Dear online claiming
The following information relates to the legislative requirements for a Bulk Bill claim and should be circulated to all clients.Bulk Billing is the term used where a person assigns their right to the Medicare benefit to the practitioner who rendered a service, or on whose behalf a professional service was rendered.
Where a practitioner agrees to bulk bill a patient for a service rendered, the patient assigns their right to a benefit to the practitioner as full payment for the medical service.
Where a practitioner and patient enter into a bulk billing arrangement, the:
- practitionerundertakes to accept the relevant Medicare benefit as full payment for the service
- patient assigned the Medicare benefit payable for the service to the practitioner, allowing the benefit to be paid directly to the servicing practitioner.
Note: The practitioner must lodge a claim for assigned benefits in accordance with the approved form and within a period of up to two years from the date of service.
A person assigns their right to benefit to the practitioner who rendered the service by signing an approved form, upon which the practitioner has entered the required details.
- The patient or other responsible person must sign the form after the practitioner has entered the required details.
- A copy of the completed assignment form must be given to the patient or other approved person.
It is a legal requirement that the assignment of benefit form be signed by the patient only afterthe service has been provided and the form completed. A copy of the completed assignment form must be given to the patient.
Note: There is no minimum age restriction for the person assigning their right to benefit to the practitioner provided the person has the capacity to understand what they are signing. Practitioner's should use their discretion to determine a person's capacity.
Additional charges for bulk bill patients
Where a practitioner agrees to the bulk billing method, patients assign their rights to benefit to the practitioner as full payment for the medical service. The practitioner (or any other person or company) cannot make any additional charge for the service.
This means that if the practitioner bulk bills, the patient cannot be charged:
- a booking fee
- an administration fee
- a charge for bandages
- a charge for record keeping
- a charge by the practitioner's service company.
Exception
The only exception where an additional charge against a bulk billed patient can be raised is where the patient is provided with a vaccine from the practitioner's own supply held on the premises, as detailed below.
Note: There are no rules forbidding a practitioner bulk billing a general consultation (eg item 23) and raising a charge for a separate procedure (eg repair of lacerations) during the one attendance, providing that the patient is advised beforehand that this is the case.
Medicare Benefits Schedule 01/11/07 paragraph 7.5.2 details the following:
If a medical practitioner direct-bills (bulk bills), they undertake to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient, with the exception of certain vaccines (see paragraph 7.5.4).
Medicare Benefits Schedule 01/11/07 paragraph 7.5.4 details the following:
Where the patient is direct-billed (bulk billed), an additional charge can only be raised against the patient by the practitioner where the patient is provided with a vaccine/vaccines from the practitioner's own supply held on the practitioner's premises. This exemption only applies to general practitioners and other non-specialist practitioners in association with attendance items 3 to 96, 5000 to 5267 (inclusive) and item 10993 and only relates to vaccines that are not available to the patient free of charge through Commonwealth or State funding arrangements or available through the Pharmaceutical Benefits Scheme. The additional charge must only be to cover the supply of the vaccine.
Should you have any queries regarding this advice please refer them to Online Technical Support Liaison at otsliaison@medicareaustralia.gov.au.
Regards
Online Technical Support Liaison Medicare Australia
