Bulk billing: 

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Bulk billing is when your doctor bills Medicare directly and accepts the Medicare benefit as full payment for their service. This means you do not have any out-of-pocket expenses.

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As mixed billing practice in Arana Hills, we continue to bulk bill patients younger than 16 yr and pensioners over the age of 65 between 8 am and before 4 pm on weekdays. 

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What is bulk billing? It simply means that if you have valid Medicare or Medibank, you do not pay cash to see a GP for issues covered by Medicare & Medibank.

Driver license examinations or employment medical s are not covered by Medicare. 

Medicare does not cover:

• examinations for life insurance, superannuation, or memberships for which someone else is responsible (for example, a compensation insurer, employer or government authority);

• ambulance services;

• most dental examinations and treatment;

• most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services;

• acupuncture (unless part of a doctor's consultation);

• glasses and contact lenses;

• hearing aids and other appliances; and

• home nursing.

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Please see following from Parliament of Australia about Medicare and Bulk billing : 

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Medicare: a quick guide

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12 July 2016

PDF version [321KB]

Amanda Biggs
Social Policy Section

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Introduction

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Medicare is Australia’s national health insurance scheme which subsidises the cost of many medical and allied health services. Medicare commenced on 1 February 1984, following the passage of the Health Legislation Amendment Act 1983 and related legislation in September 1983. At the time, Minister for Health Dr Neal Blewett described Medicare as ‘a major social reform’ which aimed ‘to produce a simple, fair, affordable insurance system that provides basic health cover to all Australians’. Medicare is largely based on the short-lived Medibank scheme, introduced by the Whitlam Labor Government in 1975 but which was later dismantled by the Fraser Coalition Government. Since being introduced, Medicare has undergone some major changes including subsidising expensive new technologies (such as PET scans), adding preventive health checks and funding new ways of delivering health care (such as team care for chronic disease management).

This Quick Guide updates the archived 2004 Parliamentary Library publication Medicare—a Background Brief with a focus on developments over the last decade. It describes the range of services and benefits now covered by Medicare, as well as eligibility requirements, billing practices, financing arrangements, safety nets, statistics on bulk billing and expenditure, significant issues and challenges.

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Medical Benefits Schedule

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Medicare operates by paying a specified benefit (in the form of a rebate) for a health or medical service for which a claim is submitted. Only services provided by private practitioners (the majority of Australian doctors work in private practice) are covered by Medicare. Services provided in a public hospital only attract a Medicare benefit if the patient elects to be treated as a private patient.

Services covered by Medicare benefits are mandated in specified tables, published as the Medical Benefits Schedule (MBS). Only clinically relevant services are eligible for benefits. A clinically relevant service is one which is generally accepted by the relevant profession as necessary for the appropriate treatment of the patient. Certain services are specifically excluded including medical examinations for insurance purposes, mass immunisations and services for which a state health service or third party insurer is responsible. Regulations can also specify that other services be excluded.

Each service listed in the MBS has an item number, a descriptor which outlines the type and scope of the service and relevant clinical requirements, the Medicare schedule fee, the applicable Medicare benefit, and any additional safety net benefits.

Most items listed in the MBS are remunerated on a fee for service basis. However, in recent years other types of practitioner payment methods (such as incentive payments for managing certain chronic conditions or for bulk billing certain categories of patients) have been introduced.

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Medicare benefits

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The level of Medicare benefit is calculated as a percentage of a mandated schedule fee for the service, and varies on the setting. A service provided in hospital attracts a benefit equal to 75% of the schedule fee; a service provided out of hospital generally attracts a benefit of 85%. In the case of non-referred attendances (those provided by a general practitioner (GP)) the benefit is set at 100% of the schedule fee. If the health practitioner chooses to bulk bill, they receive the Medicare benefit as full payment for the service and the patient pays nothing (bulk billing is discussed in further detail below).

Medicare claims and payments are administered by the Department of Human Services. The operation of Medicare itself is governed by provisions in the Health Insurance Act 1973 and related regulations. The Minister for Health has overall responsibility for Medicare.

