General practice technology provider MBSPro is developing an AI clinical co-pilot as it expands its Medicare billing platform into a broader suite of tools spanning My Health Record, AI receptionists and practice administration.
The Queensland-founded company is working on TGA applications for software as a medical device, with longer-term plans for its technology to draw together patient information and provide clinical recommendations alongside existing electronic medical record systems.
MBSPro has also made Medicare billing a major focus, using AI to recommend potentially applicable MBS items and identify future billing opportunities based on appointment information and patients’ previous billing histories.
Founder and Queensland GP Dr Casey Going told Pulse+IT the company aimed to build an intelligence layer that worked with existing EMRs.
“We call it a health intelligence layer – sitting alongside your EMR, pulling out data, making useful recommendations – even clinical recommendations, providing the clinician with a copilot,” Dr Going said.
Founded by Dr Going, who operates four practices across Toowoomba and Warwick and employs more than 60 clinicians, MBSPro launched in March last year and has since had close to 5,000 GPs sign up, with around 2,000 regular users.
The company has reached $1.2 million in annual recurring revenue and is being used across more than 150 clinics.
Dr Going said MBSPro had initially built its AI tools in response to issues experienced within its own general practices.
While it began as an AI scribe incorporating Medicare billing recommendations, it has since added tools for administration and practice operations.
“We started out as a scribe, there’s plenty of scribes, but we want to do more than that,” he said.
Finding missed Medicare billings
Rather than automatically submitting Medicare claims, MBSPro recommends potentially applicable MBS items based on information including the consultation context and a patient’s previous billing history.
The clinician remains responsible for deciding whether to use the suggested item, with billing undertaken through the practice management system and Dr Going noting “We don’t do any automated billing, but provide a way to simplify billings for clinicians.”
The platform also provides information about the criteria that must be met to claim particular items and can analyse a practice’s appointment book and previous billing histories to identify potential future billing opportunities.
For example, a patient who has previously had a care plan may be due for a review, while patients in particular age groups may be eligible for health assessments.
The system can identify those opportunities ahead of a consultation and suggest that an eligible service be provided or booked for a later appointment.
MBSPro estimates more than $50,000 in legitimate billing opportunities can go uncaptured per GP each year, while it says early users have recorded revenue uplifts of 15 to 20 per cent.
The company has also developed tools covering MyMedicare and Assignment of Benefit processes.
Its MyMedicare checker automatically retrieves patient details from an EMR and checks their registration against Services Australia’s MyMedicare database.
Dr Going said this replaced a manual process requiring practice staff to log into PRODA, enter patient information and conduct the check themselves.
Where patients are not registered, the platform can also support electronic registration.
Clinical co-pilot
MBSPro’s longer-term plans aimed to take the technology beyond administrative and billing support and into clinical decision support.
Dr Going said the company was working on TGA applications for software as a medical device as it develops technology capable of providing clinical recommendations.
The eventual aim was for an AI co-pilot to sit alongside the existing EMR, drawing together available patient information and presenting relevant information and recommendations to the clinician.
The company is also looking at expansion into hospitals and specialist-specific products from 2027.
My Health Record integration
Another capability being developed is an integration with My Health Record aimed at giving clinicians easier access to information held in the national system.
Dr Going said the integration could provide clinicians with an overview of a patient’s recent healthcare activity, including hospital visits and discharge summaries, specialist care and pathology results that may not otherwise have been sent directly to the GP.
“The idea is we’re trying to help out with interoperability,” he said, noting that currently “everyone’s sort of operating their own silo.”
Dr Going said My Health Record had its place but could be “a little bit clunky to use”, with MBSPro aiming to provide clinicians with a more accessible view of information available through the system.
The integration is intended to help clinicians identify information requiring follow-up and improve continuity of care.
MBSPro is also integrating with several of Australia’s major practice management systems, although the depth of integration differs between vendors.
Its Best Practice integration can currently read patient demographics and billing history but does not write information back to the system.
Dr Going said MedicalDirector allowed MBSPro to read additional information, and is currently being planned to support and enhance clinical care
The company’s Zedmed integration can read information and write clinical notes back into the system, while an integration with MediRecords is under development and is also expected to support extra functionality.
AI receptionist
MBSPro has also launched an AI receptionist that can answer incoming patient calls and handle appointment bookings, cancellations and rescheduling.
Dr Going said guardrails prevented the AI from providing clinical advice. If a caller reported an issue such as chest pain, for example, the system would transfer the call to a human receptionist rather than attempt to provide clinical guidance.
“It can simply book, cancel, or reschedule. If there’s anything remotely medical, it’ll push it to a human.”
For calls outside clinic hours involving potentially urgent symptoms, the system can instead direct the patient towards emergency care.
Other additions include document sorting, dashboards and analytics, as well as a service fee calculator designed to automate the calculation and distribution of GP payments within practices.
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