Identifying and definitional attributes | |
Metadata item type: | Data Element |
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Short name: | Medicare Benefits Schedule (MBS) benefit paid |
Synonymous names: | Benefit paid |
METEOR identifier: | 600470 |
Registration status: | Commonwealth Department of Health, Retired 19/10/2023 |
Definition: | The total amount of Medicare Benefit paid for services performed by a Medicare service provider, expressed in Australian dollars. |
Data Element Concept: | Service event—amount of Medicare Benefit Schedule (MBS) benefit paid |
Value Domain: | Total Australian currency N[NNN].NN |
Value domain attributes | ||
Representational attributes | ||
Representation class: | Total | |
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Data type: | Currency | |
Format: | N[NNN].NN | |
Maximum character length: | 6 | |
Unit of measure: | Australian currency (AU$) |
Source and reference attributes | |
Submitting organisation: | Department of Health |
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Data element attributes | |
Collection and usage attributes | |
Guide for use: | In general, the Medicare benefit is 85% of the Schedule fee. Services to private patients in a public hospital attract a flat Medicare benefit of 75% of the Medicare Schedule Fee. Public patients in public hospitals are not charged for medical services or hospital accommodation costs. The benefit paid for each item of service changes with changes to the Schedule fee. As a general rule, Schedule fees are adjusted on an annual basis. For bulk billed services, the benefit paid is equal to the fee charged. This is often not the case for patient billed services paid by the HIC prior to the account being settled with the medical practitioner. The benefit paid for a service may be effected by various multiple service rules. For example, operations occurring in the same episode the most expensive item will receive a benefit based on 100% of the relevant MBS schedule fee, the next most expensive item benefit will be calculated based on 50% of the relevant MBS schedule fee, and subsequent items will have benefits calculated on 25% of the MBS schedule fee. Multiple service rules apply to operations, anaesthesia and diagnostic imaging services. The benefit does not include grant payments, such as the Health Program Grant payments for use of radiation oncology equipment to provide services. Services not attracting benefits include:
Some item numbers only attract a Medicare Benefit when performed in association with other items. For radiotherapy items, when more than one field (part of the body) is subjected to radiotherapy treatment, a derived/aggregate fee item is used. When this occurs, only one benefit is payable which includes the schedule fee of the base item added to the amount calculated for the derived/aggregate fee item. Related Data Elements: ADJ_RSN_CDE |
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Source and reference attributes | |
Submitting organisation: | Department of Health |
Reference documents: | HIC encyclopedia Derived from the Medicare Benefits Schedule Book 1 November 2001. Medicare Statistics System (MSS) File Descriptions |
Relational attributes | |
Related metadata references: | See also Service event—Medicare Benefits Schedule (MBS) schedule fee, total Australian currency N[NNN].NN Commonwealth Department of Health, Retired 19/10/2023 See also Service event—Medicare fee charged, total Australian currency N[NNN].NN Commonwealth Department of Health, Retired 19/10/2023 |
Implementation in Data Set Specifications: | Medicare Benefits Schedule (MBS) state/territory data extract 2013-14 Commonwealth Department of Health, Retired 19/10/2023 Implementation start date: 01/07/2013 Implementation end date: 30/06/2014 DSS specific information: Variable name = BENPAID |