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Updates to the Medical Benefits Schedule

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The MBS is updated regularly to reflect changes to the scope of services due to changes in clinical practice, the addition of new services or the deletion of obsolete services, as well as to allow for the regular adjustment of fees. Such changes do not require amending legislation but are specified in a regulation which is classified as a legislative instrument and may be subject to disallowance arrangements.

New services and treatments are assessed by the Medical Services Advisory Committee, an independent expert committee which advises the Minister for Health on the comparative safety, clinical effectiveness and cost-effectiveness of any proposed medical service or technology, and recommends the circumstances under which MBS listing should be supported.

The MBS currently contains around 5,754 items and covers a much wider range of services from when it first commenced. Originally limited to professional medical services, pathology, radiology, acupuncture, dental services for palate deformities and optometry, the MBS now includes technologies such as PET and MRI scans, as well as new types of care arrangements such as team care and chronic disease management. Allied health services were added in 2004, nursing and midwifery in 2010 and telehealth consultations in 2011. The Department of Health lists some of these key developments on this webpage.

In the 2014–15 budget, a two year pause in the indexation of the scheduled fee for most MBS services was announced—GP services, pathology and diagnostic imaging were originally exempt. This pause was expanded at the 2014–15 Mid-Year Economic and Fiscal Outlook (MYEFO) to include GP services, and the duration was extended to 2018. Because the MBS benefit is calculated as a percentage of the schedule fee, the pause has the effect of freezing both the patient rebate and the rebate paid to the doctor if they bulk bill.

In April 2015, the Health Minister Sussan Ley announced the establishment of a Medicare Benefits Schedule Review Taskforce to undertake a major review of all Medicare items to ensure ‘services can be aligned with contemporary clinical evidence and improve health outcomes for patients’. Many of the items on the MBS have never been assessed or changed since their introduction. An interim report provided to the Minister in December 2015, recommended the removal of 23 services which were regarded as obsolete. A second report is due at the end of 2016.

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Bulk billing

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Bulk billing is where the practitioner directly bills the Department of Human Services for the service and accepts the Medicare benefit as full payment. Bulk billing is not mandatory; practitioners are free to decide whether to bulk bill or privately bill the patient. If a patient is bulk billed they cannot be charged a co-payment or an additional fee, making the service free to the patient. In 2004 the Coalition Government introduced bulk billing incentives, an additional payment to encourage GPs to bulk bill children and concessional patients. This included a higher incentive to bulk bill these groups in rural and regional areas. Bulk billing incentives for pathology and diagnostic imaging were introduced by the Labor Government in 2009.

A patient who is not bulk billed will be issued an account by their health provider. This usually means the patient must pay up-front and then claim the rebate from the Department of Human Services. Many practices now offer electronic claiming, making payment of the rebate to the patient virtually instantaneous.

Nationally, as at September 2015, across all Medicare services, the bulk billing rate was around 77.4% (Medicare Statistics, Table 1.1). However, for GP services the rate is higher at around 84.0%. The highest level of bulk billing is for Practice Nurse items (99.5%). For specialists, the bulk billing rate is considerably lower, around 30.0% with Anaesthetics recording the lowest rate (10.1%).

Bulk billing rates vary across regions. Generally, higher rates are seen in regions with a higher density of health practitioners, such as metropolitan areas and where competitive pressures apply. But bulk billing rates can be relatively high in areas with significant levels of socio-economic disadvantage. For example, regions of Western Sydney regularly record the highest GP bulk billing rates, while the more affluent suburbs of North Sydney have lower rates, likely reflecting the differing incomes and capacity to pay of residents in each community. The type of practice can also influence bulk billing levels. A number of so-called ‘corporate practices,’ (GP clinics owned by a single company usually employing GPs under contract) often market themselves as exclusively offering bulk billing.

While a $7 patient co-payment was proposed in the 2014–15 budget, it was subsequently ruled out by the new Health Minister Sussan Ley in early 2015, following criticism from medical, health and consumer groups.

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Our team of doctors take care of  women's health, Men's health, Children health and chronic disease management 7 days a week in our local community.