Gap Fee Recovery Failures
Definition
Private patients in public/private hospitals incur gaps between schedule fees and reimbursements; poor contract loading leads to unbilled gaps.
Key Findings
- Financial Impact: AUD 430.90+ per patient safety net threshold; ongoing gap losses[1]
- Frequency: Per private/compensable patient admission
- Root Cause: Inaccurate loading of negotiated health fund contracts and MBS rates
Why This Matters
The Pitch: Australian hospitals lose AUD 430+ per safety net threshold patient on gap fees. Automation recovers full entitlements.
Affected Stakeholders
Admissions Officer, Accounts Receivable, Patient Billing Team
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
Delayed Private Health Fund Claims
Missed Charity Care Write-Offs
Charity Care Policy Non-Compliance Fines
Delayed Collections from Eligibility Delays
Manual Remittance Processing Bottlenecks
Claims Denial and A/R Days Extension
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