Incorrect MBS Billing Rates
Definition
Providers incorrectly claim 100% MBS benefits for services in hospital-substitute settings like home health, breaching regulations and triggering compliance actions with claim denials.
Key Findings
- Financial Impact: AUD 25% of MBS fee per episode rejected (e.g., AUD 50-200 loss per claim)
- Frequency: Per episode of hospital-substitute treatment
- Root Cause: Manual determination of billing context (in-hospital vs. substitute)
Why This Matters
The Pitch: Home Health Care providers in Australia 🇦🇺 lose thousands in rejected claims annually on Medicare episode billing. Automation of episode classification and rate application eliminates this risk.
Affected Stakeholders
Billing administrators, Home health practitioners, Compliance officers
Deep Analysis (Premium)
Financial Impact
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Current Workarounds
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Methodology & Sources
Data collected via OSINT from regulatory filings, industry audits, and verified case studies.
Related Business Risks
Bulk Billing Co-Payment Charges
Duplicate Payment Audit Recoveries
Delayed Claims from Incomplete Documentation
WHS Risk from Inadequate Aide Competency
Provider Supervision Non-Compliance Fines
Supervision Time Overruns
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