An updated FAQ sheet addresses some of the concerns around getting consent to bulk bill from elderly or infirm patients.
The Department of Health, Disability and Ageing has added new detail to its fact sheet on the upcoming assignment of benefit changes – but those hoping for a simple answer may be disappointed.
From 1 July, doctors have to obtain their patient’s signature every time they bulk bill and store a record of this for two years.
While the requirement to obtain a patient’s consent to be bulk billed has always been a feature of Medicare, the onus to store the record has always been on the patient’s end.
During the pandemic, rules were relaxed even further to allow verbal consent.
With the new rules incoming, GPs, software providers, and practice managers have been scrambling to find compliant, usable workflows.
One of the biggest lingering questions is how the new rules will work in aged care settings, where patients may lack the capacity to consent.
“I understand we’re using taxpayers’ money, and we need to be answerable, but [the government] need to work out a [workable] process,” said Dr Henry Konopnicki, a Melbourne-based GP with special interest in aged care.
“… We know that cognitive impairment is multi-faceted, right? So how are we going to make an assessment that a person has got the cognitive ability to sign a form and understand what they’re signing?”
When DoHDA released an initial fact sheet on the changes in May, it acknowledged that there were questions about the aged care and nursing home settings in particular.
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Beyond confirming that the signature did not necessarily need to be from the patient and could instead be the person who would otherwise meet the cost of medical expenses, there was no further information.
But a new fact sheet published on Wednesday contains slightly more detail; it now links to a Services Australia webpage regarding authorised representatives.
The page details the rules around guardianship, power of attorney and legal arrangements.
The good news is that, if a patient does not already have one of these legal arrangements in place but is unable to manage their own affairs, an authorised representative may act on their behalf for Medicare purposes.
Unfortunately, the authorised representative cannot be a paid carer from an organisation, institution, or community health service and they must register with Medicare and present evidence of the patient’s medical condition.
The fact sheet also clarifies that any pathology request forms issued to patients prior to 1 July will remain valid for assignment of benefit purposes for one year, but that everything after 1 July will need to conform to the new rules.
In cases where there are unpaid or partially paid accounts, the fact sheet says the patient “may request that a cheque for the Medicare benefit is sent by Services Australia to the patient to send to the provider” under the 90 day pay doctor cheque scheme.
This program is undergoing significant changes over the coming two years.
