Common use of Account Requirements Clause in Contracts

Account Requirements. All accounts and receipts presented to HBF must be consolidated for a single Eligible Member for an Episode and must meet the following requirements: (a) The Practitioner must: (i) ensure that the account is fully unpaid; (ii) include details of a consultation in the medical records of an Eligible Member if a consultation is billed on the account; (iii) ensure that in the case of an Eligible Member with overseas visitor cover a benefit would have been payable if that member had been an Australian resident; and (iv) lodge the claim within two years of the date of Service. (b) The Practitioner must ensure that: (i) the account identifies the MBS item number for Services, ensuring that this is properly allocated for the Service and is one for which Medicare pays a benefit; (ii) where a Multiple Operation is performed, the fees set out on the account are calculated in accordance with the Medicare Multiple Operation Rule; (iii) the account includes the following information: (A) Eligible Member’s full name, address and member number; (B) Eligible Member’s Medicare number, Medicare card reference number and expiry date; (C) details of the Service, including date the Service was provided; (D) all fee information including the total fees charged for each Service provided and all gaps paid or payable; (E) any special exemptions; (F) referral details, including the date of referral, provider number and full name of the referring Practitioner; and (G) any other information relevant to assessment of the claim.