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Administration of Medicare electronic claiming arrangements
Electronic claiming for Medicare benefits was first introduced in 1992. Channels to facilitate electronic claiming were progressively introduced for use by medical practitioners, members of the public and private health insurers over the intervening decades. In 2016–17, claims for just over 97 per cent of the approximately $22 billion of Medicare benefits paid were lodged electronically.
The objective of this audit was to assess the effectiveness of Medicare electronic claiming arrangements, including an assessment of the extent to which claiming and processing efficiencies for the Government, health professionals and Medicare customers have been achieved.
To form a conclusion against the audit objective, the ANAO adopted the following high level criteria:
- Was effective planning undertaken for the implementation and ongoing delivery of Medicare electronic claiming channels?
- Has the implementation and ongoing delivery of Medicare electronic claiming channels been effective?
- Does Human Services monitor and evaluate the efficiency and effectiveness with which it delivers Medicare electronic claiming?
The audit’s methodology included:
- examination of documentation relating to the administration of Medicare electronic claiming channels, including program documentation and performance reports;
- review and analysis of departmental data related to the performance (take-up, costs/savings and timeliness) of the range of electronic channels currently available;
- ANAO analysis of quantitative data from Human Services ICT systems; and
- interviews with relevant departmental staff.
The audit found the Department of Human Services has been effective in driving the take-up of Medicare electronic claiming, with more than 97 per cent of all claims for Medicare services being lodged electronically. The department’s approach to implementing future Medicare electronic claiming could be improved by clear analysis of the costs of developing and maintaining individual claiming channels and the extent to which planned efficiencies have been realised.
