ClaimLogic Live Q&A – How is billing in public hospitals relevant to doctors?

By Máté Rudas

billing in public hospitals

Q&A Session – 28 August 2025

Q: How does billing in public hospitals (particularly in NSW) affect doctors and what services can ClaimLogic offer?

A: This is a very important question and all doctors working in public hospitals (particularly in NSW) should understand how billing in public hospitals impacts their income.

  • Scope: In NSW, the Staff Specialist Award ties private billing directly to specialists’ income via Right of Private Practice (RPP).
  • Details:
    • The RPP level system is complex and will be covered in more detail later.
    • Specialists should be aware that 40–50% of overall revenue can be lost due to breakdowns in the billing chain.
    • Key issues occur at:
      • Patient admission and opportunity to elect private status.
      • Follow-up and tracking of delayed elections.
      • Transcription errors and billing department mistakes.
      • Lack of resources and systems for follow-up and loop closure.
  • ⚠️ Important: Revenue leakage of up to 40–50% directly impacts specialists’ income. For example, a single high-value ICU admission missed at the delayed election stage can mean the loss of tens of thousands of dollars that can never be recovered.

ClaimLogic solutions: We can provide end-to-end audits of billing processes, deliver workflow and system improvements, and design tailored software architecture to solve these issues.

👉 For more detailed information, please head to our article on the Private Patient Billing inPublic Hospitals where you can also watch the video from our presentation at the CICM/ANZICS Education Day. Full Q&A video below:


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 for actions taken based on the content of this article.

Máté Rudas

Dr Rudas is the Director and Founder of ClaimLogic. 

He is Senior Staff Specialist at Royal Prince Alfred Hospital in Sydney. His clinical interests include critical care ultrasound, advanced haemodynamic monitoring and mechanical cardiorespiratory support. He is a member of the CICM Ultrasound Special Interest Group, an examiner for the ASUM DDU (Crit Care) and works as part of the NSW ECMO Retrieval Service.

Other interests include medical billing, clinical informatics and health facility design. Roles include Clinical IT lead at NBH and ICU clinical co-lead for the RPA ICU redevelopment project. 

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