The last Medicare session nobody counted

You tell a family they've got a Medicare session left. The session happens, the claim goes in, it gets knocked back, and now you're the one ringing to say the rebate isn't coming.

Some version of this keeps turning up on the Splose community page. How do you see how many sessions a client has left? How do you stop a claim being missed when the referral is sitting in the file and nobody has linked it to anything?

It's hard to see because the number doesn't live anywhere. A GP care plan gives a client up to five allied health sessions in a calendar year. That allowance sits in Medicare's rules, the sessions sit in your calendar, and nothing puts the two together unless you set something up.

In Splose, that something is a Case. You set the limit, link the appointments, and it can stop a booking that goes over, or email you once a set number of appointments has been invoiced. Depending on your clinic, that may be all you need.

The catch is the word link. A Case tracks the appointments connected to it, so every client needs a Case and every booking needs to be attached to one. You can make a Case compulsory on a service, which closes part of that gap, but someone is still setting one up for each client. At Wildflower we looked at that and decided it was too time-consuming.

So instead of counting what's linked to the client, we count what's booked against the service.

Every Medicare appointment in Splose is already booked under a service, and each of our Medicare services carries its MBS item number. That's all the count needs. There's nothing to set up per client and nothing to link, so a session can't go missing because someone forgot a step.

It's a Power Automate flow sitting on the Splose API. It pulls every Medicare appointment, groups them by client and item for the calendar year, and takes what's been invoiced and what's booked ahead off the allowance. Cancelled sessions and did-not-arrives drop out. What's left is the remaining number, and when that goes below zero, admin get an email.

A session in the diary for next month hasn't been billed, but it has already used the allowance, and you want to know that while it's still in the diary.

We got a real one in October. A client at Wildflower had all five sessions booked, and one was cancelled and rebooked. The person who rebooked it wasn't the person who cancelled it, so they figured there had to be one more left and booked another. Splose let them, which was fine, because the session was still to come. Then the email landed: five sessions, one more booked, remaining minus one.

The team rang the mum, explained it was an accidental booking and that this one would be a private session, and changed the service type in Splose. No harm, no foul. A sensible person made a sensible assumption, and it got sorted before the session rather than after the claim.

The same numbers sit on our team hub, so admin can see where every client is up to, and each time we bill, the count moves.

It's the other half of our Medicare rebate reminder. That one makes sure the claim gets lodged. This one makes sure there's a claim to lodge.

Worth saying what it can't see. Those five sessions belong to the client, not to your clinic. Medicare counts them across every allied health provider, so one dietitian visit and four podiatry visits is the lot. Our count only knows what's in our Splose, so if a family has used sessions somewhere else, the tracker will say they have some left when they don't. It's worth asking at the start of the year.

It also trusts the service. Book a Medicare client under a private service and it isn't counted, because nothing about that appointment says Medicare. And it had to be built. This isn't a setting you can switch on.

If you want to know whether you need something like it, take your last five Medicare clients. Could someone tell you how many sessions each has left, counting what's already booked, without opening each file? If yes, you're fine. If the answer depends on who you ask, a Case limit is the no-build place to start: set the limit, turn on "Make adding a case compulsory" for that service, and add a case alert.