If you are contemplating getting ECLIPSE for your practice, but are unsure of the suitability or benefits, this article should assist you in making this decision. Before getting ECLIPSE, there are some important questions to consider:
- Does your practice regularly bill for inpatient medical services?
- Would you like a quicker, more reliable way to submit these claims?
- Would you like a faster processing time, resulting in payments being made faster?
- Is your practice trying to go paperless?
- Would you like the ability to resolve problems with claims faster?
If you answered yes to most of these questions, ECLIPSE is likely suitable for your practice and will prove to be an invaluable resource for claiming to Medicare and Health Funds.
In short, ECLIPSE is a way for you to submit claims online, to health funds for inpatient services. This can be done as a No Gap claim, Known-Gap, or Patient Claim, depending on the doctor's agreement with the fund.
In more in-depth terms, Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE) is an extension of Medicare Online claiming. ECLIPSE is an initiative created by Medicare, enabling practices to lodge claims electronically. This removes the need for time-consuming manual processing and paperwork, offering a secure connection between:
- Health professionals
- Public and private hospitals
- Billing agents
- Private health insurers
- The Department of Veterans' Affairs
- Medicare
ECLIPSE can be used for both paid and unpaid inpatient medical claims and can be lodged directly with Medicare through Genie.
Benefits of Using ECLIPSE vs Manual Claiming
Claims are Processed Faster
Rather than the manual process of submitting a paper claim, and then waiting weeks for a claim to be processed, ECLIPSE claims are typically processed, and paid within days.
Complex Claims are Resolved Faster
If there are issues found by either Medicare, or the health fund for ECLIPSE claims, and report, known as an Exception is transmitted to Genie. This allows you to see the description of the issue, in turn allowing for you to resolve the problem, and resubmit the claim for processing sooner.
It’s an Easier Way to get Consent from Patients
When creating an ECLIPSE claim, you can select the appropriate checkbox for the type of Consent provided to the Patient (i.e. Written consent or Verbal consent).
It’s Paperless
As touched on above, ECLIPSE claims remove the need to submit a paper claim to a health fund. This reduces your carbon footprint, and means less cost for you and your practice.
Your Admin Workload is Reduced so Costs are Reduced
ECLIPSE claims are faster to create, and process. With less paperwork to concern yourself with, more time can be spent elsewhere, reducing the cost of time spent with inpatient, health fund claiming.
Less Room For Error
Online claiming through ECLIPSE provides less room for error. The workflow is streamlined in a way that typically prevents a user from being able to submit a claim when information is missing, including referring doctor information, informed financial consent declaration, and hospital-specific information, such as the Facility ID.
Patients are Happier
With the claiming process being more streamlined, and faster with less errors occurring, the patient has their claim paid out faster, often relieving financial strain.
Automatic eligibility for ‘90 day pay doctor cheque scheme’
Something that is currently not possible through paper‐based patient claiming is the automatic eligibility for the '90 day pay doctor cheque scheme'. What is this scheme?
- When a patient’s unpaid or partially paid medical account is lodged for payment, Medicare sends the patient a Pay Doctor Via Claimant (PDVC) cheque. The patient is required to forward the cheque to you for payment. If you do not receive the cheque or it hasn’t been banked after 90 days, Medicare will automatically cancel it. The Health Insurance Act 1973 then allows Medicare to pay you the Medicare schedule fee by Electronic Funds Transfer (EFT).
Supports unpaid or fully paid private Patient Claims
Rather than paying in-line with an agreement that would have previously been made between a health fund and the doctor, requiring a doctor to charge either 'No Gap', or a 'Known Gap', ECLIPSE Patient Claims provides a way for you to submit an ECLIPSE claim to a health fund with a private fee, allowing you to process this with a custom-gap.
Online Security via Public Key Infrastructure (PKI)
This is used to encrypt and secure all information electronically transmitted to and from Medicare Australia and private health funds. It keeps both yours, and the patient's information safe and secure – no risk of claims getting lost in unsecure mail!
In what cases is ECLIPSE unsuitable for a practice?
ECLIPSE is not suitable for GP practices, or for specialists who do not provide in-patient services.
Cost
The cost of purchasing the ECLIPSE module for use in Genie is $1,725 (including GST). This fee covers installation and training by a Genie trainer, a follow‐up visit approximately 4 weeks after installation to assist in dealing with exceptions and processing of remittance advices, and the first year’s annual fee increase of $570.
If you would like to find out more information about ECLIPSE and how it works with Genie you can also visit the Medicare Australia website for additional information and find a list of participating health funds.
If you wish to proceed, please complete an Online ECLIPSE Enquiry form. We will then be in contact to discuss your billing and how ECLIPSE can benefit your practice. Should you require any additional information, please do not hesitate to contact our Head Office on 07 3870 4085 (Option 2) or email us directly.
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