Farewell, pen-and-paper bulk billing

Changes to the Health Insurance Act 1973 have dragged it, kicking and screaming, into the computer age.

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In a rare turn of events, the government has followed through on a promise to make GPs’ lives easier – but it might not be time to celebrate yet.  

The amendment to the Health Insurance Act 1973 passed this week will ditch the onerous assignment of benefit forms that nearly started a riot late last year.  

When it kicks into action, patients will be able to pre-consent to be bulk-billed into the future rather than having to co-sign a consent form every time they are bulk-billed.  

The bill was introduced just over a month ago and sailed through both houses of parliament but is not expected to come into effect for up to 18 months, allowing time for software vendors to develop integrated solutions.  

The aforementioned riot was spurred by Services Australia axing pandemic-era verbal consent provisions for telehealth consults – it is hard to get a physical signature over the phone – but the legislation goes further.  

“In response to industry feedback, amendments under this bill streamline bulk billing and simplified billing processes,” Assistant Health Minister Ged Kearney told parliament.  

“The bill goes further than telehealth, as the amendments reform assignment of benefit broadly. 

“One aspect of the bill is to support more efficient and effective claiming processes (including use of digital technologies) and provide for appropriate protections to ensure the integrity of Medicare for future generations.” 

So far, so good. But don’t get too excited.  

While the existing requirement to fill out an “approved form” has been deleted, the new amendment sets out provisions under section 20A to allow governments to regulate the assignment of benefit agreements.  

These regulations will govern the content, manner and form of the patient’s agreement to be bulk-billed, as well as requirements relating to what information has to be given. 

There are also new record-keeping requirements which Ms Kearney said would “support auditability”.  

So, while there’s no prescribed form to fill in, the government still has a say in what information is collected, when it is collected and how it is collected.  

Just how extensive and proscriptive those government-determined requirements will be is still a mystery, although Ms Kearney did make it clear that the intention was to reduce the GP administrative burden.  

“The current requirement for an ‘approved form’ would be replaced with requirements prescribed in regulations, enabling digital solutions that give government and stakeholders the flexibility to leverage existing interactions with patients, such as appointment booking, patient registration, hospital admission processes and informed financial consent discussions,” she said.  

RACGP board chair Dr Lara Roeske, meanwhile, said the passage of the legislation was a “significant win” that will reduce red tape.

“We don’t celebrate enough [as GPs], so we do want to celebrate what we see as a successful outcome, and one that follows earnest and hard won lobbying by the college on behalf of the profession,” she told The Medical Republic.

“I think we’ve all lived long enough to know that how things are implemented and what the consequences are [can be unpredictable].”

Reducing paperwork, she said, will benefit not just GPs, but also practice reception staff, practice nurses and patients.

“Take that administrative and regulatory workload away from GPs, and [we can] … spend more time focusing on patients,” she said.

The text of the legislation itself only lays out two stipulations for what bulk-billing agreements should look like.  

One is that the treating doctor accepts the assignment of benefits as full payment for that service, which is an existing requirement.  

The other is that “the assignor assigns the assignor’s right to the payment of the Medicare benefit to the professional at the time the agreement is entered into or when the Medicare benefit becomes payable (whichever is the later)”.  

One may be left with the impression that Dr Seuss has found a new career in drafting Australian health legislation.