Does the patient have to sign the bulk bill assignment agreement?

Context

BB 2020/061

Last updated June 2026

Answer

During the 12-month transition phase for the new bulk-billing system from 1 July 2026 until 30 June 2027 verbal consent to bulk-bill will be sufficient as long as that agreement is recorded. From 1 July 2027, a signed agreement (either digital or physical) must be retained for at least 2 years.

Context

The question asked had two components. The first was whether the patient has to sign an assignment agreement and the second was whether the signed bulk bill agreements need to be retained.

Relevant legislative provisions

Health Insurance Act 1973 (HIA), section 20A, 20B(3), 127

Health Insurance Regulations 2018, (HI Regulations), section 65C

Electronic Transactions Act 1999

Other relevant materials

Academic article: Medicare Billing Law and Practice: Complex, Incomprehensible and Beginning to Unravel. https://www.ncbi.nlm.nih.gov/pubmed/31682343

Case law

Wong v Commonwealth of Australia; [2009] HCA 3

Departmental interpretation

Information available on the Services Australia website at this link:

https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/medicare-online-health-professionals (accessed January 2026)

Detailed reasoning

Services Australia has advised that legislative amendments are to be made that will provide for a 12-month transition period from 1 July 2026 during which ‘verbal assignment of benefit will be permitted for all bulk billed patients in all settings.

When obtaining a verbal agreement, it is important that this be recorded as well as the reason why a physical or digital signature could not be obtained. This will help protect you in case of an audit or a complaint from a patient about services being wrongly claimed.

However, from 1 July 2027, all assignment of benefit agreements will need to be signed, either digitally or manually. Section 20A(1) of the HIA (the Act) describes the new bulk billing process as follows:

“Bulk billing assignments

(1) An eligible person (the assignor) to whom a Medicare benefit is or will be payable in respect of a professional service may enter into an agreement to assign the assignor’s right to the payment of the Medicare benefit if:

(a) the professional service is or will be rendered to the assignor or to another eligible person; and

(b) the agreement is entered into with the person by whom, or on whose behalf, the professional service is or will be rendered (the professional); and

(i) the assignor assigns the assignor’s right to the payment of the Medicare benefit to the professional at the time the agreement is entered into or when the Medicare benefit becomes payable (whichever is the later); and

(ii) the professional accepts the assignment in full payment of the medical expenses that have been or will be incurred in respect of the professional service by the assignor; and

(d) any requirements specified in the regulations are met.”

There are two parties described in section 20A. The first is the ‘eligible person’ which is the patient, and the second is the ‘professional’ which may be a doctor or any health provider able to claim using the Medicare scheme.

Section 20A provides that the patient holds the legal right to the Medicare benefit, not the practitioner. A simple two-step process (known as bulk billing) is set out, whereby the patient assigns their right to a Medicare benefit to the practitioner, and the practitioner accepts it in full payment for the service provided.

Implicit in this arrangement is the concept of consent.

In deliberations around the operation of section 20A, Kirby J, in the High Court case of Wong v Commonwealth of Australia said:

“Even “bulk billing” is only possible by consent of both parties to that relationship.”

The method of consent is described in subsection 20A(6) of the Act and the regulations.

Subsection 20A(6) says.

“(6) Without limiting this section, regulations prescribing requirements for the purposes of this section may specify:

(a) requirements relating to the content of agreements to be entered into, or the manner and form in which the agreements are to be entered into; and

(b) requirements relating to information that must be given and the manner and form in which the information must be given; and

(c) requirements relating to the giving of notifications before or at the time agreements are entered into, or before or after information is given.”

Section 65C of the HI Regulations sets out the requirements for an assignment agreement. There are two types of agreement: an episodic pre-agreement and an episodic post-agreement.

