The Department of Health, Disability and Ageing’s answers on how assignment of benefit will work in aged care from 1 July haven’t exactly cleared up the matter.
With a little over one month to spare until new rules force GPs to start collecting and storing patient consent to be bulk billed, more information on how the process will look in aged care settings has finally arrived.
Unfortunately, it’s not very helpful.
From 1 July, all GPs will be required to store evidence that the patient they are bulk billing has chosen to assign their Medicare benefit over to them in full.
This process must be completed for every single episode of care which is being bulk billed.
Consent can be obtained either before or after the consult and in either hard copy or digital format.
E-signatures must be recorded in a format where it reliably identifies the assignor, reliably indicates assignors’ agreement (by requiring an action) and meets all other privacy and information technology requirements.
Naturally, there have been questions about how this process will work for the very young and very old who lack the capacity to consent to be bulk billed.
A new Frequently Asked Questions document released by the Department of Health, Disability and Ageing this week confirmed that the assignment of benefit doesn’t necessarily need to be made by the patient.
“Where a patient lacks mental or physical capacity to make their own financial or health decisions, an assignor can do so on their behalf,” the FAQ read.
“Under the Health Insurance Act 1973, an assignor is a person who would otherwise meet the cost of medical expenses.
“In practical terms this is usually a carer, partner, parent, or a person with Power of Attorney.”
The only limit is that the assignor cannot be a person employed by the medical practitioner who is rendering the service.
DoHDA also advised practices to consider the privacy implications of allowing someone other than the patient to make the assignment of benefit.
There are no further suggestions for what doctors should do if the patient cannot consent and the person who could reasonably consent for them, such as next of kin, is not immediately present.
The FAQ does, however, make it clear that without a signed assignment of benefit agreement the consult cannot be bulk billed.
Best Practice Chief Technology Officer Jess White told The Medical Republic that the practice management software vendor was preparing for a significant amount of GP confusion on the go-live date.
“There’s still unknowns, especially how these practices are supposed to deal with residential aged care facilities and people with disability … and the government still don’t have an answer for that,” she said, referencing this week’s FAQ document.
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She was particularly concerned about instances where Medicare claims were rejected and practices would have to re-obtain patient consent.
“That could occur two or three days post consult,” Ms White said.
“And I think anyone receiving another message asking for assignment would be going, ‘Hey, I went to the doctor three days ago, I already assigned that. What’s happening? I’m not going to click on it’.
“And again, this is actually a great program, but there are all these things that need to be managed by the clinic.”
This week’s FAQ document also confirmed that an enduring assignment of billing option, which would allow patients to consent once to being bulk billed for future consults, would become available from 2027.
“The department is working to finalise regulations to support enduring [assignment of benefit] for patients who are registered in MyMedicare or receive services from an Aboriginal Community Controlled Health Organisation (ACCHS) or Aboriginal Medical Service (AMS),” the FAQ read.
“Enduring AoB will require an agreement to be signed once (by a patient or their assignor), for ongoing and future services from a preferred clinic/practice.”
