The short answer is that GP CANNOT bulk bill and charge privately on the same occasion. There is one exception only – a supply of the vaccine from the GP’s stock.
GPs and practices often try to circumvent these rules. They try to bulk bill for some items and privately bill at the same time. This is, mainly, to make it easy on the patient’s cash flow. It is believed that patients would take it easy about the private charge if the charges are split between bulk billing and private fees. GPs and practices ‘mask’ these charges as “record creating charge”, “signup charge”, “dressing charge”, “consumables charge”, “admin charge”.
This practice is prohibited and, frankly, utterly unnecessary because patients receive their Medicare rebates in minutes straight to their bank accounts. That is if a GP practice uses Medicare online function in its practice software.
Example 1. GP bulk bills for item 23 and raise the charge of $20 for dressings separately. Wrong: GP must privately charge $39.10+$20=$59.10. A patient will have a Medicare rebate of $39.10.
Example 2. GP bulk bills for item 23 and raise the charge of $50 for a vaccine separately. Correct: GP may bulk bill any Medicare item and charge privately for any vaccine that is not part of a free Government-funded vaccination program.
Example 3. GP bulk bills for item 23 and the practice raises the charge of $20 for the creation of the record separately. Wrong: This is a prohibited practice. GP must privately charge $39.10+$20=$59.10. A patient will have a Medicare rebate of $39.10.
Example 4. GP bulk bills for item A $30 (removal of the lesion) and raise the private charge for item B $40 (removal of another lesion) separately. The Medicare rebate for item B is $35. Wrong: GP must privately charge item A $30 +item B $40= items A and B $70. A patient will have a Medicare rebate of $65 for items A and B fees in the schedule.
The Department of Human Services website contains information on Medicare billing and claiming options. Please visit the Department of Human Services website for further information.
Under the Health Insurance Act 1973, a bulk billing facility for professional services is available to all persons in Australia who are eligible for a benefit under the Medicare program. If a practitioner bulk bills for a service the practitioner undertakes to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service cannot be raised. This includes but is not limited to:
- any consumables that would be reasonably necessary to perform the service, including bandages and/or dressings;
- record keeping fees;
- a booking fee to be paid before each service, or;
- an annual administration or registration fee.
Where the patient is bulk billed, an additional charge can only be raised against the patient by the practitioner where the patient is provided with a vaccine or vaccines from the practitioner’s own supply held on the practitioner’s premises. This exemption only applies to general practitioners and other non-specialist practitioners in association with attendance items 3 to 96, 179 to 212, 733 to 789 and 5000 to 5267 (inclusive) and only relates to vaccines that are not available to the patient free of charge through Commonwealth or State funding arrangements or available through the Pharmaceutical Benefits Scheme. The additional charge must only be to cover the supply of the vaccine.
Where a practitioner provides a number of services (excluding operations) on the one occasion, they can choose to bulk bill some or all of those services and privately charge a fee for the other service (or services), in excess of the Medicare rebate. The privately charged fee can only be charged in relation to said service (or services). Where two or more operations are provided on the one occasion, all services must be either bulk billed or privately charged.
It should be noted that, where a service is not bulk billed, a practitioner may privately raise an additional charge against a patient, such as for a consumable. An additional charge can also be raised where a practitioner does not bulk bill a patient but instead charges a fee that is equal to the rebate for the Medicare service. For example, where a general practitioner provides a professional service to which item 23 relates the practitioner could, in place of bulk billing the patient, charge the rebate for the service and then also raise an additional charge (such as for a consumable).