Oct 5, 2025
6
min read
Medically Reviewed
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he Anatomy of a Missed Opportunity: Why Item Numbers Are Overlooked
To solve the problem of under-billing, we must first understand its root causes. Missed item numbers are not random errors; they fall into predictable categories, all stemming from the immense pressure of the general practice environment.
The "Default to Standard" Habit: This is the most common cause of under-billing. A GP has just spent 25 minutes navigating a complex patient presentation with multiple co-morbidities. Their cognitive energy is depleted. Faced with the administrative task of billing, the path of least resistance is to simply bill a standard Level B (Item 23) consultation. In their rush, they miss the opportunity to bill a more appropriate Level C (Item 36), which better reflects the time and complexity of the service. This single, seemingly small oversight, repeated dozens of times a day across a multi-doctor clinic, quickly adds up to a substantial revenue shortfall.
The Complexity of High-Value Items: The MBS contains numerous high-value item numbers for comprehensive services like GP Management Plans (GPMPs), Team Care Arrangements (TCAs), and Health Assessments (e.g., for those aged 75+). These items are specifically designed to reward proactive, preventative care. However, they come with complex eligibility criteria, specific documentation requirements, and time-consuming workflows. The administrative friction involved in initiating and billing for these services is so high that many GPs, despite providing the care, simply fail to complete the billing process correctly or at all.
The Fear of Non-Compliance: Medicare audits are a source of significant anxiety for clinicians. The fear of being audited and having to justify every item number billed can lead to a culture of "defensive billing." Clinicians may deliberately under-bill, choosing a lower-value item number that they feel is "safer" and less likely to attract scrutiny, even when a higher-value item would have been perfectly justifiable and compliant. This fear-based decision-making is a direct drain on the practice's revenue.
The Invisibility of Procedural and Add-On Items: A busy GP might perform multiple small procedures or services within a single consultation, such as an ECG, a spirometry test, or an iron infusion. They are focused on the clinical task at hand, and at the end of the consult, they may simply forget to add the specific item numbers for these procedural components to the main consultation bill.
Why Our Current Tools are Part of the Problem
The passive billing modules within our standard PMS systems are complicit in this problem. They are essentially digital filing cabinets. They can store a list of MBS item numbers, but they have no intelligence. They cannot look at the work that was just done and suggest an appropriate code. A PMS is a tool for recording a billing decision, not for making one. It is a classic "point solution" that is completely disconnected from the rich clinical context of the consultation itself. It relies entirely on the GP to remember the complexity, the duration, and the specific services provided, and to manually search for the correct code. In a high-pressure environment, this manual, non-contextual system is destined to fail.
Expert Tips
"Your clinic is almost certainly not claiming every MBS item number it's entitled to. The problem isn't the quality of your care; it's the quality of your tools. A passive PMS billing module is a recipe for under-billing. You need an active, intelligent AI assistant that can see the context of the consult and act as a real-time safety net for your clinicians." - Arash Zohuri, CEO, MediQo
The Unified Platform Solution: A Real-Time, Context-Aware Safety Net
This is where a unified clinical automation platform completely changes the game. It is architecturally different because it breaks down the wall between the clinical documentation and the billing process. The "Platform Advantage" is that its AI has the unique ability to understand the context of the consultation and use that understanding to provide proactive, intelligent assistance. This is the core function of MediQo's Smart MBS Billing Assistant.
Consider how this integrated system solves each of the problems identified above:
Solving the "Default to Standard": The Clinical Assistant module captures the consultation in the background, including its true duration. If the consult lasts for 25 minutes, the Smart MBS Billing Assistant will see this and proactively prompt the GP to consider billing a Level C (Item 36) instead of a Level B, providing a direct link to the MBS criteria to confirm eligibility. It turns a rushed oversight into an informed, data-driven choice.
Solving Complex Item Billing: The platform streamlines the creation of high-value services. The GP can use the Automated Care & Treatment Plans feature to efficiently generate a GPMP. Because the AI was involved in the creation of this document, the Smart MBS Billing Assistant knows that a plan was created and will automatically suggest the correct billing item (e.g., Item 721) at the end of the process. It makes billing for these complex items a simple, final step in a seamless workflow.
Solving the Fear of Compliance: The AI's suggestions are not random; they are based on the structured data captured in the clinical note. This creates a powerful and transparent audit trail. The reason for billing a higher-value item is not just in the GP's memory; it is right there in the detailed, time-stamped note that the AI helped to create. This gives clinicians the confidence to bill accurately and compliantly.
Solving Missed Procedural Items: As the Clinical Assistant captures the conversation, its Natural Language Understanding engine recognises when specific procedures are mentioned and documented (e.g., "ECG performed and reviewed"). The Smart MBS Billing Assistant will then see this and add the relevant procedural item number to its list of suggestions for the GP's review. It acts as an infallible memory, ensuring that all the work performed is captured.
In conclusion, the question is not if your practice is missing out on legitimate revenue, but how much. The financial viability of your clinic depends on closing this gap. Continuing to rely on the flawed, manual processes of the past and the passive tools within a standard PMS is a strategy for continued financial leakage. By embracing a unified AI platform, you are not just adopting a new piece of technology; you are implementing a comprehensive system designed to ensure that the full value of the clinical services you provide is accurately, efficiently, and compliantly captured. It is a strategic investment in the long-term financial health and sustainability of your practice.
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
For the owner or manager of an Australian medical clinic, this question is not just a matter of curiosity; it is a multi-million-dollar question that sits at the very heart of the practice's financial sustainability. General practice is a service business. When a clinician provides a valuable, time-consuming service but fails to bill for it correctly, the practice is effectively giving away its expertise for free. While the primary focus of any clinic will always be on patient outcomes, ignoring the business realities of revenue capture is a path to financial distress, under-resourcing, and an inability to invest in the very things that improve patient care. The uncomfortable truth is that the vast majority of medical clinics are chronically under-billing, leaving a significant amount of legitimately earned revenue on the table every single day.
This is not a reflection of a lack of care or diligence. It is a direct and predictable outcome of a deeply flawed system that relies on time-poor, cognitively-loaded clinicians to be both expert medical practitioners and expert medical coders in real-time. They are being asked to navigate the labyrinthine complexity of the Medicare Benefits Schedule (MBS) using tools—namely, the passive billing modules within their Practice Management Software (PMS)—that are fundamentally unfit for the task. The problem is systemic, but the solution is now at hand. The advent of a new class of technology, a unified clinical automation platform with an integrated AI billing assistant, is finally providing a way to systematically identify and claim these missed item numbers, ensuring your practice is fully and compliantly compensated for the excellent work it already does.
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