In a matter of weeks, all GPs will have to start keeping records of patients consenting to be bulk billed. Is your practice prepared?
From July 1, new laws will require practices to collect and hold onto proof that their patients have consented to be bulk billed – but there are still unanswered questions about what happens when a patient is too ill to consent.
“We like the idea of introducing electronic systems, but the way that this change looks like it’s been set up, it’s going to create a lot more work for practices,” RACGP president Dr Michael Wright told The Medical Republic.
“I’m really worried about the impact that will have on vulnerable patients of GPs, and the GPs providing care to vulnerable patients, whether that’s in aged care facilities or home visits, or even when we see people who are acutely unwell or delirious.”
Wait, what’s happening?
Technically, the Health Insurance Act 1973 has always required GPs to collect patient consent to be bulk billed. Traditionally, this could only be done by collecting a patient’s signature on a specific form after the consult.
The idea is that the consent requirement will discourage GPs from billing items for services which never happened, and thereby ripping off the MBS $38 at a time.
But the onus has always been on the patient to retain the evidence that they had signed over their Medicare benefit to the doctor.
There are several changes from July 1; the consent for bulk billing can be collected either before or after the consult, it does not have to be in a specific format, it can be signed electronically and the onus is on the clinician to retain the evidence that they had collected patient consent.
If the consent is being collected prior to the consult, the GP will have to estimate which broad service group the item number they will be billing will be coming from.
If this changes during the consult – say the booking was for a standard attendance but then it turned into a care plan – the patient consent to be bulk billed will have to be collected a second time.
All practices will have to start keeping records of patient consent to be bulk billed for two years.
Each assignment of benefit will only last for one episode of care, so patients will need to keep giving their consent every time the GP wants to bulk bill them.
While the Department of Health, Disability and Ageing has promised to create an “enduring” assignment of benefit, it’s not known when this will go live and what type of consult it will cover.
So I have to change everything? By July 1? Oh no!
“If you’re feeling like it’s complex… [that is because] unfortunately it is complex,” Best Practice Software assistant director Bec Bland told delegates at the RACGP Practice Owners Conference on Saturday.
While the number of changes may seem overwhelming, Ms Bland said, the only thing that practices will have to action right on July 1 is the record-keeping component.
“You don’t have to implement pre-service assignment if it doesn’t work for you,” she said.
“And again, keep in mind you don’t have to make these changes on day one … the change that you will need to make for July 1 is keeping evidence that you’ve obtained that assignment of benefit for two years.”
BP, which is the practice management software used by the majority of general practices, will have a new ‘assignment of benefit – pending’ tab.
A claim will appear here if it has been rejected (e.g., the patient completed their assignment of benefit before the appointment, and the appointment type changed) or if the patient has not actioned the request for assignment of benefit.
This last is likely to be a reoccurring issue for clinics trying to collect patient consent digitally, said Ms Bland.
“I think we’re all trained as people to be like, ‘hey, I’m not going to click on that [random] link’, whereas that’s something we’re now going to be asking our patients to do,” she said.
Will patients know what is happening?
Patient education will be essential to making sure that practices do not end up with unsubmittable Medicare claims, Ms Bland told delegates.
In an ideal world, this would be the government’s responsibility, given that it was a policy imposed on GPs by the government.
“I’ve been getting a lot of ads in my social media feed about using a Medicare card like a credit card at a GP practice,” Ms Bland said.
“It would be fantastic to see the same amount of education on making sure you consent to your doctor to bulk bill you.
“Unfortunately, I think, as we all know, that may be something that ends up on our shoulders.”
Related
I still have questions.
You’re not the only one.
The most pressing questions from the GP audience centred on how to complete assignment of benefit for elderly and infirm patients who may not be able to consent.
“It’s not something I’ve been able to get an answer from so far when asking this question to our government colleagues,” Ms Bland said.
The second-most pressing question was what to do if the clinic repeatedly tries to collect consent from a patient, but that patient does not respond.
“Unfortunately, there’s no provision in the legislation for ‘we’ve tried plenty of times to contact this patient, can we mark this as closed’,” Ms Bland said.
“There is no provision in the legislation for that, so I cannot give an answer in terms of how [the GP would receive payment in that instance], because I have the same question.”
There’s one more lingering question: is it only the patient who can sign over their assignment of benefit?
“Interestingly, the legislation doesn’t specify who the person assigning the benefit must be, if not the patient,” Ms Bland said.
“They merely need to answer: are you the patient, yes or no?”
Who wanted this?
The sting in the tail to these changes is that GPs were technically the ones who asked for them to happen.
The assignment of benefits saga began in earnest in 2023, when the Australian National Audit Office told off the Department of Health, Disability and Ageing for having allowed GPs to collect verbal consent for bulk billing from patients during the pandemic.
When DoHDA unceremoniously revoked verbal consent later that year, GPs kicked up quite the stink.
Within the week, the health minister promised that modernisation was incoming.
This is that modernisation.
“The college worked with the department to change this law to make a digital signature as legal as a pen signature,” GP Dr Walid Jammal told TMR.
“That’s what this law is about.”
He conceded that there were still practical aspects which needed to be worked through.
“From my view, I don’t think they’ve thought this through the ACCHO sector or the aged care sector, and that’s a big hurdle,” Dr Jammal said.
“But that will be worked through. They don’t want services to stop, I imagine – I’m not speaking on [DoHDA’s] behalf – but I imagine they don’t want services to stop going to all aged care patients, and they want them bulk billed, right?”
Other GPs did not share in Dr Jammal’s optimism.
“Patients often don’t know, necessarily, what they need,” GP and practice owner Dr Hamish Meldrum told TMR.
“They make an appointment for one thing, and then during the consult it changes to another thing. It changes to a mental health consult, or it changes to they need a procedure.
“And it sounds like [if we use pre-assignment of benefit] we’re going to have to go through a whole consent process, which is going to actually be quite a significant barrier for patients to get the care in a frictionless way when they need it.”
Dr Paresh Dawda, a GP with special interest in aged care, was concerned that the digital signature changes would perpetuate inequity.
“I care for people with complex chronic needs and disability,” he told TMR.
“I think the risk here is it perpetuates inequity – inequity from people who can’t perhaps consent for themselves. … What we’ve heard this morning is that digital solutions are going to be the workflow, yet the same group also have digital inequity.
“We’re perpetuating inequity issues exponentially, really, and I think that’s where the biggest issue is for me.”
The 2026 RACGP Practice Owners Conference was held at the Sydney Convention and Exhibition Centre on 23 and 24 May.
