Assignment of benefit process ‘fundamentally flawed’: RACGP

Jolyon Attwooll

17/01/2024 3:37:09 PM

In a submission to DoHAC, the college has called for an effective solution for a process many view as outdated and unnecessary.

Assignment of benefit
There was outcry among GPs when more red tape was introduced to the telehealth bulk billing process.

The ‘assignment of benefit’ process is a barrier to providing care for vulnerable patients, the RACGP has warned the Department of Health and Aged Care (DoHAC).
In a recent submission to DoHAC, Modernising the ‘Assignment of Benefit’ process for Medicare bulk billed services, the RACGP has described current legislation as ‘onerous … fundamentally flawed and challenging for patients to understand’.
‘The legislative requirements, outlined in section 20A of the Health Insurance Act 1973, are outdated and must be modernised to align with current general practice workflows,’ authors of the submission state. 
Under the existing legislation, a patient needs to physically sign to consent for bulk billing benefits to be paid directly to the health provider.
That obligation was initially waived for telehealth when it was introduced more widely in 2020, with verbal consent allowed temporarily – an arrangement the Australian National Audit Office (ANAO) criticised for its ‘failure to identify and manage legal risk’ in a report published last year.
A Services Australia attempt at a short-term fix to this issue sparked widespread controversy, following the introduction of a new form to allow verbal consent to continue, a move that was likened at the time to a ‘script from Utopia’.
Another temporary workaround incorporated into practice software has since been developed, but the new RACGP submission nonetheless suggests the requirement is unnecessary and potentially damaging to health equity.
‘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 submission states.
‘It is difficult to envisage any scenario where a patient would refuse to assign their benefit.
‘Member feedback indicates that if current requirements are maintained, it will be far simpler for practices to privately bill patients who can then claim their rebate from Medicare.’
A newsGP survey that ran shortly after the Services Australia move was made public suggested an overwhelming number of GPs could move away from bulk billing if the situation went unaddressed.
In the poll of more than 2600 GPs, 94% said they will be more likely to privately bill telehealth consultations due to the extra red tape.
Dr Emil Djakic, a member of RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), said change is essential.
‘Our members have expressed great concern about the complexity and clunkiness of what the current legislation demands of us in this process,’ he told newsGP.
‘This isn’t directly the department’s fault, they’re really just trying to follow the legislation.
‘But it’s very outdated legislation that has failed to keep up with contemporary practices.’
Dr Djakic hopes the right balance of lighter administrative burden and compliance can be struck.
‘[DoHAC] and the Government … are entitled to ensure that the way money is spent in the insurance system that is Medicare is accountable,’ he said.
‘It does sit with the current government to consult widely, not just with industry and consumers, but also with commercial delivery agencies, to procure something that is efficient, effective and accountable.’
The RACGP describes the situation as a ‘complex legal issue’ but said its suggested changes could ‘streamline the process while preserving the integrity of Medicare’.
Its recommendations include allowing patients to provide a digital signature at the point of face-to-face consultations, or shortly afterwards via a secure mobile app.
Verbal consent should be kept permanently for telehealth, according to the college.
‘A digital solution for documenting consent that is fully integrated with existing clinical information systems and utilises existing data from these systems will support current clinical workflows and avoid an overly burdensome administrative process,’ the submission states.
It also warns that age and rural/remote discrepancies ‘may create barriers to adoption’.
‘Alternatives need to be available to ensure equitable access for patients to their Medicare benefits,’ the submission concludes.
Following widespread pushback to the verbal consent requirement changes last year, Federal Health and Aged Care Minister Mark Butler intervened to request DoHAC look at potential solutions, including amended legislation.
‘My department has advised me that until these changes are made, there are no plans to pursue any broad punitive actions on this issue, unless it relates to fraudulent claims against Medicare,’ he said at the time.
Dr Djakic agrees with that approach.
‘Over-enthusiastic compliance exercises in this space are unwarranted,’ he said. ‘Minister Butler has recognised that the current processes are not fit for purpose.’
Dr Djakic also highlighted the need to clarify the process when a ‘responsible person’ is required to assign benefit, such as for aged care consultations where patients are unable to provide consent.
In the submission, the college urges for further consultation before legislative changes are put in place so the impact on providers and patients can be assessed – a point stressed by RACGP President Dr Nicole Higgins when the controversy occurred last year.
‘What’s really important moving forward is that we’re involved in discussions around what that legislative change should look like and how we modernise the process,’ she previously told newsGP.
‘It needs to be a modern system that’s digitalised and integrated with our medical software, that’s transparent, and that is seamless for both GPs and patients.’
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Dr Michael Charles Rice   18/01/2024 8:35:44 AM

It's hard to pitch the ‘assignment of benefit’ process as a barrier to anything, let alone care of the vulnerable, when it's widely ignored (or completely unknown) by practices and practitioners. Especially when the best Minsterial direction has been "yeah but nah, don't worry about it for now".

In my teaching roles, I've been careful to identify the requirement for patients to be invoiced, claim and assign. In the name of correctness. I'm never surprised that almost none has even heard of such a process. They are incredulous that claimants might be required to sign a form that can be immediately shredded. To most, the rebate is simply and incorrectly understood as "what Medicare pays the doctor" and not what the patient claims to settle their account.

While the majority of patients still appear to be bulk-billed (see and few are asked to formally claim and assign (y observation), the best argument for reform must be the absurdity of the status quo.

Dr Christopher Francis Boyle   18/01/2024 5:46:16 PM

Why not really change the system? The Medicare card could be swiped and a gap fee , if there is one, charged. This is what happens with the private health fund when I go to the dentist , physio or whoever. This make much more sense. The patient is out of pocket but not for the full amount. Wouldn't this be much simpler?
I realise that it would mean a fudamental change to Medicare but why not when you are lookig at ways of dragging Medicare into the digital age? If no gap was charged then perhaps an extra swipe of the medicare card to be receiving the paltry"bulk billing" incentive.

Dr Peter James Strickland   19/01/2024 7:13:43 PM

It should be very simple now in 2024, as Medicare have had 50 years plus to work it all out to simplify it for patients and doctors since Medibank Mk 1 in the 1970s. Chris Boyle has it right (above). Do what happens when we go to the dentist --- pay the difference between the fee and the insurance rebate (in our case the Medicare items(s)) in total. It should have always been that way from the start. The bureaucrats in Federal Health have deliberately complicated it under the falsehood that doctors will 'rip off the system' --no they won't, and because our profession will NOT condone it, but condemn false claims, and a system of auditing would be simple anyway to eliminate the fraudsters! Otherwise tell patients the Feds are failing them constantly with respect to Medicare.