The renewed red tape won’t prevent fraud and will only depress bulk billing rates even further, the college says.
It’s not clear how allowing patients to verbally consent to being bulk billed could contribute to Medicare fraud, the RACGP has told the Department of Health and Aged Care ahead of a potential move to modernise the MBS.
The rules governing Medicare assignment of benefits – where a patient gives written consent for a doctor to bulk bill them – became a flash point among GPs when a pandemic-era exemption allowing verbal consent for telehealth appointments expired last October.
Instead, GPs were expected to get a patient’s written consent to be bulk billed via email or snail mail, or alternatively via completing an online form and sending a copy to the patient.
The online forms to officially record verbal consent were not compatible with practice software.
GP outrage was significant enough to catch the attention of Health Minister Mark Butler, who promptly advised that the department would be exploring options to change the requirements.
He did not rule out introducing legislative changes, which would presumably specifically address the requirements as they are laid out in subsection 20B paragraph 3c of the Health Insurance Act 1973.
Mr Butler also said there were no plans to pursue any broad punitive actions relating to noncompliance on the issue until it was resolved, unless it related to complaints of Medicare fraud.
The minister appears to be delivering on his promise, with DoHAC running a formal consultation with key stakeholders ahead of “potential legislative amendments”.
In its submission, the RACGP called the assignment of benefit system “fundamentally flawed”.
“Patients generally appreciate having no out-of-pocket expenses, yet they must consent to be provided with bulk-billed care and receive a form documenting this,” the college said.
“It is difficult to envisage any scenario where a patient would refuse to assign their benefit.”
The college also questioned the reasoning behind an Australian National Audit Office report on telehealth services from January 2023 which found that simply noting a telehealth patient’s verbal consent for bulk billing created a fraud risk.
“Whilst the process is being reviewed due to perceived compliance risks, it is unclear how verbal consent – which has been permitted for telehealth services and remains a temporary measure – is contributing to fraudulent Medicare claiming,” the RACGP wrote.
“Complicating the process by requiring physical signatures will only cause GPs to further abandon bulk billing due to perceived red tape and excessive regulation.”
In terms of its ideal solution to the benefit assignment problem, the RACGP outlined two different solutions – one for face-to-face patients and one for telehealth.
For face-to-face consults, it said, the paper-based system involving a physical signature should be done away with entirely and patients should be able to provide a digital signature by pressing the “OK” or “yes” button on a Medicare Easyclaim EFTPOS terminal.
Alternatively, the college suggested that the Express Plus Medicare app could send patients a notification at the end of a consult prompting them to send a digital signature.
For telehealth consults, the college’s preference was that verbal consent for bulk billed telehealth remain, but with a method to record consent that would not be an administrative burden on GPs.
Related
Ideally, doctors would be able to tick a box or add a note to the patient’s file confirming consent to bulk bill.
A simplified form that is interoperable with practice software would also be preferable to the current process, the college said.
“The RACGP’s view is that alternative solutions to obtaining verbal agreement are likely to be untenable for telehealth,” it said.
“Requiring patients to provide a physical signature by mailing them a copy of the assignment of benefit form, or respond to an email, will delay Medicare claims being processed.
“Many patients will simply not respond when they receive the form.”
To protect GPs against patient non-response, the RACGP said it would like to see any legislative amendment include protections for providers who have made a reasonable effort to obtain consent from a patient.
Delayed payments for bulk billing doctors would likely lead to a substantial reduction in bulk billing rates, it wrote.
