Billings and Gap Fees

Gaps and Billings

To understand ‘The Gap’, you need to understand the Medicare Benefits Schedule, the Medicare Schedule Fee, the Medicare Benefit or Rebate, and the fee charged by your doctor.

What is the Medicare Benefit Schedule?

The Medicare Benefit Schedule is a list of procedures compiled and updated by the Commonwealth Government. Each service is allocated an Item Number and Fee – The Medicare Schedule fee.

The Medicare Schedule Fee “represents the amount the government, having regard to budgetary and economic considerations is willing to pay” (Auditor General Report No 32 1990-91) – it is NOT a recommended Doctor’s fee but only what the Government is willing to pay. The Item Number on the account from the doctor will match a particular Medicare Schedule Fee.

The Medicare Benefit (or rebate) is the amount Medicare refunds for the consult. It is 75% of the Medicare Schedule Fee for hospital services and 85% of the Medicare Schedule Fee for out of hospital services (e.g. consultations). The fee charged by  PACE Clinics is above the Medicare Benefit. The Gap charged by PACE clinics is less than the AMA  (Australian Medical Association)recommended fees.

Gaps have become a  necessity as the Medicare rebate is not keeping pace with inflation. The Federal Government has failed to adequately increase the Medicare Rebate. The Medicare Schedule was established in 1985 but has not increased in line with inflation. The costs of running a quality medical practice have expanded phenomenally with computer software, hardware, information technology, insurance, staffing and Medical Indemnity.

How much will a consultation cost me?

“Gap” fee will vary from $100-$150 for the consultation .

Full fees (including Medicare component) are payable at the time of appointment by EFTPOS, Credit Card or cash, AND instant online Medicare rebating of the fee except the “gap” is available at the clinic. We use HICAPS easyclaim and with this service,  when we run your card through our EFTPOS machine, your Medicare rebate will be automatically credited back into your nominated account virtually instantaneously if medicare has your bank details.