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  1. #1
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    Default Reaching Medicare Safety Net with M&P Fee - Part assessed?

    Hopefully I can explain my curly question well enough, the woman I spoke to at Medicare over the phone just told me it will all be assessed automatically which didn't really help me.

    I'm $200 away from the safety net and I have to pay my management and planning fee next month ($2,200). I know the scheduled rebate is quite small compared to that, but if I was already over the safety net I would get an additional amount of my out of pocket expenses back.

    Say, for arguments sake, I am $1900 out of pocket from the $2200 fee after the standard scheduled rebate.. $200 of that is pre-safety net threshold, but is the other $1700 assessed separately? Or because it is one single claim does that claim in general put me over and it's only the following claim that would be eligible for the extra back because I'm then over the safety net?

    In a nutshell, will they assess a claim in two parts, the pre-threshold and post-threshold amounts?

    If not, I'll present two or three more OB visit claims first to make sure I'm over the threshold and then put in my claim for the M&P fee as I'll then definitely be over, but I'd rather not wait the extra two months that would take, if possible..

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    It will put you over the threshold but it's a capped rebate do you will still only get the same amount back regardless

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    Quote Originally Posted by Ngaiz View Post
    It will put you over the threshold but it's a capped rebate do you will still only get the same amount back regardless
    I don't believe that's the correct in relation to my question, as there is a separate safety net cap maximum on top of the scheduled fee in the handbook, and I'm wondering whether I get any safety net rebate at all if it is the claim that puts me over and not a claim subsequent to me already being over the threshold.

    "Planning and management of a pregnancy that has progressed beyond 20 weeks provided the fee does not include any amount forthe management of the labour and delivery, payable once only for any pregnancy that has progressed beyond 20 weeks where thepractitioner intends to undertake the delivery for a privately admitted patient, not being a service to which item 16591 applies.Fee: $324.10 Benefit: 75% = $243.10 85% = $275.50 Extended Medicare Safety Net Cap: $219.45 "

    http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/5AD8FB8072888865CA257D0F0083A811/$File/201408-MBS.pdf
    Last edited by GM01; 22-08-2014 at 14:26.

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    I got about $500 back from my management fee but I think I'd already gone over the cap. You could always hold off on claiming it until after you've put enough in to go over but I think you'll be fine.

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    Quote Originally Posted by Goblin Queen View Post
    I got about $500 back from my management fee but I think I'd already gone over the cap. You could always hold off on claiming it until after you've put enough in to go over but I think you'll be fine.
    Thanks, $500 would be nearly exactly right according to the handbook ($275.50+$219.45), but holding off until I've put enough in to go over is exactly what I'm thinking of doing if it's not 100% clear whether the claim gets assessed in part!

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    I'd wait until your already over

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    Mine was item 16590. I'm quite sure the maximum rebate would be $494.95.

    The way I understood it was this.

    Because the invoice will put you over the threshhold you get 85% of the schedule fee, $275.50 plus the maximum capped amount of $219.45 therefore the maximum rebate if the invoice is putting you over the threshold is $494.95.????

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    As it is a capped amount I would claim it first so I could receive the max rebate from ante natal appts.

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    I was already over the safety next when I paid mine and only got the capped amount back, I think it was just under $500 from memory?

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    @GM01 if you are under the safety net you will get $275.50 back, if you are over the safety net you will get $494.95, so I'd wait if I were you


 

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