MBS ANSWERS

How do I correctly administer a known-gap claim without breaking the law that applies to illegal split bills?

Context

I’m working as a surgical assistant. I sometimes charge the patient a gap. My registration with each fund is ‘known gap’. As an example - Bupa pays $386 for assisting a 49518. I want to charge the patient $100 gap. Do I need to charge the fund $486? and then charge the patient $100 or do I charge the fund $386 (under their known gap scheme flag) and separately bill the patient $100. I’m confused about split billing - what is allowed and what isn’t allowed and where we can charge the fund only their known gap scheme amount and where we have to charge the fund the entire amount or whether this is actually what’s always needed? 

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RECOMMENDED RESOURCE
RECOMMENDED RESOURCE

Health Insurance Act – Cases and Commentary by Bruce Topperwien

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HOW TO AVOID THE MEDICAL BILL RIP OFF
HOW TO AVOID THE MEDICAL BILL RIP OFF
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