Oct 5, 2025
6
min read
Medically Reviewed
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Overlooked Area #1: Prolonged and Complex Consultations (Level C/D)
The Problem: This is the single most common and costly area of under-billing. A GP spends 25, 30, or even 40 minutes with a patient dealing with a complex issue, multiple co-morbidities, or a difficult mental health presentation. At the end of this demanding consultation, exhausted and running late, they revert to muscle memory and bill a standard Level B (Item 23). They have just provided a Level C (Item 36) or even a Level D (Item 44) service but have only claimed for a fraction of its value. The "why" is simple: time pressure and the cognitive friction of having to consciously recall the duration and justify the complexity.
How an Integrated AI Solves It: A unified platform like MediQo makes this oversight almost impossible. The Clinical Assistant module, which documents the consultation, is aware of the true, elapsed time. The Smart MBS Billing Assistant sees this duration data. If the consult exceeds the 20-minute threshold for a Level C item, it will automatically and proactively prompt the clinician with a suggestion: "This consultation lasted 26 minutes. Consider billing a Level C (Item 36) instead of a Level B." It doesn't just suggest the number; it provides the data-driven reason, allowing the GP to confidently and compliantly bill for the time they actually spent.
Overlooked Area #2: Chronic Disease Management Plans (GPMPs and TCAs)
The Problem: GP Management Plans (Item 721) and Team Care Arrangements (Item 723), along with their associated review items (Item 732), are high-value items designed to reward proactive, long-term patient care. They are central to managing the epidemic of chronic disease in Australia. However, they are notoriously under-utilised. The reason is the perceived administrative burden. Creating a comprehensive plan that meets MBS requirements is time-consuming, and the billing process is often seen as a separate, cumbersome step. Many GPs provide the care and create the plan but simply fail to complete the final step of billing for it correctly.
How an Integrated AI Solves It: The "Platform Advantage" is its ability to create a seamless, end-to-end workflow. A GP can use the Automated Care & Treatment Plans feature to dramatically speed up the creation of a high-quality, personalised plan. The AI assists by pulling in data from the patient's history and the current consultation. Because the AI was a partner in the creation of the plan, the Smart MBS Billing Assistant knows that a GPMP has just been generated. Therefore, at the conclusion of the workflow, it automatically presents the correct item number (e.g., 721) for the clinician's approval. It transforms the billing from a separate, forgettable task into the simple, logical final step of the plan creation process itself.
Expert Tips
"Most overlooked MBS items are not missed because of a lack of knowledge, but because of a lack of time and a lapse in memory. A context-aware AI billing assistant acts as a perfect, infallible memory for the clinician, proactively reminding them of the opportunities they are too busy to see in the moment." - Arash Zohuri, CEO, MediQo
Overlooked Area #3: Mental Health Care Plans
The Problem: Similar to chronic disease plans, Mental Health Care Plans (e.g., Items 2715, 2717) are vital, high-value services that are frequently under-billed. A GP might have a long, in-depth conversation about a patient's mental health, effectively performing the work of creating or reviewing a plan, but they may not formalise it in the correct document or may forget to bill the specific mental health item number, defaulting again to a standard consultation item.
How an Integrated AI Solves It: This is where the AI's ability to understand context is critical. MediQo's Clinical Assistant uses Natural Language Understanding to analyse the content of the consultation. It can recognise keywords and phrases related to mental health (e.g., "depression," "anxiety," "K10 score," "referral to psychologist"). When the Smart MBS Billing Assistant sees this rich, contextual data in the notes, combined with a consultation duration of over 20 minutes, it can make a highly intelligent suggestion: "The clinical note indicates a detailed mental health assessment. Consider billing a Mental Health Care Plan item." This proactive, content-driven prompt ensures that this specialised work is recognised and properly compensated.
Key Takeaways
Prioritizing Ethical AI Implementation
Optimizing Practice Efficiency and Revenue
The Power of Unified Platforms
Strategic Innovation for Sustainable Growth
In the intricate economy of an Australian general practice, the Medicare Benefits Schedule (MBS) is the ultimate rulebook. It defines the value of every service provided, yet its sheer size and complexity make it a constant source of frustration and, more significantly, a primary driver of lost revenue. For every busy General Practitioner, the gap between the care they deliver and the MBS items they claim is a costly reality. In the rush of back-to-back consultations, clinicians often default to standard, familiar item numbers, inadvertently overlooking a host of more appropriate, higher-value items that accurately reflect the complexity and comprehensiveness of their work. This is not a matter of negligence, but a direct result of the cognitive overload placed on them by a system that expects them to be both clinical experts and coding specialists.
This chronic under-billing is a significant drain on the financial health of a practice. The good news is that these missed opportunities are not random; they fall into predictable categories. By understanding which item numbers are most commonly overlooked and why they are missed, practice managers can begin to develop strategies to reclaim this lost revenue. While manual audits and staff training can help, the truly transformative solution is a technological one. A simple, passive Practice Management Software (PMS) billing module is part of the problem. The answer is a proactive, AI-powered billing assistant, a core component of a unified clinical automation platform, that can act as an intelligent, real-time safety net to ensure these valuable item numbers are never overlooked again.
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