Revenue Management Services

• AusHealth offers end-to-end revenue management, relieving all the pain points in your revenue lifecycle.
• Our experienced PLOs are ready to reduce the burden on your back end, preventing debt from becoming a problem. And if you have a debt problem? Well, we can help with that, too.
• Your patients are safe with us: we’re experienced in supporting people who need care and understanding when it comes to financial hardship.
• Our expertise comes from more than 40 years of working with Australian hospital CFOs; and yes, all your compliance and data security needs are met.
• We pay it forward into the community! AusHealth is a charity and all proceeds from our financial management services are used to support medical research.

The admission process sits at one of healthcare’s most important intersections: patient experience, duty of care, funding, compliance and the organisation’s right to be paid for the care it delivers.

AusHealth provides experienced Patient Liaison Officers and specialist financial clearance support to establish the correct funding pathway, complete the required documentation and identify payment risk early.

This strengthens revenue capture without losing sight of patient dignity or the circumstances behind each account.

An estimated $24 billion of hospital-related debt across the Australian health system remains uncollected, reducing the funding available for critical service delivery. (Based on statistics from Compare The Market Health Debt Survey, 2026.)

Our admissions and financial clearance support includes:

• Identity, eligibility and payer routing: Verify identity and Medicare eligibility, then direct the episode to the correct funding pathway, including private health insurance, compensable schemes, DVA, reciprocal arrangements, Medicare-ineligible or overseas cover, guarantors and self-funded care.
• Insurance confirmation and guarantees of payment: Capture and verify fund, overseas and travel-insurance details, coverage, waiting periods and eligibility; notify the insurer and obtain guarantees of payment where required.
• Patient election and informed financial consent: Complete patient election, informed financial consent and assignment of Medicare benefits in one compliant, documented step, with interpreter support where required, protecting both private patient revenue and the activity-based funding attached to the episode.
• Capacity and authorised representatives: Assess capacity, verify the authority of attorneys, guardians, trustees, executors or other representatives, and document access rights before financial information is discussed or agreements are made.
• Financial risk, hardship and vulnerability: Apply structured assessment across five hardship dimensions, seven vulnerability domains, six debt-risk dimensions and five cause categories so payment arrangements and support pathways begin before accounts age into avoidable debt.
• Patient propensity-to-pay assessment: Assess each account against more than 400 indicators, 218 economic profiles, more than 130 payer and insurer profiles, and more than 100 visa-subclass rules to identify payment risk early and support appropriate intervention.
• Guarantors and payment arrangements: Identify the party responsible for payment, assess guarantor strength and establish a clear, documented payment guarantee before discharge wherever possible.
• Complex and long-stay admissions: Review funding status throughout the admission, coordinate insurer and payer liaison and escalate cases requiring specialist investigation, alternative funding or medical repatriation assessment.

Services can be delivered onsite or remotely. Every check, consent, authority and decision is documented to support auditability and compliance with applicable privacy, credit, consumer and patient-rights requirements.

Bottom line: We navigate the complexity and manage the risk from admission, helping you collect more of the revenue you are entitled to and direct more funding to patient care.

If admissions, consent and financial clearance are being managed through separate workflows, a focused review can identify where revenue is leaking and where earlier intervention would improve both collection and patient experience.

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: info@aushealth.com.au

Insurance claims management is where revenue is often won or lost. Missed deadlines, incomplete documentation and incorrect payer routing can turn revenue already earned into an avoidable loss.

Health funds, compensable schemes, overseas insurers and government payers each have different rules, portals and time limits. Early, active management reduces denials, underpayments and claims ageing beyond recovery.

AusHealth combines healthcare claims expertise with specialist recovery capability to submit each claim to the right payer, in the right form and within the applicable timeframe.

Our insurance claims management service includes:

• Eligibility and coverage confirmation: Confirm membership, policy currency, waiting periods, benefit limits and pre-approvals before an episode is billed across health funds, overseas cover, workers’ compensation, motor accident and CTP schemes, and DVA.
• Payer validation and routing: Confirm the funder liable for each episode so compensable, DVA and privately insured care is not incorrectly billed to the patient or written off.
• Compensable claims across Australian jurisdictions: Manage workers’ compensation, motor accident and CTP claims under the relevant state, territory or Commonwealth scheme, with liability confirmed before invoicing.
• International and Medicare-ineligible patient claims: Manage overseas visitor and student health cover, reciprocal healthcare arrangements and travel-insurance claims within the applicable insurer and policy timeframes.
• Clean first-pass submissions and active follow-up: Confirm that coding, documentation and payer requirements are complete before lodgement, then track each claim through assessment and payment so it does not age unnoticed.
• Denial, dispute and underpayment recovery: Identify the cause of a rejection or short payment, correct and resubmit the claim, manage appeals and reconcile remittances against the amount claimed.
• Claims reconciliation and reporting: Maintain claim-level records of lodgement, status, payment, denial reason and recovery action so revenue teams can explain the ledger and address recurring causes of leakage.

