Oct 5, 2025
6
min read
Medically Reviewed
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The First Line of Defence: Real-Time Identification and Prevention
The most effective way to deal with under-billing is to prevent it from ever occurring. The missed opportunity happens in the final, rushed moments of a consultation, when a cognitively-loaded GP defaults to a standard billing code instead of the more appropriate, higher-value item that accurately reflects the complexity of the service they just provided. A standalone billing app cannot solve this because it has no knowledge of what just happened in the consulting room.
This is where the deep integration of a unified platform, the core of the "Platform Advantage," becomes a game-changer. MediQo's Smart MBS Billing Assistant is not a separate application; it is an intelligent engine that works in concert with the Clinical Assistant module. This seamless connection allows it to identify missed opportunities in real-time.
Context from the Conversation: During the consultation, the Clinical Assistant uses Natural Language Understanding to capture the conversation as structured data. It recognises when a GP is performing a mental health assessment, creating a chronic disease management plan, or spending significant time on patient education and counselling.
Proactive, Data-Driven Suggestions: The Smart MBS Billing Assistant analyses this rich, structured data at the end of the consult. It sees that the consultation's content and duration align with the criteria for a higher-value item number. It will then proactively prompt the GP with a suggestion: "The consultation notes indicate a review of a GP Management Plan. Consider billing Item 732."
This real-time intervention is a powerful safety net. It offloads the cognitive burden of MBS recall from the clinician and places it onto the AI, which can perform the task with perfect consistency. It ensures that the value of complex services, which are the most likely to be under-billed, is identified and presented to the GP for confirmation. This proactive, context-aware assistance is the single most powerful tool for plugging the "leaky bucket" of daily under-billing.
The Second Layer: Retrospective Analysis to Uncover Systemic Patterns
While preventing errors in real-time is critical, a unified platform can also provide a second, powerful layer of analysis by looking at the bigger picture. Individual missed opportunities are often symptoms of deeper, systemic patterns within a practice's billing culture or workflows. Identifying these patterns requires the ability to analyse large volumes of aggregated, anonymised data, a task that is impossible with a standard PMS but is a core capability of an AI-powered platform.
This is the role of the Practice Insights module within a unified platform like MediQo. By analysing months of clinical and billing data, the AI can uncover trends and patterns of under-billing that would be completely invisible to a human auditor. For example, the Practice Insights dashboard might reveal that:
"Only 15% of patients over 75 have been billed for the annual Health Assessment (Item 705), despite 80% of them having had a consultation lasting over 30 minutes." This is a clear, data-driven signal of a massive missed revenue opportunity.
"Dr. Smith consistently bills Level B consultations, even when her average consultation duration is 6 minutes longer than the practice average." This might indicate a need for targeted education or support for that specific clinician.
"The practice has a high number of patients diagnosed with diabetes, but a very low rate of billing for GP Management Plans (GPMPs) and Team Care Arrangements (TCAs)." This highlights a systemic failure to bill for valuable chronic disease management work.
These are not just interesting statistics; they are actionable business intelligence. They allow the practice manager to move from guessing to knowing, and to implement targeted training, new clinical workflows, or educational initiatives to address these systemic gaps. This retrospective analysis turns the platform into a strategic management tool, helping to fine-tune the financial performance of the entire practice.
Expert Tips
"AI helps you find missed revenue in two ways: first, by acting as a real-time co-pilot for your GPs to prevent under-billing on a case-by-case basis. Second, by acting as a 'financial MRI' for your entire practice, retrospectively identifying systemic patterns of missed opportunity that you can then strategically correct." - Arash Zohuri, CEO, MediQo
Beyond Billing: Identifying Missed Clinical Opportunities with Financial Impact
The most sophisticated application of AI goes even further. It helps to identify not just under-billed services, but missed clinical opportunities that have a direct and positive financial consequence. This is about using the AI to proactively identify patients who are eligible and overdue for specific, high-value preventative care services.
The Practice Insights engine can be configured to act as a proactive population health tool. It can answer complex queries that a standard PMS cannot, such as:
"Generate a list of all patients with a diagnosis of asthma who have not had a spirometry test (and associated MBS item) billed in the last 12 months."
"Identify all patients with diabetes who are eligible for their annual Cycle of Care review but have not yet been booked."
"Flag all children who are due for their next round of immunisations based on the national schedule."
The platform can then help to automate the outreach to these patient cohorts. This is a profound shift from a reactive, episodic model of care to a proactive, preventative one. The clinic is not just waiting for sick patients to call; it is systematically identifying opportunities to provide valuable, MBS-reimbursable preventative care. This is a true "win-win-win": the patient receives better, more proactive care, the clinic's revenue becomes more predictable and robust, and the overall health of the patient population improves. This is a level of strategic operation that is simply impossible without the data aggregation and analytical power of a unified AI platform.
In conclusion, the challenge of under-billing and missed opportunities is too complex and pervasive to be solved with manual processes or simplistic, standalone apps. The solution requires a multi-layered, data-driven approach that can only be delivered by a unified AI platform. By combining real-time, context-aware coding assistance to prevent individual errors, and powerful retrospective analysis to identify systemic patterns and proactive care opportunities, a platform like MediQo provides a comprehensive system for optimising your practice's revenue cycle. It ensures you are not just working hard, but you are also working smart, and being fully compensated for the incredible value you provide.
Discover how MediQo's single, AI-powered platform can unify your clinic from the first call to the final bill. Request a Demo.
Key Takeaways
Prioritizing Ethical AI Implementation
Optimizing Practice Efficiency and Revenue
The Power of Unified Platforms
Strategic Innovation for Sustainable Growth
In the complex business of running an Australian medical clinic, the gap between the services rendered and the revenue captured represents a significant threat to financial stability. Every clinic owner and practice manager is acutely aware of this "leaky bucket" of missed financial opportunities, but plugging the holes has traditionally been a frustratingly manual and imprecise process. Under-billing occurs not through a lack of effort, but through a combination of human oversight, the immense complexity of the Medicare Benefits Schedule (MBS), and the sheer time pressure of modern general practice. Clinicians, rightly focused on their patients, often miss opportunities to bill for the full scope of their work. Identifying these missed opportunities after the fact has required laborious manual audits, and preventing them in real-time has been all but impossible.
This is a classic data problem, and it is a problem that Artificial Intelligence is now perfectly positioned to solve. However, the solution is not a simple, standalone billing app or another "point solution" that operates in a vacuum. These tools lack the deep, contextual understanding of your practice's operations to be truly effective. The real power to identify and eliminate under-billing and missed opportunities comes from a unified clinical automation platform. Such a platform can leverage AI in two powerful and complementary ways: first, by providing real-time, context-aware coding assistance during the consultation to prevent errors from happening; and second, by performing retrospective, practice-level data analysis to uncover systemic patterns and proactive care opportunities that have a direct financial impact.
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