🩺 New Intensivist Billing Checklist
Everything you need to know to be billing-ready from day one.
Have you just passed your fellowship exam, or do you know someone who has?
Congratulations! 🎉
Becoming an Intensivist comes with many exciting new opportunities and challenges — getting paid for your work should not be one of them!
Whether you’re starting your first consultant position or transitioning into a new role, there are some important steps to ensure you’re ready to bill correctly and get paid from day one.
Now that you have completed your Intensive Care fellowship and embark on independent practice, you’ll need to consider more than just your clinical responsibilities. We’ve prepared a simple billing checklist to help you navigate the process and avoid some common — and potentially costly — pitfalls.
1. Understand Where the Money Comes From
Before you start billing, it’s important to understand how healthcare services are funded and paid for in Australia.
Depending on where you work, your contractual arrangements and the patients you treat, payments may come from Medicare, private health insurers, patients themselves or other third-party payers.
Understanding the distinction between public and private patients, Medicare benefits, health fund payments and the various billing arrangements is an essential first step for any new Intensive Care specialist.
For a more detailed discussion including this, and a number of other relevant topics, you can watch our ICU Billing Webinar hosted by ANZICS
ICU Billing: Trust No One Assume Nothing
2. Understand Your Contract — and Your Billing Rights
Not all consultant positions come with the same billing arrangements.
Before you start, make sure you understand your contractual framework and, importantly, who is entitled to receive the revenue generated from your services.
🏥 Staff Specialist
As a staff specialist, you may still be required to document and submit billing information. However, in most instances, the hospital will process the claims, and the revenue will initially be paid to the hospital under the applicable contractual arrangements.
👨⚕️ Visiting Medical Officer (VMO)
As a VMO, you will generally be responsible for your own billing, whether you manage it yourself, through a practice manager or via a billing agent.
The revenue is generally paid directly to you or your nominated practice entity.
📅 Locum Consultant
Locum arrangements can vary significantly. Depending on your contract, you may or may not have independent billing rights.
Never assume that working as an Intensivist automatically entitles you to bill privately.
💡 Why does this matter?
Understanding your contractual arrangements is essential to setting up your Medicare provider numbers and payment arrangements correctly — which brings us to the next step.
3. Get Your Medicare Provider Numbers Sorted Early
This is one of the most important steps, and one that can cause significant problems if left until the last minute.
Make sure your Medicare provider numbers are obtained, checked and correctly configured well before your first day of work.
A few important considerations:
- ⏰ Don’t assume provider numbers can be backdated. Delays in obtaining the correct provider number can result in services being ineligible for Medicare benefits.
- ✅ Check your specialist status. Ensure Medicare recognises your specialist qualifications and that you’re eligible to claim the relevant specialist services, rather than simply being able to request investigations or refer patients.
- 🏦 Check your payment arrangements. Ensure the relevant practice and organisation details, ABN and nominated bank account arrangements are correct in PRODA.
- 🔄 Already have a provider number from your registrar or fellow days? Make sure your Medicare records have been updated to reflect your new specialist status.
- 🔀 Changing contractual roles? If you’re moving from staff specialist to VMO, or locum to VMO, obtaining a new provider number may help avoid complications associated with changing existing arrangements.
⚠️ A particularly important warning for overseas-trained specialists:
If you’re subject to Section 19AB of the Health Insurance Act, you may require an exemption before you can access Medicare benefits at your intended location.
This can add significant time to the application process, so planning well ahead is essential.
4. Complete Your Health Fund Registrations
Having a Medicare provider number does not automatically mean you’re ready to submit claims to private health insurers under their gap-cover or no-gap arrangements.
You also need to register with the relevant health funds.
Importantly, health fund registrations may not be able to be backdated. This means that even if you’ve already provided the clinical service, you may not be eligible to claim under the fund’s gap-cover or no-gap scheme if your registration wasn’t active at the time.
Some funds can take up to two weeks to process registrations.
📅 Our recommendation: Allow at least 2–3 weeks before your planned start date to complete all health fund registrations. Longer may be needed if there are complications or outstanding documentation.
If you want to start submitting claims as soon as you commence work, don’t leave this until your first day on the job.
5. Have a Chat With Your Accountant or Financial Adviser
This step isn’t strictly necessary for billing, but it can save you a lot of unnecessary administrative work later.
Before setting up your provider numbers and health fund registrations, consider discussing your proposed financial arrangements with your accountant or financial adviser.
For example:
- Will you be billing in your own name or operating through a practice structure?
- Which bank account should receive your payments?
- Are there any relevant tax, business structure or accounting considerations?
Getting these arrangements sorted early can help avoid having to change bank account details, ABNs or other registration information later.
