Australia’s Medicare Benefits Schedule (MBS) is, on the face of it, a helpful system that provides healthcare providers with government financial assistance towards a range of medical services for patients. However, MBS is also a system that General Practitioners are often reluctant to use due to its complexity – and for another reason: fear.
GPs worry that they will be accused of committing fraud via their billing practices, and therefore significantly err on the side of caution. A large study published in April 2023 by the University of Sydney researchers found that contrary to popular belief, GPs tended to charge Medicare less through MBS than what they should have because they were concerned that they could be penalised for making errors when audited.
We’re talking about a substantial amount of money here. The UoS researchers estimated the MBS charging shortfall for the 2021-22 year to be as much as $351 million.
That may seem like saving money, but it is in fact leading to an increase in out-of-pocket costs for patients who potentially miss out on accessing healthcare, with GPs and clinics being deprived of badly needed revenue. It’s a bad outcome for everyone involved, one that’s not in the best interest of society.
Far North Queensland’s MediBetter was established in 2023 specifically to address this problem, according to Co-Founder Kate Taudevin.
“GPs are simply not utilising the MBS to its full potential, and it shouldn’t be like this. The MBS comprises thousands of individual item numbers; one of the most commonly missed or forgotten MBS item numbers is for an electrocardiogram (ECG),” Taudevin explained.
“Many GPs report they simply don’t bill this item number because they struggle to remember it, and it’s too difficult to search the MBS for it,” she added.
The solutions that MediBetter is working on use Microsoft artificial intelligence (AI) technology, which runs in the Azure cloud. Enterprise software developer Intergy Consulting, based in North Sydney, is MediBetter’s technology partner on the project.
MediBetter is currently readying two MBS billing optimisation solutions for release, with their core solution being BOSS which stands for Billing Optimisation and Support Software.
BOSS is designed to analyse GP consultation notes. It does so in real-time to interpret the MBS. Through BOSS, GPs are provided with billing recommendations and MBS item numbers, flagging potential missed billing opportunities and clarifying compliance considerations.
Whereas the standalone BOSS offering is scheduled for an early 2025 release, MediBetter has recently released to beta testers their first solution, MIA, an MBS Interpretation Assistant.
MIA acts as a virtual assistant for GPs and administrative staff, and provides easy, instant access to accurate, up-to-date MBS information. With MIA running, GPs and clinic staff can avoid time-consuming phone calls to MBS or emails to get support with the difficult to use official system.
“Think of MIA as ChatGPT specifically for MBS,” Taudevin said.
Using MediBetter solutions can make a substantial difference for GPs’ revenue, trials suggest.
“Prototype testing of BOSS showed a 43 per cent improvement in billings, and that equates to around $150,000 annually for an average full-time equivalent GP in Australia, or $900,000 annually for an average clinic” Taudevin said.
Testing suggests that with MediBetter’s solutions GPs can achieve a substantial return on investment, potentially reaching 650 per cent or more.
In addition to clarifying item numbers, MIA’s support on co-billing (billing multiple MBS item numbers at the same time) guidelines, will provide the most value to GPs.
Other benefits include time savings by avoiding significant manual processes and paperwork, along with archaic methods for correcting billing errors which can take up to six weeks to rectify.
Initially, MediBetter’s goal is to capture at least 20 per cent of the GP market in Australia within 12 months of launching BOSS.
This would be around 5000 to 6000 GPs, targeted with direct engagement such as building a waitlist of practitioners interested in MediBetter’s solutions, and strategic partnerships.
One such partnership that’s at the negotiations stage involves a clinical education company that has access to over 20,000 clinicians.
MediBetter is also working toward building out integration capabilities with practice management systems and existing clinical software solutions.
For technology partner Intergy Consulting, its Founder and Managing Director, David Crotty, pointed to the social aspects of the software development work, and the project being a very concrete demonstration of the benefits AI can bring.
“Better care means fewer illnesses down the track so it’s better to be preventative than reactive,” Crotty said.
According to Taudevin, optimising MBS billing will also improve the nation’s health data, whilst ensuring that GPs are remunerated sufficiently.
“The accuracy of our nation’s health data will improve as GPs will be using the correct MBS item numbers to accurately reflect the nature of their consultations. It’s a multi-layered problem, and the positive flow-on effect of directing critical funding back into the primary healthcare system will be substantial” Taudevin said.
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