But it’s gonna be kind of lame. Sorry.
There’s good and bad news for GPs frustrated with Medicare’s near-total ban on just charging patients the gap between the private fee and the Medicare rebate, which has previously only been possible via an antiquated cheque system.
Good news first: Medicare is officially ditching the aforementioned antiquated cheque system in July 2028 and replacing it with a modernised electronic benefit payment system with no more snail mail.
The bad news is that it will only work for services where the MBS fee is more than $697 and it will still take three months to process in order to “preserve the attractiveness of bulk billing (immediate payment) relative to gap-only billing”.
Because it is illegal to raise any additional charge when bulk billing, it is technically also illegal to bulk bill a patient and then charge a separate gap fee.
That raises problems for privately billing GPs treating patients who may have enough money to cover the gap fee, but not enough to cover both the gap and the Medicare rebate.
There are other reasons that the government does not allow gap-only payments.
“Despite the benefits of gap-only billing i.e., assisting with affordability up front (at the time of service), this form of billing has the potential to discourage bulk billing and encourage service price inflation,” a new consultation paper read.
“By allowing patients to pay the gap component only, fees appear less expensive to the patient at the time of service because the Medicare benefit component is ‘hidden’.
“This is likely to encourage some providers to charge a larger gap to patients who might otherwise have been charged a smaller gap.
“Similarly, some providers are more likely to ask patients who might otherwise have been bulk billed (no gap) to pay a gap amount.”
Under the current rules, the only workaround is for the GP to accept the gap fee as payment on the spot, and then have their patient sent a physical cheque under Medicare’s Pay Doctor Via Claimant (PDVC) scheme.
The cheque will contain Medicare’s portion of the payment (i.e. the schedule fee).
Then, the GP has to rely on the patient forwarding that cheque to their practice for banking; if the patient does not pass it on within 90 days, though, Medicare cancels the cheque and electronically transfers the money across to the GP.
This is technically an option for any GP Medicare service, big or small.
It’s a somewhat complex system and has been on the chopping block since at least 2021, but no action had actually been taken.
That is, until December’s Mid-Year Economic and Fiscal Outlook provided $88.9 million over five years for “an orderly transition from the use of cheques across the Australian Government as part of the Government’s Cheques Transition Plan, including to establish a new Medicare electronic gap‑only billing system to replace current Pay Doctor via Claimant arrangements”.
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Now, the Department of Health, Disability and Ageing has officially launched a consultation on the proposed new system, which is set to kick off by 1 July 2028.
The modernised arrangements, as set out in the consultation documents, would see the provider submit an electronic Medicare claim for the service to Services Australia and receive the Medicare benefit directly via electronic funds transfer after 90 days.
This effectively keeps the system as-is but cuts out the rigamarole of sending the patient a physical cheque and hoping that they pass it on to the practitioner sooner than 90 days.
According to consultation documents, the 90-day delay is a feature of the system, not a bug.
“A 90 day payment delay would preserve the attractiveness of bulk billing (immediate payment) relative to gap-only billing,” one fact sheet reads.
The other key change is that only services which have an MBS fee of $697 or higher will be eligible for the gap-only payment scheme.
This would effectively make the scheme redundant for any GPs who had been using it to charge gap fees only to patients for regular consults.
Including lower-cost services in the gap-only billing arrangements, the consultation paper said, will expose patients to the risk of price inflation.
“Providers choose how to bill patients,” the Department of Health, Disability and Ageing said.
“Providers are not required to use current PDVC billing and would not be required to use gap-only billing.
“Providers can instead choose other billing arrangements including bulk billing or patient billing.”
The only other option currently being considered by the department is to remove all gap-only billing solutions.
The consultation will close on 27 February.
