Ye olde Medicare cheque will be mourned by some doctors and patients after all.
There will be very few winners out of the government’s plan to modernise gap-only billing for Medicare, but one of those will be the big banks.
As reported by The Medical Republic this week, the Department of Health, Disability and Ageing has released firm plans to axe the somewhat obscure Pay Doctor Via Claimant cheque system by July 2028, to be replaced by a more limited EFT process.
Under the current system, privately billing GPs can technically choose to charge patients a gap fee on the spot and then wait for the government to either send the Medicare rebate as a cheque via post or transfer the Medicare rebate electronically after a 90-day wait.
Right now, this can be done for any Medicare service big or small.
When the new system comes in, only services with a Medicare rebate greater than $697 will be eligible to be billed as gap-only.
This excludes virtually all GP consults.
While the Pay Doctor Via Claimant system is somewhat convoluted, Western Sydney GP Dr Adrian Sheen has been using it almost exclusively to charge gap fees for close to a decade.
“It is a complicated method, but actually having got it to work, it works perfectly well after a bit … and it’s been the best thing we’ve done for the practice in the last 10 years, there’s no question about that,” he told TMR.
He’s not the only one, either; while less than 1% of the total Medicare spend moves through the Pay Doctor Via Claimant scheme, it was still used by 39,000 providers and 588,000 patients in 2024.
Rather than cashing the cheques sent to patients by Medicare and then passed on to the practice, Dr Sheen chooses to wait 90 days for Medicare to cancel the cheque and simply transfer the Medicare rebate to his account.
Patients, he said, were often happy to be paying a smaller fee up front, while the practice benefitted from avoiding higher EFTPOS fees.
“If you come to see me, I have the option of charging you the whole fee of $120 … and I would then pay you immediately back, through Medicare, your rebate of $40,” Dr Sheen said.
“But [instead] what I do is to charge you $80 and the $40 difference, the Medicare fee, comes as a cheque.
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“I don’t have to pay a 1.5% [EFTPOS fee] on that Medicare moiety.
“When you multiply that by the fact that all accounts that are paid are charged … a 1.5% fee, this is millions [lost to EFTPOS fees each year].”
There is “absolutely no reason”, he said, that GPs should be pushed to pay higher business fees associated with transactions for Medicare.
“It is solely there because of political desire,” Dr Sheen said.
While Dr Sheen’s practice is firmly in the minority when it comes to using the Pay Doctor Via Claimant system so regularly, he said that it was also commonly used by pathology and radiology providers in scenarios where a patient has accessed multiple services which may be relatively low-cost individually, but stack up to a high fee.
When the minimum gap payment threshold of $697 is introduced, the department acknowledged in consultation documents, most pathology services will be ineligible.
It is unclear, at this stage, whether there will be any exceptions for situations where multiple MBS items summing to $697 or more are being billed at the same time or close together.
