College gets serious about mixed billing

A how-to guide published by the college includes a legal way to charge a membership and bulk bill. Any takers?

---

The RACGP is making good on its president’s exhortations to abandon bulk billing by actively suggesting mixed billing methods – including a subscription-model loophole. 

A subscription model generally sees patients pay their practice yearly up-front “membership” fee in return for being bulk billed for the remainder of the year.  

Subscription may present an attractive alternative to private billing or bulk billing only, but its major downfall is that it is illegal to charge patients a fee while you bulk bill them. 

Section 20A of the Health Insurance Act 1973 says that when a Medicare benefit is payable, “the practitioner accepts the assignment in full payment of the medical expenses incurred” – i.e. without extra private fees. 

Clinics which have trialled the billing model have not always met with success.  

Canberra-based National Health Co-Operative, which charged a $10 monthly fee, went into voluntary administration almost exactly one year ago.  

Meanwhile, news broke last week that innovative subscription-based GP corporate Osana went into voluntary administration. 

Earlier this week, however, the RACGP revived the idea by including a legal workaround to billing membership fees in an article on NewsGP.  

One way to legally incorporate a membership fee, according to the college, is to privately bill the first consult with a patient each year and then bulk bill any additional consultations.  

TMR’s resident Medicare billing expert, Dr Margaret Faux, noted that while bulk billing and charging a separate membership fee at the same time is illegal, this may not be.  

“However, charging a separate membership fee on a separate day, when not bulk billing, has never been tested in court,” she said.   

“Given the way Medicare works, in my opinion, it would be unlikely that a court would find this type of arrangement illegal, though it remains moot.” 

Dr Faux, a lawyer who completed her PhD in Medicare compliance, said it was also important to remember regulations require that the full amount of the fee for the service is included on claims for reimbursement and that anything not genuinely forming part of the service fee should not be added to the item code.  

“For example, doctors should not charge $500 for an initial consultation using item 23 or 36, when the truth of the matter is that this represents $100 for the consultation, and $400 as an annual membership fee,” Dr Faux told TMR.  

“It is another area where the law is poorly defined, almost impossible to police, and needs an urgent update to reflect modern medical practice.” 

The Medical Republic has asked the Department of Health what it makes of this arrangement.  

Any practices willing to try their legal luck with this model, please let us know how you go.  

The RACGP’s suggestion follows explosive comments by president Adjunct Professor Karen Price at last year’s Annual General Meeting, where she called for “as many people as possible” to privately bill.  

In the newsGP article published this week, the RACGP again called for practices to abandon bulk billing. 

So long as GPs bulk bill, it argues, the government won’t be motivated to improve the patient rebate.  

“The RACGP believes the government will take notice of any reduction in the bulk billing rate, however it is likely that a consistent trend in reduced bulk billing will need to emerge to prompt action on primary care funding,” it says.  

It would appear that any changes to the bulk billing rate over the last year haven’t yet caught the attention of the government – the annual Medicare indexation will be 1.6% this year. 

While this is stronger than last year’s indexation factor of 0.9%, the fact remains that CPI rose 5.1% in the 12 months to March 2022.