Access Gap Cover (AGC) is a medical gap cover scheme administered by AHSA on behalf of its participating funds. It consists of state-based fee schedules. Your provider number (location) determines which fee schedule to use.
- It can be used for admitted patients or patients receiving Hospital-Substitute Treatment.
- You can opt in and out on an episode-by-episode basis.
- It is a ‘no gap’ and a ‘known gap’ scheme (no additional registration is required for ‘known gap’).
- It has defined terms and conditions and a billing guide to which you must adhere if you wish to participate.
- AGC benefits and the allowable patient co-payment (where the doctor charges a co-payment) are maximum fees only under the terms of AGC and are not prescribed or recommended fees.
Benefits for doctors
The benefit of using Access Gap Cover (AGC) allows for a ‘known gap’ of up to $500 per doctor per episode on top of the AGC fee (where written Informed Financial Consent has occurred). Doctors can also choose to ‘opt in and out’ of AGC on an episode-by-episode basis.
Other benefits of AGC include:
- Improved cash flow for doctors – 21-day turnaround (provided the hospital account has been received and there are no issues with the Medicare claim).
- Reduces bad debts for doctors.
- Benefits are paid directly into your nominated bank account.
- You do not have to deal with Medicare – the fund will send you the total payment which includes the Medicare and the health fund benefit.
- Doctors only need to register once with AHSA, who will then provide your details to all participating AHSA funds.
- There is also just one fee schedule per state, one set of terms and conditions and one billing guide for all participating AHSA funds.
Find out more
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