Concerns remain over new assignment of benefits laws

Amid growing confusion, the Federal Government has moved to clarify what’s required of practices ahead of fast-approaching changes to obtaining an ‘assignment of benefit’ for bulk-billed services.
 
With sweeping new laws to take effect on 1 July, the Department of Health, Disability and Ageing (DoHDA) has released a new frequently asked questions document, outlining some of the major changes and how practices can prepare.
 
The new laws will impact the process whereby patients assign their Medicare benefit to a provider in exchange for not incurring any out-of-pocket costs.
 
An assignment of benefit is currently carried out via a standard form, and received verbally in some cases, such as telehealth – however, this is all set to change.
 
The new laws involve several major changes, including the need for an electronic or physical signature to be collected from the patient, or responsible person, as part of the assignment of benefit, and a requirement for practitioners to keep that completed agreement for two years.
 
The incoming change has led to confusion among many GPs who have been left uncertain about how it will impact workflow and how to obtain consent from patients who are elderly or vulnerable.
 
RACGP President Dr Michael Wright said it is an area of concern the college has already raised with the Federal Government.
 
‘They really need to work out how these regulations can be fixed to make sure that there’s a safety net for patients who aren’t able to sign,’ he told newsGP.
 
‘And for the GPs who are providing that care to them in good faith, that there is a backup plan that is Medicare-compliant, because certainly GPs don’t want to be falling foul of Medicare regulations.
 
‘We really need to fix this up.’
 
In the DoHDA’s FAQs, it is explained that if a patient is unable to sign an assignment of benefit agreement, ‘an assignor’ (for example, a parent, partner, carer, relative, person with power of attorney or friend) could be asked to sign instead.
 
However, ‘without a patient or assignor’s signature, an assignment of benefit agreement is not complete, and a bulk-billed claim should not be made’.
 
Dr Wright said this risks those most vulnerable being left without access to bulk-billed care.
 
‘We’ve seen this issue being raised, particularly for GPs who are working in aged care facilities,’ he said.
 
‘What are the practicalities of this assignment of benefit in patients who aren’t able to physically sign the form?
 
‘Unfortunately the frequently asked questions provide some clarity, but that doesn’t really fix the problem.’
 
Dr Wright uses the example of an aged care home where a patient may not be able to sign themselves and an assignor is not there, ‘then that patient’s care provider is unable to bill’.
 
‘There’s a real risk there that the people who have the most need, most disadvantage, and need for care won’t be able to or can’t advocate for themselves, and indeed these regulations put up an additional barrier,’ he said.
 
It is a concern echoed by RACGP NSW&ACT Council member Dr Paresh Dawda, who attended a jam-packed Practice Owners Conference session on the topic on Saturday.
 
‘There’s some unknowns around more vulnerable populations, hard-to-reach populations, and I’m thinking about aged care, palliative care, disability care, homelessness, and what happens in those situations,’ he told newsGP.
 
In other changes coming on board from 1 July, patients will be able to assign a benefit before (episodic pre-service assignment) or after (episodic post-service assignment) a service is received, so long as patient agreement is made prior to a Medicare Benefits Schedule claim being lodged under the upcoming changes.
 
The FAQs explain that if the medical service provided is different from what has been assigned under an episodic pre-service agreement, a new assignment of benefit agreement will need to be obtained which reflects the service provided. Otherwise, a post-service episodic assignment of benefit agreement should be obtained from the patient. 
 
Also, verbal assignment of benefits will no longer be accepted, documents will no longer be able to be annotated, and practitioners, billing agents, and private health insurers will no longer need to use an ‘approved form’, so long as agreements include the information required for each type of episodic agreement.
 
This means the existing ‘approved forms’ (DB4e and DB020) will no longer meet the requirements for a valid assignment of benefit agreement, the FAQs state.
 
The concept of an ‘approved form’ is being replaced with a mandatory information set (referred to as a ‘data set’) that must be provided to, and agreed by, ‘the assignor’.
 
While there will be no prescribed template or mandatory form, the DoHDA says an assignment of benefit agreement can be presented in any format (paper or electronic).
 
‘If all required information is present and the assignor has agreed, the document will constitute a valid record of assignment of Medicare benefit, regardless of its format,’ it said.
 
The DoHDA added that Services Australia will make example templates available on its website soon to assist providers, however their use is optional.
 
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