Public Hospital billing

Are GPs legally required to name referrals for patients they send to public hospital outpatient departments?

23 January 26

We have been told that we must make GPs put a name (of a specialist) on their referrals so that we can bill Medicare for patients we see as public outpatients. Some GPs refuse to do this. What…

Are there bulk bill incentives for urgent after-hours attendances in COAG 19(2) exempt EDs located in MM5 areas and are they changing from 1 November 2025?

26 October 25

Could you please confirm whether there are any incentive payments available for after-hours and unsociable-hours MBS item numbers (e.g. 585, 594, 599) when used for patients presenting to an a…

When can you bill a new patient item (e.g.110) when a patient is privately admitted to a public hospital but is already known in some way in outpatients to your clinical team?

28 September 25

When can you bill a new patient item (e.g. 110) when a patient is privately admitted to a public hospital but is already known in some way in outpatients to your clinical team?
E.g. When a pa…

Do referrals to public hospital outpatient clinics have to be written exclusively by GPs or specialists exercising a ROPP?

18 August 25

The CFO of our public hospital gave a talk on Medicare billing recently and told us that any referral written by anyone other than a GP or specialist exercising a ROPP cannot be used to bill M…

How do we know when a patient is admitted? Is there a definition of admission?

18 August 25

At what precise moment in time does a non-admitted patient in the emergency department become admitted? Is it when the admitting doctor makes the decision to admit, or is it after the paperwor…

Do I have to bill a 110 before a 116?

4 August 25

This question has come from two almost identical experiences shared by physicians. The first was reported in my PhD and the second, which appears to have happened around the same time, was sha…

Does Medicare have records of all item numbers billed for private patients in public hospitals? What if the patient was first seen as a public patient?

28 July 25

If a patient is admitted to a public hospital but chooses to come in as a private patient, the specialist will submit an invoice to the private fund. Will Medicare have a record of all item nu…

Does the patient have to sign the bulk billing consent agreement on the day of treatment or can they sign it later?

13 July 25

If a patient has treatment on Monday-Friday, could they just sign on the Friday for all events that week? Or do they have to sign the bulk bill voucher every day at the end of treatment?

…

I was informed by askMBS that two item 13706 services are generally paid in one day. Is that correct?

7 July 25

Is the following correct? For item 13706, I was informed by askMBS that two items are generally paid in one day, as long as they are clearly indicated to be separate transfusion episodes -…

Can diagnostic imaging for a public hospital outpatient be bulk billed if there is a named referral and patient consent, but the registrar completes the imaging request form – and is it true that the request does not have to be signed?

29 June 25

Can a request for diagnostic imaging in a public hospital be Medicare billed if:
1) appropriate GP referral to a named obstetrician has occurred
2) the patient has elected to be a no fee pri…

Can staff specialists at NSW public hospitals register for gap cover schemes? If yes, are their claims paid at the gap cover rate or the MBS rate?

29 June 25

Would you kindly be able to confirm whether a Staff Specialist of a NSW Public hospital is eligible to register for participation in the Medical Gap Cover Scheme? I was under the impression th…

I am a VMO haematologist at a public hospital. I have been told we cannot bill inpatients (neither public nor private) for blood product transfusions. Is this correct?

9 June 25

I am a fee for service VMO haematologist at a public hospital in Sydney. My head of department has indicated that we are not permitted to bill for inpatient blood product transfusions (eg: ite…

If a patient cannot ‘elect’ to be a private outpatient due to not having a named referral, how does that impact downstream services such as pathology, radiology, chemo etc?

12 May 25

Patients under ROPP in a Clinic must ‘elect’ for the duration of their referral according to our LHN guidelines. If they cannot ‘elect’ because of an absence of a named referral, we understand…

Can you claim MBS items that have an “(H)” at the end of the description and no 85% rebate as outpatient services?

14 April 25

I work in a public hospital and suddenly all of my outpatient procedures that I bulk bill are being rejected. They have been paid without issue for years. What’s going on?

…

Is the name of the patient’s GP required on an in-hospital referral?

24 March 25

On an internal referral written by a Specialist/ Physician does the patients GP details have to be written as per the Health Insurance Regs Section 99. As it is an internal referral the patien…

Can nurse practitioners bulk bill public hospital outpatients if they do it under their own ABN?

10 March 25

I am a nurse practitioner (NP) and am locked in a debate with my public hospital employer/management about MBS billing of NP services provided to public hospital outpatients. Is this allowed?
…

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Topics

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Public Hospital billing

Are GPs legally required to name referrals for patients they send to public hospital outpatient departments?

Are there bulk bill incentives for urgent after-hours attendances in COAG 19(2) exempt EDs located in MM5 areas and are they changing from 1 November 2025?

When can you bill a new patient item (e.g.110) when a patient is privately admitted to a public hospital but is already known in some way in outpatients to your clinical team?

Do referrals to public hospital outpatient clinics have to be written exclusively by GPs or specialists exercising a ROPP?

How do we know when a patient is admitted? Is there a definition of admission?

Do I have to bill a 110 before a 116?

Does Medicare have records of all item numbers billed for private patients in public hospitals? What if the patient was first seen as a public patient?

Does the patient have to sign the bulk billing consent agreement on the day of treatment or can they sign it later?

I was informed by askMBS that two item 13706 services are generally paid in one day. Is that correct?

Can diagnostic imaging for a public hospital outpatient be bulk billed if there is a named referral and patient consent, but the registrar completes the imaging request form – and is it true that the request does not have to be signed?

Can staff specialists at NSW public hospitals register for gap cover schemes? If yes, are their claims paid at the gap cover rate or the MBS rate?

I am a VMO haematologist at a public hospital. I have been told we cannot bill inpatients (neither public nor private) for blood product transfusions. Is this correct?

If a patient cannot ‘elect’ to be a private outpatient due to not having a named referral, how does that impact downstream services such as pathology, radiology, chemo etc?

Can you claim MBS items that have an “(H)” at the end of the description and no 85% rebate as outpatient services?

Is the name of the patient’s GP required on an in-hospital referral?

Can nurse practitioners bulk bill public hospital outpatients if they do it under their own ABN?

Topics

Specialities

Public Hospital billing

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