Bulk bill payments to health professionals

Bulk billing

Bulk billing is when you bill Medicare directly for a patient’s medical or allied health service.

In a bulk billing arrangement both of the following apply:

• you accept the Medicare benefit as full payment for the service
• the patient assigns their right to a Medicare benefit to you, so we pay the benefit to you.

Assignment of benefit

A patient assigns their right to a Medicare benefit to you by signing a completed assignment of benefit form.

You can use the approved assignment of benefit form for manual or online claiming.

The patient or other responsible person must not sign a blank or incomplete assignment of benefit form.

Signature by a third party

If the patient can’t assign their right to a Medicare benefit, we can accept a third party’s signature on the form.

This may be the patient's:

• parent
• guardian
• power of attorney
• other responsible person.

You must complete all of the following:

• a note in the Patient signature field that the patient is unable to sign
• a note in the Provider Use field, why the patient is unable to sign - for example, unconscious, injured hand
• initial or sign your notes.

With Medicare Easyclaim, a patient assigns their right to a Medicare benefit to you. The patient must select either the OK or YES button on the EFTPOS terminal in your practice.

Additional charges and bulk billing

If you bulk bill a patient, you can’t make additional charges for that service.

This includes, but isn’t limited to:

• any consumables used, including bandages and dressings
• record keeping fees
• a booking fee to be paid before each service
• an annual administration or registration fee.

An exception is where you give the patient a vaccine or vaccines from your own supply held at your premises.

This exception only applies to general practitioners and other non-specialist providers for the following attendance items:

• 3 to 96
• 5000 to 5267.

It only relates to vaccines not available to the patient free of charge through either:

• Commonwealth or state funding arrangements
• the Pharmaceutical Benefits Scheme.

The additional charge must only be to cover the supply of the vaccine.

Bulk billing and private billing together

Where you provide a number of services on a single occasion, you can choose to bulk bill some or all of those services.

The exception is when the Multiple Operational Rule affects the services. In this case the provider can use only one claiming channel. This also applies to the diagnostic imaging multiple services rules (DIMSR).

Where some but not all of the services are bulk billed, a fee may be privately charged for the other service or services. This fee can’t be used for additional charges in relation to a bulk-billed service.

Claiming bulk bill payments

You must lodge a bulk bill claim within 2 years from the date of service. Read about bulk bill late lodgements for claims older than 2 years.

Electronic claims

You can submit bulk bill claims electronically through either:

• Medicare Online for health professionals
• Medicare Easyclaim.

To claim both in-hospital and out of hospital services, you’ll need to complete a separate DB1 header form for each.

You can use the In- hospital services header (DB1H) form through HPOS Bulk Bill Webclaim for services provided through either:

• in-hospital
• day hospital.

You can do this through HPOS using your Provider Digital Access (PRODA) account.

For services provided out of hospital, use the Out of Hospital Services (DB1N) form.

Both forms enable payment to go to a provider other than the one who provided the service.

This is for situations where a short term locum is acting on behalf of the provider. You can’t use this option for payments to or through a person who doesn’t have a provider number.

Payment through Electronic Funds Transfer only

We no longer send cheques for bulk bill and Department of Veterans' Affairs (DVA) payments to providers.

You must give us your bank details to get your bulk bill and DVA claims paid through Electronic Funds Transfer (EFT).

If you practice at more than one location, you must submit bank details for each location.

Providing your details

Provide your bank details to us by registering for EFT payments using Medicare online claiming or Medicare Easyclaim.

To register for EFT payments, fill in and submit both of these forms:

• Provider registration for Electronic Funds Transfer payments form (HW029)
• Online Claiming Provider Agreement form (HW027).

Bulk bill late lodgements

A Medicare claim must be lodged with us within 2 years from the date of service. This is outlined in the Health Insurance Act 1973 section 20B(2)(b).

To find out more, go to bulk bill late lodgements.

Bulk bill adjustments

You can call the Medicare provider enquiries line to delete a claim you lodge on that day.

You can change an item number or other details on a processed claim that’s under 2 years old.

The table below shows how to submit a request for an adjustment.

Your patient must sign any changes to their information. This is because you’re changing the original agreement you made with the patient to accept the patient’s assigned benefits.

You can’t request an adjustment unless a new assignment of benefit form has been signed by your patient or a third party.

A change to a previously paid or an omitted bulk bill incentive or PEI item

We'll accept requests to change a previously paid bulk bill claim if the date of service is within 2 years. This applies to both omitted items and item changes.

The table below shows how to submit changes to previously paid bulk bill incentive or patient episode initiation (PEI) items.

Bulk bill adjustment statements

When we process an adjustment for bulk billing, we’ll send you a bulk bill adjustment statement.

These statements now show all service lines for the patient. Previously, they only showed the service lines that had been adjusted.

The result line will show the difference between the original and revised service lines.

The tables below show the reason codes we use in adjustment statements. They include codes for an underpayment, overpayment or statistical bulk bill adjustment.

Underpayment of the previous benefit paid

Overpayment of the previous benefit paid

Statistical bulk bill adjustment

Contact us

For more information call the eBusiness service centre.