Private Hospital Billing Across Australia

Private hospital episodes are where inpatient billing gets complicated — two payers, several item numbers, and timing tied to discharge. DEVZ Solutions handles it end to end for specialists Australia-wide, lodging with Medicare and the health fund simultaneously and reconciling the gap so nothing is left unclaimed.

What is private hospital billing?

Private hospital billing covers the claims generated when a patient is admitted to a private hospital and treated by a specialist. Unlike a rooms consultation, a private admission almost always involves both Medicare and the patient's private health fund. Medicare pays a scheduled benefit; the health fund pays a benefit, frequently under a no-gap or known-gap arrangement. The correct MBS item numbers must be applied to each service, and the amounts from each payer reconciled.

This is the heart of inpatient medical billing, and it is where most avoidable revenue loss occurs.

Where private hospital claims go wrong

The common failure points are consistent across practices:

• Incorrect or incomplete item numbers for a multi-part procedure.
• A provider not yet registered with the patient's health fund, so the fund portion is never paid.
• Known-gap and no-gap arrangements applied incorrectly.
• Claims lodged outside Medicare's time limits.
• Rejections that are never corrected and resubmitted.

Each is preventable with disciplined process. Our revenue leakage guide shows how these small gaps compound over a year.

How we handle private hospital episodes

We take admission and treatment details in whatever format suits you, code the episode with the correct item numbers, lodge with Medicare and the relevant health fund, and follow up until payment lands in your own account. If a provider is not yet registered with a fund, our health fund registration service resolves that so future claims are accepted from day one. Anything previously rejected is pursued through rejected claim recovery.

Who we bill for

Our private hospital billing supports surgeons, anaesthetists, gastroenterologists, physicians and proceduralists — anyone treating admitted private patients. Practices that prefer a complete handover can also outsource billing entirely.