Can GPs Bulk Bill Patients Who Are Inpatients at a Private Mental Health or Substance Abuse Hospital?
Question: GPs have been seeing a patient who is an inpatient at the XYZ private hospital. They are not an emergency/general hospital they are inpatient for mental health/substance. The Doctor wants to know if they are eligible to bulk bill the patient even though they are an inpatient there? As the hospital does not provide the services necessary for the patient and they have to come to see the GP?
The answer depends on how the private hospital, such as XYZ, is funded. Let’s break it down:
Scenario 1: Hospital Funded by State or Federal Government
If XYZ Private Hospital is funded by the State, Federal Government, or any government authority, the answer is NO.
This restriction is based on Section 19(2) of the Health Insurance Act 1973, which explicitly states that Medicare benefits cannot be paid for professional services rendered by, on behalf of, or under arrangements with:
- The Commonwealth (Federal Government),
- A State or Territory Government,
- Local governing bodies, or
- Authorities established by law under any of these governments.
In this case, the patient’s treatment is covered by government funding, and Medicare cannot be billed.
Reference: Section 19(2) of the Health Insurance Act 1973
Scenario 2: Hospital Funded by Private Fees
If XYZ Private Hospital operates solely on private fees and does not receive any government funding, the GP may bill Medicare for seeing the patient.
However, it’s important to ensure that the service provided is not covered under any existing hospital funding arrangements or agreements.
Anecdotal Exceptions
Over the years, there have been cases where GPs successfully billed Medicare for patients who were classified as “inpatients on leave.” For example:
- A patient at a mental health hospital visits family over the weekend and develops a sore throat.
- The patient sees a GP for this unrelated issue, and the service is successfully billed to Medicare.
While these cases exist, they may not be the norm and could depend on how the circumstances align with Medicare rules.
Key Takeaway
Before billing Medicare, the GP should verify how the hospital is funded and whether the specific service falls outside hospital-funded care. When in doubt, consult the Ask MBS Medicare Benefits Schedule or seek professional advice to ensure compliance.
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