Billing Terminology

No Gap

'No Gap' medical billing occurs when:

·          The doctor charges the Medicare fee, or

·          The doctor and the Private Health Fund (either directly or via a private hospital) have an agreement for payment above the Medicare fee and the doctor charges the agreed fee, or

·          The doctor uses an existing Private Health Fund 'product' (such as HBA's Ezyclaim or Medibank Private's GapCover) and does not charge the patient an additional amount.

Gap

'Gap' medical billing occurs when the doctor charges the patient an amount in addition to the Medicare fee, such that the patient receives an out-of-pocket expense.

Schedule Fee

The Federal Government, through the Department of Health and Ageing, each year sets fees which determine the amount the Government will contribute for most medical services that are rendered to patients in Australia who are eligible to receive Medicare benefits. The fees are published each year in what is known as the ‘Medicare Benefits Schedule’ (MBS), and the fees are known as the Schedule Fees.