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Four pitfalls of bulk billing

In a recent Forum article, Medicare Australia reminded doctors that when a professional service is being bulk billed, the doctor is prohibited from charging any co-payment (i.e. any other charge) for the service being provided, except for certain vaccines.

02 Apr 2012

In a recent Forum article, Medicare Australia reminded doctors that when a professional service is being bulk billed, the doctor is prohibited from charging any co-payment (i.e. any other charge) for the service being provided, except for certain vaccines.

In agreeing to bulk bill the patient, the doctor has agreed to accept the Medicare rebate for that professional service as full payment for the service.  Raising a separate charge, for example for dressings used in treating a patient’s wound during a consultation, would contravene the Section 20A of Health Insurance Act 1973.

The AMA encourages doctors to set their fees based on their practice cost experience.  Explanatory Note G.1.3 in the Medicare Benefits Schedule states that medical practitioners are free to set their fees for their professional service.  Practice costs, such as employing staff, and operating expenses, such as rent, electricity, computers, continuing professional development, accreditation and professional and business insurance must all be met from the single fee charged by the medical practitioner.

The first pitfall of bulk billing is that you may not be covering these costs, or be appropriately remunerated for your service.

The second pitfall is this may threaten the sustainability of your practice. 

As a GP, I understand the strong commitment that GPs have to their patients, particularly around bulk billing their disadvantaged patients wherever possible.  Herein lies the second of the pitfalls of bulk billing.  I suspect this recent warning from Medicare is the likely result of some practices trying to maintain their commitment to bulk billing while trying to recoup some of the increasing costs of providing medical care. 

Practices can recoup the costs of providing care in a variety of ways.  The efficiency gains that larger practices realise is one way.  Subsidising bulk billed patients with the fees billed to other patients is another.  Full patient billing is yet another.  Contravening the Act, and facing possible recovery action and/or prosecution, is not a recommended option.

The third pitfall of bulk billing and raising separate charges* is that it hides the true cost of providing a medical service from Government.

The fourth pitfall of is it excludes the out of pocket payment counting towards the patient’s Safety Net thresholds. The original and extended Medicare Safety Nets are there to assist patients who have high out of pocket expenses for out of hospital MBS services. It is important for you to review your fees on a regular basis. If you find your fees do not reflect the true costs as well as the value of the services you provide the AMA has several resources, developed by the AMA Council of General Practice, on its website to assist you to move to patient billing.

 

*Except for vaccines from the practitioners own supply, which are not covered by any Commonwealth or State programs or available through the Pharmaceutical Benefits Scheme.


Published: 02 Apr 2012