Bulk billing? You need the patient’s signature

3 minute read

The penalty for failing to record consent is death. Just kidding, but you could actually have to repay the rebate to Medicare.

Services Australia has issued a festive and timely reminder that no good deed goes unpunished: if a GP intends to bulk bill a consult, just telling the patient or letting them find out at reception is not enough.

Under the strict definition of bulk billing laid out in the Health Insurance Act 1973, specifically subsection 20B paragraph 3c, the patient must sign an agreement to assign their right to the payment of the Medicare benefit to the practitioner. The signature can be in a physical written format or via email.

Failure to get the signature essentially means that the entire claim is non-compliant, and Medicare may demand repayment.

If the non-compliant claims are found to be fraudulent in nature, Medicare will also refer the provider to the Commonwealth Director of Public Prosecutions.

Having documentation of a patient’s consent to be bulk billed for a specific service on a certain date – i.e. their signature on an agreement to assign the Medicare rebate to the doctor or practice – make a compelling case against accusations of fraud.

With the emergence of telehealth and general upheaval over the last three years, the Department of Health has allowed providers to obtain verbal agreement to be bulk billed instead.

But this was only ever a temporary measure and the verbal option will be scrapped completely in January – hence the reminder from Services Australia.

The RACGP claims that the Department of Health will be reviewing the need for GPs to seek patient consent to bulk bill at all, given that telehealth has been made permanent.

Unless the DoH intervenes and extends the temporary verbal consent measures until the review is over, which it told NewsGP that it may do, not collecting patient signatures for bulk billing in the new year could land doctors in a world of pain.

RACGP funding and health system reform committee member Dr Emil Djakic said that an attempt from Medicare or the Professional Services Review to crack down on doctors over missing signatures would be met with anger.

“The very appearance of that would see a howl of protest across our industry, meaning ‘all right, guys, we’ll stop bulk billing completely then,’” he told The Medical Republic.

Just the fact that Services Australia had taken the time and energy to put out the advisory was somewhat baffling to the Tasmanian GP.

“This is an overly intrusive piece of productivity-sapping action when we’re trying to create a system that’s more efficient,” Dr Djakic said.

It would be a better use of time, he said, to reform the way Medicare works as an insurer. After all, patients are rarely, if ever, required to sign a form every time they want to use private health cover.

“When I go to the dentist and show my private Medibank card, I don’t have to sign anything to say I’m happy for Medibank to pay their share,” Dr Djakic said.

“So why is this insurer [Medicare] insisting on being out of step with contemporary practice?”

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