The rules for patient consent to be bulk billed are good news for the doctors who love paperwork, bad news for the other 99.99%.
Doctors who want to bulk bill patients for a telehealth appointment have a compulsory new form to fill out documenting a patient’s verbal consent, courtesy of Services Australia.
The only other alternatives are getting written consent via email, privately billing the patient or running the risk of repaying all those benefits in the event of an audit.
To be clear, 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.
When telehealth was introduced over the pandemic, Services Australia made a temporary exception and allowed practitioners to get verbal consent from patients and simply make a note of it in the consult notes.
That exception was flagged as ending in December last year, but was extended at the last minute so the Department of Health and Aged Care could develop what the AMA said would be a “solution that is more suitable for permanent telehealth services”.
At the time, the medical association said it hoped the department would take the opportunity to “streamline arrangements” and reduce paperwork.
This particular wish does not appear to have been granted.
Under the new arrangements, doctors can still collect verbal consent to bulk bill – but they will have to follow it up by completing an online form which then has to be sent to the patient via email or text.
There are two approved forms to choose from: bulk bill voucher electronically transmitted claims form DB4E and assignment of benefit Medicare bulk bill webclaim form DB020, the latter of which can only be used in conjunction with HPOS Medicare bulk bill webclaim.
Services Australia instructs doctors to type “patient verbally agreed” in the patient signature field of these forms, but only after discussing this with the patient.
Alternatively, GPs can email a patient to ask for written consent to bulk bill if they’ve done a telehealth appointment.
This is also a multi-step process.
First, the doctor needs to tell the patient during the consult that they plan to bulk bill.
Then, the doctor has to send an email to the patient’s nominated email address with the details of the service – including item numbers, benefit amounts and the date/time of service – the customer statement and a privacy notice.
Including the patient’s Medicare card number or the doctor’s provider number in this email is apparently a no-no, presumably for privacy reasons.
The patient then replies to that email, explicitly writing that they agree to the assignment of the Medicare benefit directly to the health professional.
Only once that is done can the doctor complete general, specialist and diagnostic assignment of benefit voucher form DB4 and submit the claim, writing “email agreement” in the signature block.
A copy of the form also must be sent to the patient.
The Albanese gov’t tripled GP incentives for bulk billing, woohoo! Now they introduce the requirement for a signed patient consent form in order to bulk bill a telehealth consultation! ??How is that meant to work? ? ?? #BulkBilling #TELEhealth #Medicare— Dr Rob Mathews (@robmathews) October 2, 2023
The third and final way to get bulk billing consent from a patient for a telehealth appointment is to obtain a physical signature via snail mail.
The new arrangements first appeared in a DOHAC fact sheet dated September 18 and took effect immediately.
In the fact sheet, DOHAC credited the new requirements to prove verbal consent to an Australian National Audit Office report on Medicare telehealth services released in January.
That ANAO report found that verbal consent for bulk billing created a fraud risk.
To spell it out: if there’s no patient acknowledgement that the consult being billed by the doctor actually happened, Services Australia could potentially be defrauded by GPs $38 at a time.
The ANAO also found that DOHAC officials had not only failed to properly assess the legal implications of verbal consent before putting it in place, but also outright ignored concerns from staff members about the potential for fraud as early as March 2020.
The report is about as snippy as official wording allows and takes the department to task for not clarifying to doctors that the verbal consent policy might not meet the legal requirement to provide patients with a copy of what they’re getting bulk billed for.
“The legal consequences of failing to observe such requirements can be severe [for practitioners],” the ANAO wrote.
“Where a provider does not provide a copy of the signed agreement in approved form to the patient, there is no legal basis for Services Australia to pay the benefit to the provider.
“Additionally, providers can be criminally liable for failing to complete the agreement form properly.”
It led to a recommendation that DOHAC develop better procedures for structured and documented risk assessments whenever there’s a change to the MBS, which the department accepted.
Failure to have a signature from the patient acknowledging their consent to being bulk billed makes an entire claim non-compliant, meaning Medicare can theoretically demand repayment.
If it considers the non-compliant claims to be fraudulent in nature, there’s every chance that Medicare will also refer that doctor to the Commonwealth Director of Public Prosecutions.
DoHAC has reportedly assured the RACGP that no retrospective compliance will be carried out on this front.
Generally, however, doctors are advised to keep a copy of all correspondence, claims and forms for at least two years for auditing purposes.
College president Dr Nicole Higgins said she would raise the issue with DoHAC and Health Minister Mark Butler on behalf of members.