Bulk billing

Last updated

Bulk billing is a payment option under the Medicare system of universal health insurance in Australia. It can cover a prescribed range of health services as listed in the Medicare Benefits Schedule, at the discretion of the health service provider. [1] The health service provider - usually a doctor - is paid 85% of the scheduled fee for outpatient services; and 75% of the scheduled fee for inpatient services, by billing the government via the patient's Medicare card. The service provider receives a fixed proportion of the scheduled fee but avoids the costs and risks of billing and debt collection. It could be described as a form of factoring.

Contents

Bulk billing rebates may be collected and paid directly to the service provider, or the service provider may collect the equivalent fee from the patient; leaving the patient to claim the rebate online, over the telephone, by mail, or at a Medicare office. Increasingly, service providers offer electronic lodgement at the practice using EFTPOS. [2]

Under Medicare, it is not permissible to charge the patient a co-payment with bulk billing (although this was previously permissible): a service provider who bulk bills for a service may not charge the patient further for that service.

Decline in bulk billing

Service providers may choose whether or not to use bulk billing. In January 2023, it was reported that only 42.7% of general practitioners bulk billed, while outside of Sydney and Melbourne less than a third bulk billed. In the Australian Capital Territory and Tasmania, only 5% and 6.9% of GPs bulk billed respectively. [3] The key purpose of bulk billing is to provide an economic constraint on medical fees and charges.

To address the decline in bulk billing, the Australian Medical Association (AMA) called on the federal government to revise indexation to ensure rebates better reflect the rising costs of providing medical care and running a practice, which it says would encourage more GPs to bulk-bill. The President of the AMA said that "the average government contribution to Medicare claims have fallen in real terms by more than 5 per cent over the past two decades, placing significant cost pressures on doctors." [4]

2014 co-payment proposal

In the 2014 Australian federal budget, the Abbott government proposed to impose a $7 co-payment for all bulk billed GP and medical test visits. The proposal was to reduce the medicare rebate payable to service providers by $5 (which applies to all consultations, and not just bulk billed ones) with the additional $2 paid by patients also going to providers. The proposal was widely criticised. [5] In March 2015, the Health Minister Sussan Ley announced that "we are not pursuing it at all" with Prime Minister Abbott declaring the co-payment was "dead, buried and cremated". [6]

Related Research Articles

<span class="mw-page-title-main">Medicare (United States)</span> US government health insurance program

Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, including those with end stage renal disease and amyotrophic lateral sclerosis. It was begun in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS).

Medicare is the publicly funded universal health care insurance scheme in Australia operated by the nation's social security agency, Services Australia. The scheme either partially or fully covers the cost of most health care, with services being delivered by state and territory governments or private enterprises. All Australian citizens and permanent residents are eligible to enrol in Medicare, as well as international visitors from 11 countries that have reciprocal agreements for medically necessary treatment.

<span class="mw-page-title-main">General practitioner</span> Generalist medical doctor working in primary care

A general practitioner (GP) or family physician is a doctor who is a consultant in general practice.

Resource-based relative value scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all health maintenance organizations (HMOs).

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

The Pharmaceutical Benefits Scheme (PBS) is a program of the Australian Government that subsidises prescription medication for Australian citizens and permanent residents, as well as international visitors covered by a reciprocal health care agreement. The PBS is separate to the Medicare Benefits Schedule, a list of health care services that can be claimed under Medicare, Australia's universal health care insurance scheme.

Medical billing is a payment practice within the United States healthcare system. The process involves the systematic submission and processing of healthcare claims for reimbursement. Once the services are provided, the healthcare provider creates a detailed record of the patient's visit, including the diagnoses, procedures performed, and any medications prescribed. This information is translated into standardized codes using the appropriate coding system, such as ICD-10-CM or Current Procedural Terminology codes—this part of the process is known as medical coding. These coded records are submitted by medical billing to the health insurance company or the payer, along with the patient's demographic and insurance information. Most insurance companies use a similar process, whether they are private companies or government sponsored programs. The insurance company reviews the claim, verifying the medical necessity and coverage eligibility based on the patient's insurance plan. If the claim is approved, the insurance company processes the payment, either directly to the healthcare provider or as a reimbursement to the patient. The healthcare provider may need to following up on and appealing claims.

<span class="mw-page-title-main">Medicare card (Australia)</span>

A Medicare card is a plastic card, the same size as a typical credit card, issued to Australian citizens and permanent residents and their families. The card or the Medicare number is required to be provided to enable the cardholder to receive a rebate of medical expenses under Australia's Medicare system, as well as subsidised medications under the Pharmaceutical Benefits Scheme (PBS). The card is usually green in colour, although interim cards are light blue and cards for Reciprocal Health Care Agreement visitors are light yellow. The cards are issued by a government agency called Services Australia.

