BSBMED302B - Prepare and process medical accounts

BSBMED302B - Prepare and process medical accounts

BSBMED302B
Prepare and process medical accounts

This unit describes the performance outcomes, skills and knowledge required to provide advice to patients regarding fee structures and process referrals, and to prepare and process medical accounts for a range of patients.No licensing, legislative, regulatory or certification requirements apply to this unit at the time of endorsement.

Application

This unit applies to individuals who are skilled operators and apply a broad range of competencies in various medical administration contexts. They may exercise discretion and judgment using appropriate knowledge to provide technical advice and support to a team.

Elements and Performance Criteria

ELEMENT	PERFORMANCE CRITERIA
1. Provide advice to patients about fee structure	1.1. Identify and advise patients of schedule of fees for different services 1.2. Advise patients regarding entitlements and rebates 1.3. Schedule medical appointments using appropriate booking and account systems
2. Process referrals to specialist practitioners	2.1. Check referrals to ensure validity 2.2. Follow correct procedures for referral 2.3. File referral letters according to legislation and enterprise policies and procedures
3. Prepare medical accounts for bulk billed and private patients	3.1. Accurately follow procedures for billing based on account type 3.2. Identify and cost procedures which are not eligible for Medicate rebate 3.3. Select and complete appropriate account and billing documentation according to enterprise and legislative requirements 3.4. Follow procedures for preparing Veterans' Affairs, workers compensation and motor vehicle third party accounts accurately 3.5. Forward medical account to designated person or organisation according to legislation and account processing procedures
4. Process accounts	4.1. Receive and document payments 4.2. Prepare and issue receipts to person or authority according to legislation and office policies and procedures 4.3. Reconcile Medicare payments with claims made by the medical practice 4.4. Follow-up overdue accounts 4.5. Provide and store financial records and data in accordance with policies and procedures of the medical practice

Required Skills

Required skills

communication skills to listen and follow instructions and communicate professionally and clearly with patients, allowing for patients difficulties in understanding

literacy skills to read and understand financial procedures and documentation

numeracy skills to work with basic financial and accounting procedures, file documents and interpret data in tables, graphs and diagrams

proofreading skills to check calculations, invoices and fee structures.

Required knowledge

health care system

Medicare entitlements, schedule book, MedClaims

public and private health insurance systems

provisions of relevant legislation from all levels of government that affects business operations, codes of practice and national standards, such as:

anti-discrimination legislation

ethical principles

privacy laws

Freedom of Information Act

compensation systems, including workers compensation

procedures for patients without Medicare card or number.

Evidence Required


The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.
Overview of assessment
Critical aspects for assessment and evidence required to demonstrate competency in this unit	Evidence of the following is essential: communicating information on a range of entitlements and benefits using appointment and referral systems to ensure accuracy of billing records and processes applying knowledge of the healthcare system and practice polices and procedures to ensure timely and accurate collection of accounts.
Context of and specific resources for assessment	Assessment must ensure: access to an actual workplace or simulated environment access to office equipment and resources examples of documentation and resources.
Method of assessment	A range of assessment methods should be used to assess practical skills and knowledge. The following examples are appropriate for this unit: direct questioning combined with review of portfolios of evidence and third party workplace reports of on-the-job performance by the candidate review of authenticated documents from the workplace or training environment analysis of responses to case studies and scenarios demonstration of techniques observation of presentations oral or written questioning to assess knowledge of workplace emergencies, risks and hazards observation of performance in role plays assessment of documentation.
Guidance information for assessment	Holistic assessment with other units relevant to the industry sector, workplace and job role is recommended, for example: BSBITU306A Design and produce business documents.

Range Statement


The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.
Fees may relate to:	advice to patients AMA recommendations Department of Veterans' Affairs insurance medical reports Medicare (hospital, medical) other items sold to patients (e.g. immunisations, dressings) other services provided by the clinic provision of copies of medical files provision of legal and other reports provision of repeat prescriptions refund only scheduled fees services provided to Divisions of General Practice services with no fee structures Transport Accident Commission workers compensation
Entitlements and rebates may relate to:	Department of Veteran's Affairs Medicare private health funds (level of cover, restrictions) Transport Accident Commission workers compensation
Medical appointments may include:	block limited block sequential
Systems may include:	software-based accounting and appointment systems print-based accounting and appointment systems
Procedures for referral may include:	checking for 'acceptable evidence' (e.g. name of referring doctor, address or service provider number of the referring doctor) checking that the referral is valid (e.g. length of time stated in the referral has not been exceeded) entering patient details into computer system filing patient notes maintaining patient information recording information word processing
Policies and procedures may include:	abiding by state/territory and federal legislation accessing and updating files bank reconciliations and preparing banking documentation correspondence format end of session, end of day, end of week, end of month and end of year procedures following instructions information specific to the enterprise management of provider numbers for doctors managing particular Medicare problems (e.g. lost cards, newborns, foreign national, new card numbers, patients separating from family cards) office practice manual RACGP Code of Practice for the Management of Health Information in General Practice RACGP Entry Standards for General Practices recording information security, confidentiality and privacy procedures
Procedures for billing may include:	additional information attachments claims dates and names Department of Veteran's Affairs items of service descriptions of services explanatory notes forms Health Care cards hospital item numbers of services levels of fees medical certificates Medicare item numbers Medicare provider numbers name of service provider patient details payment options referrals services that are consultation items, and those that are procedural items treatment vouchers vouchers workers compensation
Account type may include	bulk billing private
Appropriate account and billing documentation may include:	accounts enterprise's templates (e.g. for accounts, accompanying reports) forms invoices receipts reports statements vouchers
Designated person or organisation may include:	Australian Medical Association Department of Veteran's Affairs guardian Health Insurance Commission patient Transport Accident Commission workers compensation organisations
Legislation may relate to:	consent duty of care equal opportunity malpractice negligence occupational health and safety (OHS) privacy relevant state/territory and commonwealth Acts workers compensation
Account processing procedures may relate to:	additional information attachments claims dates and names debt collection descriptions of services explanatory notes forms Health Care cards item numbers of services levels of fees medical certificates Medicare item numbers Medicare provider numbers name of hospital name of service provider overdue accounts patient details payment options receipts reconciliation of claims and payments referrals vouchers workers compensation
Storing procedures may relate to:	date order period of storage storage conditions
Financial records may relate to:	computerised billing software credits and debit amounts daily/weekly summaries/reports general ledger Medclaims (electronic billing of Medicare) overdue accounts overdue debtors list/report payment history payments received receipt book statements statistics types of payments and related documentation/reports (e.g. credit card payments, EFTPOS)

Sectors

Unit sector

Competency Field

Administration - Medical Services Administration

Employability Skills

This unit contains employability skills.

Licensing Information

Not applicable.