming arrangements.
Inpatient
A patient formally admitted to hospital or an approved facility, subject to the applicable rules and claim context.
Known Gap
A health fund arrangement under which a provider may charge a permitted patient gap, subject to fund rules and disclosure requirements.
MBS
The Medicare Benefits Schedule, which lists Medicare-subsidised professional services and associated rules.
Medicare Online
A digital claiming channel used through compatible practice management software after appropriate registration.
No Gap
A billing arrangement where the patient is not charged an out-of-pocket gap for the relevant insured service.
PRODA
Provider Digital Access, the Australian Government identity and authentication service used to access services such as HPOS.
Provider number
A location-specific identifier used by eligible health professionals for Medicare-related claiming and administration.
Revenue leakage
Income lost or delayed through missed services, incorrect details, rejected claims, inadequate follow-up or incomplete registration.
Schedule fee
The fee set in the MBS for an item. It is not necessarily the same as the practitioner’s fee or the total amount paid.
Specialist billing
Billing administration tailored to specialist medical services, referrals, MBS items and relevant payer pathways.