Bulk Billing

Can an inpatient of a private psychiatric hospital attend bulk billed outpatient appointments whether by telehealth or face-to-face?

28 October 24

This question came from a consumer. I am an inpatient in a private mental health unit in a private hospital. I am under an inpatient psychiatrist. While I am an inpatient, I have a telehealth review consultation booked with an outpatient psychiatrist who is known to me. I also have a review consultation with an outpatient specialist in person, and a review consultation in an outpatient clinic at a public hospital. I am allowed to leave the private hospital to attend the in-person consults and will then return. But I have heard that these services can’t be bulk billed. I am a pensioner so cannot afford private fees.

Can we charge sleep study equipment hire fees to patients when we bulk bill their sleep studies?

5 October 24

This questioner said that every time they called Medicare about this, they received different advice and were concerned they may be billing incorrectly. The setting was outpatient sleep studies which are bulk billed by the respiratory and sleep physicians using item 12250. The company (described as an external provider) supplies the patients with the sleep study devices and charges them a hire fee for the equipment. Is this allowed?

Can allied health professionals using a Team Care Arrangement charge a separate gap when bulk billing?

4 October 24

This physiotherapist was under a misunderstanding that there existed a separate bulk billing law just for allied health professionals.

When bulk billing, is the patient’s agreement to assign their Medicare benefit required for all items or just the consultation items?

2 October 24

The questioner added that everything they had read talks about telehealth items only. Their understanding was that the assignment of benefit is only required for consultation items but not for other items. They gave the example of whether consent was required to bulk bill a 11714 ECG.

Can a nurse practitioner bill Medicare for public outpatients when the nurse practitioner is simultaneously being paid by a hospital that does not have a section 19(2) exemption?

30 September 24

I’m a Nurse Practitioner working in a small rural centre. I am a public employee 4 days a week and work privately on one day in the co-located primary health clinic/urgent care centre, which I bulk bill. A GP has left, and I have been asked to cover the clinic on two of my hospital days until a replacement is found. On these two days I am paid by the hospital as I still cover the emergency department. I have been asked to bulk bill the patients I see at the clinic on these two days even though I will be simultaneously being paid by the hospital. Both entities are wholly owned by the public health service, and it does not have a section 19(2) exemption. The GPs who work in the clinic are not employees of the public health service like me.

Can we charge facility fees to cover the cost of consumables when bulk billing?

30 September 24

A GP practice wanted to know how to “manage” facility fees for bulk billing patients. The question said that the practice needed to charge this fee to cover the cost of consumables, but the doctors also wanted to bulk bill and be able to claim the full bulk bill incentives. The practice is in a regional area where the bulk bill incentives are highest.

Is an SMS or email a valid signature on the bulk bill voucher?

1 August 21

How can I obtain the patient’s signature consenting to bulk billing over a phone call, through a telehealth video consultation or in circumstances where the patient is not required to be physically present such as case conferences?

Can we obtain the patient’s signature to consent to bulk billing once, and use it for ongoing care?

20 January 21

The question posed was: Can the bulk bill “Assignment of Benefit” be specific to the hospital setting? We understand that patients sign this upon admission, and while it is not specific to any one doctor, it covers all the services rendered to the patient whilst in care.

Does the patient have to sign the bulk bill voucher?

21 September 20

The question asked had two components. The first was whether the patient has to sign the bulk bill voucher and the second was whether the signed bulk bill vouchers need to be retained.

Are annual enrolment or membership fees legal in a bulk billing setting?

1 August 20

Annual enrolment or membership fees have become a controversial feature of bulk billing GP practices in recent years. One example was the now defunct National Health Co-op in the ACT, which publicly charged a $100 per year membership fee and a $30 sign up fee in return for bulk billed services. It was even awarded State based grants to support this business model. However, there is debate around the legalities of these arrangements with the Federal Government expressing the view that such arrangements breach the bulk billing law.

Can I bulk bill a Medicare service and charge for a related non-Medicare service simultaneously?

1 August 20

A gastroenterology practice asked whether a service provider providing two services to a patient on the same day, one for which there is an MBS item number, and the other for which there is not, can bulk bill the MBS service and simultaneously collect private payment for the non-MBS service. The question related to an outpatient context and both services were clinically relevant for the treatment of the patient, meaning neither would be considered cosmetic. NB: The scenario presented in this question is distinct from the common scenario of bulk billing a consultation and charging a private fee for a cosmetic botox injection, which is permitted, because Medicare specifically excludes rebates for cosmetic procedures, which are not clinically relevant. In this scenario, both services are clinically relevant. It is an important distinction and often a point of confusion.

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