Using the 'Bupa Hospital' flag

From August 2018, in private hospitals, BUPA's gapcover scheme will only be available for procedures done in hospitals that have an agreement with Bupa. For other private hospitals, BUPA will pay up to the Medicare schedule fee only. For more details on the scheme, please see the Bupa website at https://www.bupa.com.au/for-providers/bupa-medical-gap-scheme.

For public hospitals, the Medical Gap Scheme is available, but is subject to some conditions in relation to planned vs unplanned admissions, and hospital eligibility checks. Please see the above linked website for details.

If a patient is treated at a hospital that is not a Bupa-agreement hospital, Bupa recommends billing the full fee to the patient, and possibly transmitting an electronic patient claim. Rebates will be provided up to the Medicare schedule fee only. Gapcover claims will be rejected.

To assist with identifying hospitals where the scheme is applicable, the hospitals lookup table in Access Anaesthetics has a checkbox labelled 'BUPA Hospital'. This box should be ticked for any hospital that has an agreement with Bupa. Bupa has published a list of these hospitals (see below).

DATA CHECK

If you select a Bupa gapcover fee for a procedure done at a hospital that is not flagged as a Bupa hospital, the data check will give you a warning that you should not use the gapcover fee.

If desired, the data check can be turned off in Options > Data Entry.

USING THE LOOKUP TABLE

The contents of the hospitals lookup table in AA is entirely under the management of the individual practice, and is not updated by any processes in AA. Consequently, it is up to the individual user to specify which hospitals are Bupa hospitals. To assist with this, we have included a hospital reference list which has been derived from a Health Department list of Australian hospitals, and from a list of agreement hospitals provided by Bupa. This reference list can be opened from the hospitals lookup dialog box in AA, using the button circled above.

The hospital reference table lists Australian hospitals, with their address, hospital category, provider numbers and Bupa type. You can use this reference table to update your own hospital lookup table as appropriate.

Note that public hospitals do not have an entry in the Bupa column. In general, these should be flagged as Bupa hospitals since the Medicare Gap Scheme will generally apply.

Some points to note are:

•	Where the name of the hospital in the reference list is identical to that in the AA lookup table (for your state), the Bupa flag and provider number will be automatically copied to the AA list.

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There will likely be many hospitals where the names in the reference table don’t match the hospital names in your own AA lookup table, owing to slight spelling differences. In this case the Bupa flag will remain unchecked in your AA lookup table. It is up to the individual practice to set any Bupa flags that need to be set.

•	A number of buttons are provided on the bottom of the form to assist in updating your hospitals list, or viewing hospitals in your own list that don't match the reference list.

•	It is not necessary for your hospitals to match the reference hospitals. This list is provided for assistance only.

•	The data in the reference list will be updated from time to time, but it's accuracy cannot be guaranteed.

•	Public hospitals do not have any notation in the Bupa column. However, it is recommended that these be designated as Bupa hospitals, since the Medical Gap Scheme will normally apply.