New Access Gap Cover Schedules – Effective 1 July 2024
In a move aimed at enhancing healthcare accessibility and transparency, updated Access Gap Cover (AGC) schedules will come into effect from 1st July 2024. Following a comprehensive review of benefits, these new schedules integrate AHSA indexation above the Medicare Benefits Schedule (MBS) fee for targeted specialties across various states and territories. The Australian government has also introduced changes to MBS indexation, which have been duly incorporated into the AGC framework.
To access the latest schedule, please visit the Schedules section on the AHSA website. Detailed information about the AGC benefit review, including Frequently Asked Questions, can be found here.
Updated AGC Participating Funds Contact List
A revised list of funds participating in AGC is now available, featuring updated contact details for each fund. This resource provides essential information regarding patient insurance products, coverage specifics, and claims processes. For inquiries related to patient insurance coverage or claims, please consult the updated Participating Fund Contact List on the AHSA website.
Important Access Gap Cover Reminders
To facilitate efficient claims processing, please adhere to the following guidelines:
- Provide patients with written ‘Informed Financial Consent’ if a gap fee is charged.
- Ensure all fees adhere to AGC rules; separate charges outside these guidelines are not permissible.
- Do not levy fees such as ‘Booking Fees’ or ‘Administration Fees’ as per AGC Billing Guide and Terms & Conditions.
- Clearly itemize each MBS code with a corresponding fee.
- Include the total charge on the account submitted to the fund, inclusive of any patient co-payment, to ensure accurate benefit review and processing.
It is crucial to submit the entire charge to the fund, including any patient co-payment. Submitting separate gap accounts to patients without notifying the fund or Medicare could impede accurate benefit assessments.
By following these guidelines, healthcare providers contribute to faster claims processing and uphold the integrity of AGC benefits. Your commitment helps enhance private healthcare value by minimizing or eliminating medical gaps for private patients.
For further assistance, please contact access@ahsa.com.au with any queries.