Services can be delivered onsite or remotely. Claims and recovery actions are documented to support auditability and compliance with applicable privacy, payer, scheme and hospital requirements.

Bottom line: We get each claim to the right payer, in the right form and within the relevant timeframe, helping health services recover more revenue, reduce aged receivables and avoid unnecessary write-offs.

If your ledger contains denied, underpaid or ageing claims, a targeted review can identify what remains recoverable and where the claims process is leaking revenue.

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: info@aushealth.com.au

Some patients bring clinical, funding and financial complexity that standard revenue-cycle workflows were not designed to manage.

This includes Medicare-ineligible overseas visitors, patients covered by reciprocal arrangements, asylum seekers and people whose capacity, mental health, language, housing or other circumstances complicate consent, billing and recovery. They need care and deserve dignity, while health services still need to identify the correct payer and protect legitimate revenue.

The financial risk starts well before an account becomes overdue. Patients may not be identified correctly, the wrong funding pathway may be applied, or consent may not be valid or properly documented. We provide a dedicated pathway from identification and consent through to billing, payer liaison and recovery.

Our end-to-end process entails:

• Identification and eligibility: Review inpatient, short-stay, emergency and outpatient activity to identify patients without valid Medicare eligibility, confirm their status and direct the episode to the appropriate funding pathway.
• Capacity-aware consent: Support valid patient election and informed financial consent through capacity screening, authorised-representative verification and interpreter-assisted explanation where required.
• Payer and coverage confirmation: Establish the payer actually liable, including overseas visitor or student health cover, travel insurance, reciprocal arrangements, government programs, compensable schemes, sponsors or guarantors.
• Clean billing and insurer liaison: Prepare complete claims and engage domestic and overseas insurers or government payers early, reducing delays, disputes and revenue leakage.
• Complex case coordination: Bring together clinical, social work, interpreter, legal, immigration, insurer and financial considerations where an extended stay or possible medical repatriation requires a coordinated response.
• Culturally safe financial navigation: Use trauma-informed and culturally responsive engagement, structured hardship assessment and appropriate payment pathways, with collection paused when vulnerability, capacity or consent requires review.
• Specialist recovery: Where an account remains unpaid, apply targeted tracing, payer engagement, propensity-to-pay assessment, payment arrangements and evidence-based write-off processes suited to complex and overseas accounts.

Governance and patient experience

Services can be delivered onsite or remotely. Actions and decisions are documented to support auditability and compliance with applicable privacy, consumer-credit, healthcare and patient-rights requirements.

Bottom line: We manage the complexity from identification to recovery, helping health services protect revenue while treating every patient with dignity.

If Medicare-ineligible and complex patients are being managed through a standard admission and billing process, a focused review can identify where revenue is leaking and where patients are falling between workflows.

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 0401 123 060

Email: info@aushealth.com.au

Hospitals are increasingly faced with the costly and complex task of medical repatriation, and as post-Covid visitor numbers to Australia rise, so do the repatriation discussions hospitals must manage.

AusHealth provides an extensive suite of services to arrange aeromedical transport, assess cost subsidisation and work with clinical staff on discharge planning.

Repatriation brings together overlapping and sometimes competing domains (clinical, hospital, legal, immigration, ethical and cultural), alongside pressing concerns: recovering the cost of caring for Medicare-ineligible visitors, balancing the legal duty to treat all patients with emergent needs, and discharging patients to facilities that can safely continue their care.

AusHealth manages that complexity from assessment to arrival, protecting revenue while keeping patient safety and dignity at the centre.

