Medicare and HICAPS Reconciliation for Optometry Practices

Two Different Payment Systems, Two Different Schedules

Optometry practices deal with two distinct payment systems running in parallel. Medicare covers eligible consultations through bulk-billed rebates, arriving as batched settlements similar to a GP clinic. HICAPS handles private health fund claims for items Medicare doesn't cover, like spectacles and contact lenses, settling on its own separate schedule.

Why One Combined Account Causes Problems

Because Medicare and HICAPS settle separately and at different times, tracking both through a single combined clearing account makes it genuinely difficult to identify which payments relate to which claims. Two dedicated clearing accounts, each matched against the relevant claims report, keep the picture clean.

The Cost of Letting Reconciliation Slide

Unreconciled claims can sit unnoticed for months. That often means lost revenue from rejected claims that were never resubmitted, and a distorted view of the practice's actual profitability since income appears lower than it should.

Setting This Up Properly

• Separate clearing accounts for Medicare and HICAPS settlements.
• Regular matching against claims reports from your practice management software, ideally weekly.
• A process for flagging rejected claims so they get resubmitted rather than written off silently.