Butler intervenes on bulk billing consent debacle

4 minute read

The new paperwork was the talk of the GP community this week, and it didn’t go unnoticed by the Health Minister.

Health Minister Mark Butler has moved to “streamline” consent requirements for telehealth bulk billing after an outpouring of GP anger.

While the announcement hasn’t officially been made at time of writing, the RACGP has been told by Mr Butler’s office to share a statement with members. 

“I have asked my department to provide options to address concerns about the assignment of benefit for Medicare bulk billed claims, including legislative amendments,” the statement reads.

“My department has advised me that until these changes are made, there are no plans to pursue any broad punitive actions on this issue unless it relates to fraudulent claims against Medicare.”

It follows a week of outrage after Services Australia confirmed that recording a patient’s verbal consent to be bulk billed in consult notes would no longer be allowed.

While verbal consent is still an option, doctors now have to fill out an additional form and send that to the patient before claiming any rebates.

There is no easier option, either.

The other two kosher methods for obtaining patient consent to be bulk billed are getting them to reply to an email explicitly stating that they consent to be bulk billed for the service or physically sending them a form to sign and return via snail mail.

Collecting a patient’s written consent to bulk bill has been a longstanding – if somewhat obscure – requirement under subsection 20B paragraph 3c of the Health Insurance Act 1973.

“Somebody said to me ‘this is only something that’s really small, why has it upset everybody so much?’” RACGP president Dr Nicole Higgins said.

“And [it’s because] this goes to the core of what we do, and it reflects the lack of communication … a lack of respect and a complete disruption to how we all work.”

It also came at a time, Dr Higgins told The Medical Republic, when GPs were already feeling demoralised.

“It doesn’t reflect or respect the changes that we’ve all made to adapt during covid,” she said.

It would certainly be a shame for the government, she said, for GPs to be discouraged from bulk billing telehealth appointments just as MyMedicare is rolled out, given one of the chief lures of the scheme is that patients can access longer telehealth rebates that come with a triple bulk-bill incentive.

Taking the secret fourth option of never recording the patient’s consent to be bulk billed runs the risk of Medicare demanding those rebates be paid back, based on a lack of evidence that the service actually happened or happened as described by the practitioner.

“The Act is quite prescriptive,” AMA vice president Dr Danielle McMullen told TMR.

“[It explicitly states that] for bulk billing to occur – so for the payment to be made directly to the doctor – that there needs to be explicit consent from the patient on a prescribed form.”

Because this is the way it’s laid out in the legislation, it will take a legislative amendment passing parliament to change it, so there probably won’t be a permanent fix to the issue until early next year.

Dr McMullen confirmed that she had spoken directly with Mr Butler and Department of Health and Aged Care representatives throughout the week and that work was under way to find both short- and long-term solutions.  

“There is work in the department to see whether they can modify the [verbal consent] form and modify the interim process,” she said.

“And then you have the legislative change – we want to make sure we get it right, so that won’t happen overnight.

“But there is a strong commitment to make that happen as quickly as possible and with the input of doctors to make sure that it fits with our workflow.”

Dr McMullen said work was already under way with software vendors to find ways to streamline the process of filling in the verbal consent form.

The AMA also reported that DoHAC had agreed not to conduct any retrospective compliance on bulk billing consent as it relates to telehealth.

“We’ve got to make sure that we’ve got solutions going forward that really balance the need for compliance and oversight of Medicare spend but that also works with workflow and isn’t bureaucratic red tape,” Dr McMullen said. 

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