ClaimLogic Live Q&A -Is there a viable billing software that can be used for public hospital billing (NSW)?

Q&A Session – 30 September 2025

Q: Is there third party billing software that can be used in public hospitals (NSW)?

The short answer: Yes, but with limitations.

Scope: In NSW, Right of Private practice billings form a significant part of Staff Specialist revenue under the NSW Staff Specialist Award. Depending on Level election, close to 50% of income may be derived from private patient billings, yet gaps and inefficient processes can account for as much as 50% of potential RPP revenue being lost.

For further details, please read our related articles on the Private Patient Billing In Public Hospitals and the NSW Staff Specialist Award – Right of Private Practice (RPP).

In NSW, all billing under Rights of Private Practice (RPP) must be managed by Local Health District (LHD) billing departments. NSW Health is also transitioning to centralised billing under the Patient Billing Standardisation Program (PBSP) and implementing the Single Digital Patient Record (SDPR) across all NSW public hospitals.

Details:

• All billing submissions to Services Australia must go through PBRC, the billing software used by NSW Health.
• This means options for third-party billing software are limited but not entirely excluded.

• Possible solutions include:
  • ✅ Departments using third-party software to generate billing data, then submitting it to the billing department in a format that can be uploaded into PBRC without manual transcription, also reducing errors in item attributes and financial class selection.
  • ✅ Departments engaging third-party billing companies to prepare billing data and submit it to the NSW LHD Billing Team (or HealthShare once centralisation is complete).

• The future integration options are still uncertain — it remains unclear what in-built billing capacity the SDPR will have or whether NSW Health’s centralised billing will provide dedicated APIs for third-party integration.

⚙️ ClaimLogic recommendations:

• Begin with an audit to identify key sources of revenue loss and process errors.
• Develop a cost-effective framework to streamline existing workflows and, where needed, introduce bespoke billing software solutions.
• ClaimLogic can assist with the entire process, from audit to implementation.

💡 Funding note:

• There are provisions for limited use of funds from #1 and #2 accounts to cover administrative costs associated with generating private billing.
• Specialists or specialist groups may also fund third-party solutions privately, typically costing around 1% of billings, which is minor compared to the potential improvement in revenue capture.

More info: 👉 Read our related blogs and watch the full Q&A video for further discussion:

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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.