Our medical repatriation services

• Aeromedical transport and clinical escort: Arrange domestic or international aeromedical transport with the right equipment and staff, including specialist flight clinicians and registered flight nurses experienced in critical care.
• Funding, insurance and cost subsidisation: Administer insurance and repatriation costs and assess cost-subsidisation options, so care for Medicare-ineligible visitors is funded from the right source rather than absorbed by the hospital.
• Discharge planning and destination due diligence: Work with clinical staff on discharge planning and confirm the receiving home or facility, caregiver support and access to appropriate follow-up care before a patient is moved.
• Clearances, consent and logistics: Obtain government clearances, arrange home travel and secure valid informed consent, coordinating the immigration, legal and practical steps a repatriation requires.
• Multi-domain coordination: Bring together the clinical, hospital, legal, immigration, ethical and cultural considerations a repatriation involves, so decisions are made in one coordinated process rather than across disconnected workflows.

Coordination can be delivered onsite or remotely, with each assessment, clearance and decision documented for auditability and compliance with applicable privacy, immigration, consent and patient-rights requirements.

Bottom line: From the first assessment to the patient’s safe arrival, we manage the clinical, financial and logistical complexity of repatriation, helping hospitals recover the cost of Medicare-ineligible care, free acute capacity and move patients on safely and with dignity.

If repatriation cases are being handled across disconnected clinical, financial and administrative workflows, a focused review can identify where cost is going unrecovered and where a coordinated repatriation pathway would move patients on sooner.

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: info@aushealth.com.au

Get a clear picture of your organisation’s financial performance and a roadmap for future success.

AusHealth has three solutions to help you identify shortcomings in your revenue management processes:

• Revenue Cycle Management (RCM) Review
• Debt Collections Process & Portfolio Analysis
• Compliance Audit & Insights

Revenue Cycle Management (RCM) Review

AusHealth’s Revenue Cycle Management (RCM) Review is a strategic tool for gathering valuable information, uncovering hidden problems and revealing unseen threats to your bottom line. It’s also the means to set focused goals that align with your organisation’s objectives.

As an RCM review provider, AusHealth can be pivotal in transforming insights into actionable strategies that propel growth.

Our RCM review will incorporate the following services:

• Patient Registration & Financial Clearance
• Patient Admissions & Financial Care
• Insurance Management
• Clinical Coding
• Debt Collection

Debt Collections Process & Portfolio Analysis

AusHealth will undertake a comprehensive process and portfolio evaluation, including a detailed analysis of risk, potential returns and diversification options.

The evaluation seeks to identify, quantify and explain the sources – and contributions – of risk and return in a portfolio.

Our portfolio analysis platform is powered by a suite of services as well as proprietary and institutional-grade intellectual property.

For clients with more complex requirements, we offer a range of custom analytics including portfolio stress testing as well as a full-service consulting program.

Compliance Audit & Insights

At AusHealth, we understand the complexities of privacy, confidentiality and PCI compliance. When it comes to debt collection and Insurer Management, we strictly adhere to the ACCC/ASIC Debt Collection Guidelines.

Our Statutory Compliance Audit services provide a comprehensive audit of all our clients’ labour-related records, status determination, criticality analysis and expert consultation with solution-based presentations.

This ensures clients meet all necessary compliance requirements, minimizing risk exposure and liability.

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: info@aushealth.com.au

Unleash the value of Business Process Outsourcing (BPO) and Knowledge Process Outsourcing (KPO) through our scalable front and back-office solutions. Whether you’re looking for patient financial care, clinical coding, insurance management or debt collection, we have the team to help you.

Aushealth offers a suite of BPO solutions:

• Patient Financial Care (Patient Liaison) BPO
• Debt Recovery & Insurance Management BPO
• Clinical Coding & Auditing BPO
• Staffing Solutions

Patient Financial Care (Patient Liaison) BPO

Effective patient financial care at – or after – presentation helps hospitals and other healthcare providers manage and optimise their revenue lifecycle and maintain brand reputation.

AusHealth’s BPO/KPO teams are among the best in Australia and fit seamlessly into a hospital or healthcare provider’s operations. Regular upskilling and knowledge-sharing are part of AusHealth’s commitment to excellence, ensuring that workers remain agile and informed.

AusHealth offers full-time and part-time, casual or needs-based outsourcing of its patient liaison staff. Our use of advanced technologies, data analytics and automated systems means a patient’s financials are taken care of efficiently and effectively.

Find out about our Patient Admissions & Financial Care solution.

Debt Collection & Insurance Management BPO

Debt collection and insurance management can be one of the most demanding and time-consuming parts of the revenue cycle.

