What Does Outsourced Medical Billing Cost in Australia?

Medical billing services in Australia do not all use the same pricing model. A provider may charge a percentage of billings, a fee per claim, a monthly retainer, an hourly administration rate, or a combination of these. DEVZ Solutions keeps the model simple: 2.5% + GST at $20,000+ processed per doctor per month, or 3.5% + GST below that, invoiced monthly.

Common medical billing pricing models

1. Percentage-based medical billing fees

With a percentage-based model, the billing provider charges an agreed percentage of the value of billings processed. This structure can align the administration fee with the doctor's billing volume: lower billing volume produces a lower service fee, while a higher volume produces a higher fee.

When comparing percentage-based services, the percentage alone is not enough. Ask what work is included: claim preparation, lodgement, rejected-claim follow-up, reconciliation, health-fund administration, backlog work, reporting and communication can all affect the real value of the service.

2. Per-claim fees

Some billing arrangements charge a fixed amount each time a claim is submitted or processed. This may be easy to understand for a very small number of claims, but the cost can become less predictable when a doctor has many services, multiple claims within an admission or a high-volume outpatient practice.

DEVZ does not use a per-claim fee for its standard billing service.

3. Monthly subscription or retainer

A monthly fee can provide predictable overheads, but doctors should confirm whether the retainer covers unlimited work or only a defined number of claims, hours or services. Extra charges may apply if the practice moves outside the agreed scope.

4. Hourly administration fees

Hourly billing may suit one-off administrative projects, but it does not always map neatly to an ongoing billing workflow. A claim can require follow-up at different times, and the doctor may find it harder to predict the eventual administration cost.

5. Setup, registration or onboarding charges

Some practices need additional work before normal billing can start, such as health-fund registration support, provider-location setup or onboarding assistance. These activities should be clearly distinguished from the ongoing billing fee. DEVZ discusses any additional onboarding or registration scope before proceeding.

What do 2.5% and 3.5% + GST mean?

DEVZ invoices a percentage of monthly inpatient billings processed. The $20,000 threshold applies per doctor, per calendar month. The qualifying percentage applies to the entire month's eligible processed inpatient billings.

What should be included in a medical billing fee?

Price should be compared with scope. A low headline fee can be poor value if the doctor is still doing most of the administrative work. Depending on the agreed service, a comprehensive billing provider may assist with:

• organising billing information supplied or authorised by the practitioner;
• claim preparation and lodgement;
• Medicare and private health fund claiming pathways;
• ECLIPSE inpatient medical claiming where applicable;
• bulk billing and private billing workflows;
• rejected and outstanding claim follow-up;
• payment reconciliation and visibility of unresolved items;
• health-fund registration administration where agreed; and
• communication with the practitioner when billing information needs clarification.

Why inpatient billing can require more specialist administration

Many straightforward outpatient claims can be handled efficiently by practice staff. Inpatient billing can involve additional layers: Medicare, private health insurers, ECLIPSE, hospital and provider details, gap arrangements, patient eligibility, multiple services and more complex reconciliation.

That is why inpatient billing is the dedicated service of DEVZ Solutions. Our educational guides on outpatient and bulk-billing rules are general information, not an offer to administer outpatient services.

Medical billing costs for new doctors

A new specialist may not have enough administrative volume to justify employing a dedicated billing staff member from day one. Outsourcing can convert part of that fixed staffing requirement into a variable billing cost that grows with the practice.

For that reason, DEVZ can support a new doctor's eligible inpatient billing, while the doctor or their chosen provider continues to manage any outpatient work. Read our guide to medical billing for new doctors and solo specialists.

Questions to ask before choosing a billing provider

• Is the quoted percentage or fee GST-inclusive or GST-exclusive?
• Are rejected claims and follow-up included?
• Is reconciliation included?
• Are there separate per-claim, software, subscription or minimum monthly fees?
• Are there setup or registration charges?
• Does the provider handle both inpatient and outpatient billing if your practice needs both?
• Who receives the Medicare and private health fund payments?
• Will the billing provider work in its own system or require access to your practice software?
• Is there a lock-in contract?

How the DEVZ pricing model works

DEVZ Solutions charges 2.5% + GST at $20,000+ processed per doctor per month, or 3.5% + GST below that, invoiced monthly. There are no per-claim charges and no lock-in contracts for the standard billing service.

DEVZ uses its own secure, Medicare- and ECLIPSE-compliant billing software rather than remotely logging into the doctor's practice-management system. Medicare and private health fund payments go directly to the practitioner's nominated account; DEVZ does not receive, hold or pool the doctor's medical income.

For more detail on what sits behind the service fee, see Why DEVZ charges 3.5% + GST.