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‘Like a script from Utopia’: Bulk billing change raises GP ire
In an update to the ‘assignment of benefit’ requirement, GPs can still get verbal consent to bulk bill telehealth – but will need to fill in more forms.
Verbal consent for bulk billed telehealth is still possible, but extra form filling will be necessary.
A Services Australia update that requires GPs to fill in a form documenting patients’ verbal agreement to be bulk billed for telehealth has been likened to the ABC satirical program Utopia.
The change relates to expectations in the Health Insurance Act 1973, which requires patient consent for Medicare bulk billing benefits to be paid directly to the provider.
In the early stages of the COVID-19 pandemic, the requirement to get written consent for bulk billing for telehealth was shelved, with verbal consent introduced as a temporary measure.
The Department of Health and Aged Care (DoH) acknowledged the approach was under review last year, and changes have now come into effect according to guidance published on the Services Australia website last month.
Services Australia states the preferred method for obtaining patient consent to be bulk billed for telehealth consultations is in writing or via email, while verbal consent remains possible – but only by using accompanying forms.
While it had been previously possible to document verbal consent in clinical notes, that option is no longer available for GPs.
For Dr Emil Djakic, a member of RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), the requirement is just another unwarranted and unnecessary administrative burden on general practice.
‘This is purely an entire script of Utopia,’ he told newsGP.
‘This is an analogue approach to a digital platform, and as such it’s primitive.’
Dr Djakic believes the requirement is likely to deter GPs from bulk billing telehealth consults.
‘I appreciate that the department is trying to wrestle with the concept of how we insure against fraud, and I respect their willingness to be enthusiastic about protecting their side of the public purse obligation,’ he said.
‘That’s a big driver for them, and they’ve raised that. But they’re actually going to end up hurting and harming patients more.’
The change appears to have been prompted, at least in part, by a critical Australian National Audit Office (ANAO) report published earlier this year.
The ‘Expansion of Telehealth Services’ auditor analysis rebuked DoH officials for a ‘failure to identify and manage legal risk’ by allowing verbal consent to be documented in patient notes.
It said the arrangement ran contrary to the Health Insurance Act.
‘Public-facing guidance on the temporary policy did not clarify that notating verbal consent in provider records alone could not address other statutory requirements requiring a signed copy of the agreement to be provided to the patient,’ the report authors wrote.
‘The legal consequences of failing to observe such requirements can be severe.
‘Where a provider does not provide a copy of the signed agreement in approved form to the patient, there is no legal basis for Services Australia to pay the benefit to the provider.
‘Additionally, providers can be criminally liable for failing to complete the agreement form properly.’
Services Australia has flagged two forms for completion under the new approach: the DB020 digital form to be used with Medicare bulk bill webclaims; and the DB4E digital form for electronically transmitted claims through HPOS bulk bill webclaim.
For most scenarios, newsGP understands the DB4E form is the appropriate form to use.
While the DoH has assured the RACGP that no retrospective compliance will be carried out, there is no clear indication of the approach in the future.
‘You should keep a copy of all correspondence, claims and forms for at least two years,’ the Services Australia website advises.
‘This is for auditing purposes if you are subject to a compliance review.’
Dr Djakic in the meantime believes many GPs are going to be frustrated by the increase in bureaucracy.
‘When there’s too many steps in a billing process, it reaches the point where you just say, “too hard”,’ he said.
‘Unless it gets somehow embedded in clinical software programs, but I don’t think the software providers are all that interested.’
RACGP President Dr Nicole Higgins also said she was ‘surprised and dismayed’ to discover the change.
‘As a practice owner this meant scrambling to change procedures to be compliant and caused significant disruption,’ she wrote in last week’s Friday Fax update to RACGP members.
‘I will be raising this with the department and the [Federal Health and Aged Care] Minister on your behalf.’
The changes to the assigned benefit rules come into effect a short time ahead of the tripling of the bulk bulling incentive, a flagship measure announced for the May Federal Budget which is due to be introduced on 1 November.
More information on assignment of benefit and signature requirements can be found on the RACGP website.
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