Managing Medicare session caps

Today's topic, I'm gonna talk to you about a workflow that we have running in our clinic today which helps our admin team with keeping track of and ensuring that we are not over-allocating or over-booking Medicare-related sessions for our clients.

Now obviously within Splose, we know that they have cases where you can set limits, you can set obviously counts session count limits, you can set financial limits on those, and they work perfectly fine depending on the type of clinic that you're in and the way in which you wish to use that.

For us, we've slightly shifted our approach to how we go about it so that we're not capping the number of sessions that we can book, that we still allow them to book, but that rather than it being done on the front end, we're actually notified after the fact and as we start to head towards those caps.

So what you can see on screen here at the moment, this is an email that our team gets when a client has effectively reached their cap.

So if we have booked all 5 sessions, say for our standard CCMP, we will get an email that says, hey, for the 2026 period, we have invoiced 3 of 5 because that's the allocated number.

And we have 2 future sessions booked with 0 remaining.

And that list, obviously, it continues to grow and change as we bill.

And if we go over, and this actually happened to us last week, so it's working, works very, very well, is we booked 5 sessions, 1 had been canceled, rebooked, and because the person who rebooked the session wasn't the same person who canceled it, they went, no, there must be 1 more session left.

And so they then booked another session, and again, it allowed it to book in Splose, which is fine because it was in advance.

There had been no harm, no foul, session was yet to come.

But what we got immediately was an email that says, "Hey, little Johnny has had 5 sessions already, but you've got 1 booked in advance, and his remaining is -1." And so at that point we knew, okay, whoops, we're not actually allowed to, we can't allocate that session to Medicare.

So the team jumped on the phone, called the mum back, and went, actually, sorry, we've just realized that we can't actually do that because of this.

We realized that it was an accidental booking.

It's gonna be a private session, just giving you the heads up.

We changed the session service type in Splose.

No harm, no foul.

We can move on to the next thing.

So this is obviously a notification on how it looks, but we also then track it in our team hub, let's call it.

So we can see here pretty much where all of our clients are at for their Medicare allowance based on the number of sessions that they've got and the type of service that was delivered.

And each time we bill, that count or that cap or that allowance changes.

So if we were to bill somebody next, the total amount billed would increase, the cap or the count would increase, and the remaining sessions left would obviously decrease.

And we would receive notifications throughout that process to make sure that we weren't going over and above what was actually possible through the Medicare rebates.

Although it is small, it does stack up, and we didn't want to be in a circumstance where we committed to a family that, yes, great, you've got a Medicare session available, we then put that through, it gets knocked back, and then we have to say, hey, sorry, that rebate's not coming because we can't deliver it because you've already exhausted your allocations.

So this is just one way that we help our team and obviously also help our clients in keeping on top of those sessions and counts.

Cheers.