<span class="mw-page-title-main">Australian Medical Association</span> Professional organization based in Australia

The Australian Medical Association (AMA) is an Australian public company by guarantee formed as a professional association for Australian doctors and medical students. The association is not run by the Australian Government and does not regulate or certify doctors, a responsibility which lies with the Medical Board of Australia and the Australian Health Practitioner Regulation Agency. The association's national headquarters are located in Barton, Australian Capital Territory, in addition to the offices of its branches in each of the states and territories in Australia.

<span class="mw-page-title-main">Medical education in Australia</span>

Medical education in Australia includes the educational activities involved in the initial and ongoing training of Medical Practitioners. In Australia, medical education begins in Medical School; upon graduation it is followed by a period of pre-vocational training including Internship and Residency; thereafter, enrolment into a specialist-vocational training program as a Registrar eventually leads to fellowship qualification and recognition as a fully qualified Specialist Medical Practitioner. Medical education in Australia is facilitated by Medical Schools and the Medical Specialty Colleges, and is regulated by the Australian Medical Council (AMC) and Australian Health Practitioner Regulation Agency (AHPRA) of which includes the Medical Board of Australia where medical practitioners are registered nationally.

Health care prices in the United States of America describe market and non-market factors that determine pricing, along with possible causes as to why prices are higher than in other countries.

General medical services (GMS) is the range of healthcare that is provided by general practitioners as part of the National Health Service in the United Kingdom. The NHS specifies what GPs, as independent contractors, are expected to do and provides funding for this work through arrangements known as the General Medical Services Contract. Today, the GMS contract is a UK-wide arrangement with minor differences negotiated by each of the four UK health departments. In 2013 60% of practices had a GMS contract as their principal contract. The contract has sub-sections and not all are compulsory. The other forms of contract are the Personal Medical Services or Alternative Provider Medical Services contracts. They are designed to encourage practices to offer services over and above the standard contract. Alternative Provider Medical Services contracts, unlike the other contracts, can be awarded to anyone, not just GPs, don't specify standard essential services, and are time limited. A new contract is issued each year.

Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately.

Concierge medicine, also known as retainer medicine, is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. In exchange for the retainer, doctors agree to provide enhanced care, including commitments to ensure adequate time and availability for each patient.

In the United States, Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.

<span class="mw-page-title-main">Health care in Australia</span>

Health care in Australia operates under a shared public-private model underpinned by the Medicare system, the national single-payer funding model. State and territory governments operate public health facilities where eligible patients receive care free of charge. Primary health services, such as GP clinics, are privately owned in most situations, but attract Medicare rebates. Australian citizens, permanent residents, and some visitors and visa holders are eligible for health services under the Medicare system. Individuals are encouraged through tax surcharges to purchase health insurance to cover services offered in the private sector, and further fund health care.

Bundled payment is the reimbursement of health care providers "on the basis of expected costs for clinically-defined episodes of care." It has been described as "a middle ground" between fee-for-service reimbursement and capitation, given that risk is shared between payer and provider. Bundled payments have been proposed in the health care reform debate in the United States as a strategy for reducing health care costs, especially during the Obama administration (2009–2016). Commercial payers have shown interest in bundled payments in order to reduce costs. In 2012, it was estimated that approximately one-third of the United States healthcare reimbursement used bundled methodology.

Balance billing, sometimes called surprise billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays. It is a pervasive practice in the United States with providers who are out of network, and therefore not subject to the rates or terms of providers who are in-network. Balance billing has a variable prevalence by market and specialty.

Whitecoat Health Service Directory, commonly referred to as Whitecoat, is an online directory of healthcare professionals. It was launched in Australia in 2013 and New Zealand in 2018. The service allows consumers to rate their experience of a healthcare provider and read other users’ recommendations and reviews. By 2016, Whitecoat was the largest website of its kind in Australia. Whitecoat has drawn significant criticism from professional medical bodies.

The Better Access Scheme also known as the "Better Access to Psychiatrists, Psychologists and General Practitioners initiative" is a program of the Australian Government that provides subsidised mental health care to Australian residents. Under the scheme, General Practitioners (GPs), Paediatricians and Psychiatrists with a Medicare provider number are able to refer patients to eligible allied health practitioners for treatment of mental health conditions under Medicare. The scheme is a key component of health care in Australia and aims to improve the treatment and management of mental illness within the Australian community. The introduction of the Better Access scheme has provided over 30 million individual treatment services for Australians with mental health disorders since its inception.

References

  1. ↑ "Medicare Bulk Billing"
  2. ↑ "Billing and claiming options"
  3. ↑ Mikala Theocharous (2023-01-28). "Bulk-billing GP crisis hits all-time high, affecting over 50 per cent of Australians". Nine News . Retrieved 2023-02-02.
  4. ↑ Anthony Galloway (2023-01-29). "Falling rate of bulk-billing sparks urgent call for overhaul of Medicare". Sydney Morning Herald . Retrieved 2023-02-02.
  5. ↑ The Age, 19 June 2014: Medical copayment deserves to fail in the senate
  6. ↑ Sydney Morning Herald, 3 March 2015: Abbott government scraps GP co-payment
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.