Subsection 65C(4) sets out the requirements of an agreement as follows:

“(4) The professional must ensure that the assignor is given the following information, in writing, before or at the time either party offers entry into an episodic agreement:

(a) the name of the person to whom the agreement services covered by the agreement are or will be rendered;

(b) the date on which the agreement is proposed to be entered into;

(d) for each agreement service covered by the agreement—the information mentioned in column 2 of the item of the following table that applies in relation to the agreement service.”

The table that follows sets out the different requirements for pathology services, diagnostic imaging services, and any other type of service. The following information is required for other types of services, where the agreement is made after the service is rendered, namely:

“(a) the identifying details of the professional …;

(b) the date on which the agreement service is rendered;

(c) the number of the item in the general medical services table or the pathology services table that specifies the agreement service”.

For a pre-agreement, the third of these requirements is:

“(c) the category of professional services to which the agreement service belongs, as specified in the Health Insurance (Assignment of Medicare Benefits - Categories of Professional Services) Determination 2026, as in force from time to time”

The category for each item or series of items is available at MBS online. Those categories are very broadly identify the types of services, for example, the category for items 23, 24, 53 and 59 is ‘GP – Standard’, and for MBS items 104 to 117 it is ‘Specialist – Standard’.

From 1 July 2027, the patient will be required to sign the assignment agreement to evidence their consent, and there is a requirement in section 127A of the HI Act that agreements be retained for at least two years.

From the government perspective, the signature requirement is good policy, designed to protect the integrity of public money, in two ways:

It is the only active involvement the patient has in a bulk billing transaction, and it therefore provides the only opportunity for the patient to review and query the services being claimed against her/his Medicare number, and
It is a critically important safeguard against fraudulent billing (such as billing for fictitious services) because it is the only evidence of both the practitioner and patient being in the same place at the same time.

From the practitioner perspective, retaining copies of signed bulk bill vouchers is a good idea, because it evidences practitioner presence and patient consent. Entries in clinical records cannot do this to the same extent. For example, an unethical practitioner could easily make an entry in a clinical record for an existing patient, without having provided a service, and the patient would likely never know that a claim had been bulk billed under their Medicare card.

Section 20A and 20B are two of the key machinery provisions of the Act, underpinning the operation of the Medicare scheme. Think of them like pulmonary veins that deliver oxygenated blood to the heart. These sections deliver approved payments of public money to your pocket. Removing them from the scheme would obliterate patient consent and render the scheme more vulnerable to abuse.

Examples and other relevant information

Other important legal provisions relating to bulk billing that you should be aware of.

1. Asking patients to sign blank bulk bill forms or forms with missing details is illegal per section 127 of the Act.

2. Not giving patients, a copy of their signed bulk bill form is an offence, but penalties can be waived if you have a ‘reasonable excuse’ as to why you didn’t give it to the patient. This is also in Section 127.

3. Using a Medicare Easyclaim terminal has a special legal provision, so having the patient (not you) press ‘yes or 'OK' on the terminal is a legally valid signature, per section 63(2)(b) of the HI Regulations.

4. If the patient is unable to sign, you can indicate ‘unable to sign’ and notate why. This has always been an available option on the prescribed form (the DB4).

5. Medicare is a fee-for-service scheme meaning you must obtain the patient's consent for each separate service. It is not permissible to obtain a blanket ongoing consent to bulk bill, such as for a course of chemotherapy.

6. The Department is bound by the provisions of the Electronic Transactions Act 1999 and so SMS/email signatures are permitted, providing certain criteria are met. This will help you to understand how to manage the bulk bill signature requirement in situations where the patient is not physically in the same place as the practitioner when the service is provided, such as case conferences and telehealth. See answer BB 2020/062.

7. From 1 July 2026, bulk billing is permissible before a service has been provided, but the approved general description of the services to be provided must be included in the agreement. Do not ever ask a patient to sign a blank agreement, either before or after a service has been provided. It must either include the general description of the services to be provided or, after the service has been provided, the item numbers for those services.