Assignment of benefit process ‘fundamentally flawed’: RACGP

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‘The legislative requirements, outlined in section 20A of the Health Insurance Act 1973, are outdated and must be modernised to align with current general practice workflows,’ authors of the submission state.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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assignment of benefit bulk-billing MBS