AusHealth’s Debt Collection & Insurance Management BPO is a back-office solution. It can conveniently and securely review, submit and manage your claims, and recover your outstanding debt.

Our approach extends beyond cost-saving: we bring experience, a commitment to quality, and innovation in debt collection and insurance management.

When it comes to managing insurance, we provide flexibility, access to advanced technologies and the benefits of long-standing relationships.

AusHealth’s solutions can be accessed on a full-time or needs-based arrangement.

Clinical Coding & Analytical Auditing BPO

Our clinical coders and health information managers are certified, experienced and knowledgeable. They support hospitals on a permanent, long-term or short-term basis; services can be provided remotely or on-site depending on a client’s needs.

Find out more about our Clinical Coding solutions, and here for our Analytical Auditing solutions.

 Staffing Solutions

AusHealth understands that finding the right talent for short-term, project or long-term staffing gaps can be a challenge. That’s why we offer comprehensive on-site and remote staffing solutions for:

• Patient financial care
• Clinical coders
• Health information managers
• Accounts receivable specialists
• Insurance specialists

Our flexible solutions ensure that you have access to skilled professionals who can work onsite or remotely, based on your specific requirements.

Bottom-line benefits of BPO/KPO:

• Improve your recovery rate to 85% and as high as 90%
• Reduce your insurance payment wait times – in some instances from one year down to just 60 days
• Improve your cash returns by more than 30%
• Significantly reduce your aged debt and doubtful debt provisions
• Reduce your regulatory risk (including Privacy, Confidentiality and ACCC) to less than 5% probability of an adverse event; and save approximately $350,000pa in legal costs
• Reduce your operating costs by more than 2FTE – amounting to $195,000pa
• Increase your PCIS compliance to 100%
• Reduce your default rates to less than 2% (subject to hardship assessments)

HOW CAN WE HELP?

Schedule an in-person or a virtual meeting

Call: 1-800 724 457

Email: info@aushealth.com.au

Quality and Compliance

AusHealth is certified to AS/NZ ISO 9001 standards.

AusHealth clinical coders/health information managers provide complete and accurate diagnostic and procedure codes for all inpatient episodes of care in accordance with the relevant classification conventions, standards and rules, including:

• ICD-10-AM/ACHI/ACS Latest Edition
• state clinical coding authorities
• Independent Health and Aged Care Pricing Authority (IHACPA).

AusHealth is a member of the Healthcare Financial Management Association.

Insurance: AusHealth holds appropriate workers’ compensation insurance, public liability insurance, professional indemnity insurance and products liability insurance.

Risk management: AusHealth’s risk management system operates in line with the AS/NZS ISO: 31000.

Contract management: AusHealth’s contract management methodology aligns with the principles of CMS, an ANSI-approved (contract management) standard.

Industry participation policy: AusHealth complies with state based industry pParticipation policies and any supporting procedural and reporting requirements.

Cultural responsiveness and accessibility: AusHealth has a diversity policy in place that strives to create and foster a supportive and understanding environment in which all individuals realise their maximum potential within AusHealth, regardless of their differences.

Social: AusHealth is a registered charity and all profits earned from its commercial operations are invested into medical research development and commercialisation. Since its inception in 1985, AusHealth has provided more than $50 million in profit to commercialise new medical technologies.

Records management: AusHealth complies with all privacy and security requirements of records as per state government principles, legislation and standards including AS ISO 15489 ‘Information and Documentation – Records Management’.

Customer satisfaction: AusHealth has adopted industry best practice and benchmarked its process against the Australian Standard AS ISO 10002-2006 ‘Customer satisfaction – Guidelines for complaints handling in organisations’.

Modern slavery: AusHealth aligns with all applicable modern slavery laws, statutes and regulations are adhered to including but not limited to the Modern Slavery Act 2018 (Cth).

Data security

AusHealth is committed to protecting the data critical to its business operations, patients, debtors and staff.

We use a modern SFTP architecture that leverages each client’s own identity provider for safe, cloud-based file transfer, and we conduct rigorous annual reviews of our PCI compliance to maintain the strongest possible security posture in a rapidly changing threat landscape.

In alignment with both ISO 27001 and the Essential Eight, our systems and services provide a solid foundation for meeting external regulatory obligations, both legal and contractual, and for satisfying the requirements of our rapidly expanding base of SOCI-classified clients.

All information security measures are developed in line with industry best practice, compliance requirements and client expectations.