Backdated Lodgement of Bulk Bill Claims for Medicare for item 10997.

Q: Can our Practice lodge backdated claims for item 10997? The services were provided but not billed for.

A: Backdated Lodgement of Bulk Bill Claims for Medicare

Lodgement Timeframe

1. Medicare Lodgement Period: Medicare allows bulk bill claims to be lodged for up to two years after the service has been provided.
2. Lodgement Beyond Two Years: Medicare permits bulk bill claims for services provided longer than two years ago in specific circumstances. For example, if services under a Care Plan were not paid due to a failure to submit the claim, backdated claims are permissible.

Backdated Lodgements for Item 10997

Medicare Requirements:

• Service Completion: The service must have been completed and recorded per the MBS schedule descriptor.
• Backdated Lodgement:
  • Complete the original assignment of the benefit form (electronically via Practice software)
  • Obtain the patient’s signature. (Or any other form of consent)
  • Submit the claim using your usual method.

Important Consideration: Ensure that any claim on the date of the backdated 10997 was also a bulk billing claim. Medicare prohibits mixed billing claims for these services.

References:

Services Australia. Late lodgement of Medicare Claims. https://www.servicesaustralia.gov.au/apply-for-bulk-bill-late-lodgement-for-mbs-claims?context=20#:~:text=Apply%20a%20late%20lodgement%20of,within%20the%202%2Dyear%20period. Last accessed 12.08.24.

Services Australia. Bulk billing claims. https://www.servicesaustralia.gov.au/assignment-benefit-for-bulk-bill-patient-claims?context=20#unabletosignsensitiveissue. Last accessed 12.08.24.

HEALTH INSURANCE ACT 1973 – SECT 20B Claims for medicare benefit (b). https://www8.austlii.edu.au/cgi-bin/viewdoc/au/legis/cth/consol_act/hia1973164/s20b.html. Last accessed 12.08.24.
Medicare Benefits Schedule – Note MN.12.4. https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&qt=NoteID&q=MN.12.4. Last accessed 12.08.24