And trust us — changing these details across multiple health funds is not anyone’s idea of fun!
6. Gather Your Paperwork
To complete your health fund registrations, you’ll generally need a few supporting documents.
The two most important are:
📋 Medicare Provider Number Confirmation
You’ll need evidence confirming your provider number and associated practice location.
This can generally be provided as:
- A Medicare provider number confirmation letter; or
- A screenshot from PRODA/HPOS showing the relevant provider number details. Best to obtain a full screenshot showing:
- HPOS/PRODA logo.
- Date and time stamps.
- The relevant Provider Number(s).
- URL address.
🏦 Bank Account Verification
You’ll also need documentation verifying the bank account nominated to receive payments.
A redacted bank statement showing the bank name / logo, the account name, BSB and account number is generally suitable.
You can remove transaction details and other unnecessary financial information.
Having these documents ready before you start the registration process will make everything considerably smoother.
7. Understand the Rules of ICU Billing
Getting registered is only half the battle.
Knowing what you can bill, when you can bill it and how to bill it correctly is just as important.
Unfortunately, the Australian Medicare Benefits Schedule (MBS) is not always straightforward, particularly when it comes to Intensive Care services.
There are specific rules, explanatory notes, restrictions and interpretations that can significantly affect both your billing compliance and the revenue you receive. Whether you’re a newly qualified Intensive Care specialist or have been practicing for decades, understanding these requirements is essential to keep your billing compliant.
At ClaimLogic, we strongly believe that billing education should be freely accessible to the entire ICU community — not just our clients.
That’s why we’ve developed a range of free educational resources, including:
- 🧭 Navigating the Maze: Our educational series exploring the complexities of ICU billing and the MBS.
- 📰 ClaimLogic Learning Centre: Practical articles addressing common billing questions, pitfalls and misconceptions.
- 💬 Free Monthly Online Q&A Sessions: An opportunity to ask questions and discuss real-world billing issues.
Whether you’re a brand-new consultant or have been practising for decades, these resources are available to everyone.
Because understanding the rules isn’t just about optimising revenue — it’s also about ensuring compliant, defensible billing practices.
✅ Your New Intensivist Billing Checklist
Before your first day as an Intensivist, make sure you’ve ticked off the following:
- Confirm your billing rights. Understand your contract, employment arrangements and who is entitled to receive the billing revenue.
- Obtain or verify your Medicare provider numbers. Ensure your specialist status, practice locations and payment arrangements are correct, and any required exemptions are in place.
- Gather your paperwork. Have your Medicare provider number confirmation and bank account verification documents ready.
- Speak with your accountant or financial adviser (optional). Confirm your preferred financial arrangements before completing registrations.
- Engage a billing agent. Ideally, one who understands the complexities of Intensive Care billing. (We happen to know one! 😉)
- Complete your health fund registrations. Allow at least 2–3 weeks before starting work.
- Familiarise yourself with ICU billing rules. Take advantage of the free educational resources available.
⏰ One Final Piece of Advice: Don’t Leave It Until the Last Minute!
We cannot emphasise this enough!
At ClaimLogic, we regularly help consultants who have started work without having all their registrations and billing arrangements correctly established.
We do everything we can to facilitate retrospective registrations, backdating requests and the submission of outstanding claims.
But the reality is that retrospective fixes are not always possible, and success is never guaranteed.
Sometimes, despite everyone’s best efforts, this can mean lost revenue for clinical work you’ve already performed.
And that is an entirely avoidable situation.
A little preparation before you start can save weeks of frustration, unnecessary paperwork and potentially significant financial losses.
🚀 Starting a New Role as an Intensive Care Specialist?
ClaimLogic is here to help.
We’re an ICU-specific medical billing agency, combining purpose-built digital billing technology with specialist billing expertise, compliance support and personalised guidance.
Whether you’re starting your first consultant job, changing hospitals, moving into private practice or simply looking for a better way to manage your billing, we can help you get everything set up correctly from the outset.
📩 Contact us today for an obligation-free discussion about how we can support you.
Disclaimer
This blog is provided for educational and general informational purposes only and does not constitute legal, medical, or financial advice. While every effort has been made to ensure accuracy, billing requirements under the Medicare Benefits Schedule (MBS) are complex and subject to change. Clinicians should always consult the official MBS, relevant hospital policies, or seek independent professional advice before making billing decisions. While we use reasonable effort to ensure that our overview articles are accurate, current and complete, we do not represent, warrant, or guarantee (to the maximum extent permitted by law) their accuracy, currency, or completeness or imply that they are applicable to your individual situation. ClaimLogic accepts no liability arising from actions taken based on the content of this article.
