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Medicare Information

Information about Medicare

All examinations performed by North Coast Radiology are done so in observance of the Medicare Benefits Schedule. The Medicare Benefits Schedule provides criteria which determine if rebates offered by Medicare can be accessed by patients.

 

For a patient to be eligible for a Medicare rebate there are certain criteria that all referrals must display.

 

– Referrer name
– Referrer provider number
– Referrer contact details
– Examination requested
– All relevant clinical history

 

Examinations have medicare eligibility rules which apply and your referring practitioner will be able to advise you as to general eligibility.  Information regarding specific eligibility for individuals and specific examinations will be provided by our staff during the appointment booking process. Any questions please contact your local branch.

What is the Medicare Benefits Schedule? How does it impact costs?

The Medicare Benefit Schedule is a list of medical examinations created and managed by the Commonwealth Government. Each item is given a unique Medicare 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.

The Item Number on the account from the Radiologist will match a particular Medicare item Number and thus Schedule Fee. The Medicare Benefit (or rebate) is the amount Medicare refunds for the procedure.

Since Medicare eligibility is confirmed once we have viewed your referral request.

If you have any questions regarding this please contact your nearest Branch.

Fees charged by North Coast Radiology for some radiology examinations are equal to this fee ensuring your out of pocket expense is $0. However, some are above the Medicare Benefit resulting in a gap fee for patients.

Gap fees have generally increased for patients as the Medicare rebate is not keeping pace with either inflation or the true cost of providing the service. The Federal Government has not adequately increased the Medicare Rebate for radiology examinations.

What is covered if no Medicare card available but private health insurance is in place?

Your private insurer may cover gap fees for specialist services such as Radiology. However, they do not generally cover the fee that is equivalent to the schedule fee determined by Medicare. Without a Medicare card you cannot claim the medicare rebate and this will be the likely fee you will be out of pocket for. Please check with your own insurer regarding what they will and will not cover you for.

What does an examination that is 'non-rebateable' mean?

The Medicare Benefits Schedule indicates which examinations qualify for a Medicare rebate.  Eg. GP’s can now refer for a number of MRI examinations – but not all. Your referring practitioner should be able to advise you of the Medicare rebate eligibility of the examination they are asking you to do.

When your appointment with us is confirmed we also advise you of the expected cost, applicable Medicare rebates and any out of pocket costs.

Will a referral form with a medicare item no detailed be bulk billed?

Medicare item numbers mean that a medicare rebate can be claimed back because the examination meets criteria as determined by Medicare.

The rebate amount may or may not be the same as the usual North Coast Radiology Group fees apply; meaning some examinations will be Bulk Billed (rebate amount is the same as the service fee) and some may have an out of pocket fee (service fee exceeds the available rebate leaving you with a gap).

All information regarding applicable fees and available medicare rebates will be given at the time your appointment is confirmed.