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Medicare and Health Funds fee schedule updates - 1 July 2021
Posted by Sinclair Hughes on 01 July 2021 07:57 AM

Medicare, TAC, WorkSafe (Vic) and AHSA (Gap Cover) are the only government agencies and insurers who have provided their updated fee schedules. 

A list of the Health Funds with the date of their latest fee schedule is available from this link.

Click on the following link to view the full list of item changes from Medicare:

It will be imperative that you complete all of your online claims for service up to and including 30 June 2021 before you download and import the new file.

Item numbers that have been deleted in the 1 July 2021 file, will no longer be available for online claims once the new file is imported.

Please note that the rates only need to be downloaded and imported once per database. Please check with others in the practice to ensure they have finished their online claims to 30 June.

Invoice codes (Setup – Financial – Charges – Invoice Items) referencing the old item numbers, e.g. 49561, will still be available for use when producing invoices that are not online. We would recommend that you edit these after you have finished invoicing and set the entries ‘Available’ column to ‘No’ for all relevant Billing Types. The ‘code’ (e.g. 49561) will still be available for reporting purposes but will not be able to be used when invoicing.

Once the 1 July Rates file has been downloaded and imported, for other than online claiming (or if you opt out), you will need to create new invoice codes for the relevant item numbers. This can be done via ‘Make Codes’ (Setup – Financial – Charges – Invoice Items). For more information, please refer to the online documentation.

Check list

  • All online claiming for services up to 30 June completed.
  • Confirm all secretaries have completed online claiming.
  • Download latest Rates files (Medicare and DVA).
  • Import latest Rates files.
  • Set superseded or deleted invoice codes to Available – No.
  • Add new invoice codes using ‘Make Codes’ for the item number range applicable to the Provider.
  • Update your Private fees (if applicable) to reflect the price changes, if applicable (Setup – Financial – Charges – User Fee Schedules).

To download and import the new Medicare and Health Funds rates file:

  1. Log into SPM using a login that has permissions to access the Import option in the following locations.  
  2. Go to Utilities module then:
    • Import -> Health Fund rates 
  3. Click on the button 'Download Rates.Aus file'.  Accept the default values and click on Go.
  4. When that has finished click Close and then choose 'Import Rates.Aus'
    Note - if you have already imported the rates during May you may need to use the 'Alternate' button on the import page to force the computer to use the latest rates file and not to reuse the file you previously downloaded.

The import process could take 15-20 minutes and can be completed while other staff are still using SPM - although as it may cause some slow-down the import process should ideally be performed when no-one is using SPM.

When a small message box appears saying that the import has been successful you can exit by clicking on the Cancel button.
When we next notify you that an updated rates file is available with the latest rebate schedules, you will need to repeat this process.