‘Like a script from Utopia’: Bulk billing change raises GP ire

Jolyon Attwooll

2/10/2023 3:23:57 PM

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.

Stressed GP by computer
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.
Log in below to join the conversation.

billing billing' 'bulk bureaucracy incentive'

newsGP weekly poll Should after-hours Medicare rebates extend to all-day Saturday?


Login to comment

Dr Bram Singh   3/10/2023 7:23:19 AM

No more bulk billing teleconference for me. Period.

Dr Sonali Sooveere   3/10/2023 7:34:03 AM

Does the form need to be signed for each consult? Or when a patient signs one when they register with my Medicare- would that be sufficient?

Dr Aletia Vivienne Johnson   3/10/2023 9:15:48 AM

Add to this to the other genius decision somebody made - if you bill a mental health item and a consultation item, you must now state the time that the mental health portion of the consultation began - and I am THIS close to retiring… and I’m only 44!

Dr James Edward McLeod   3/10/2023 9:34:28 AM

I don't see the problem really.... My 90 year old half blind patients love me emailing them consent forms, privacy forms, a schedule of fees and a practice telehealth policy and they eagerly print the forms, sign them, scan them and return them to me via email before we start the telehealth consult. The hold up is great, I get to have a coffee in the 45 minutes it takes them to read the paperwork, and then I often leave to get a massage or haircut in the time taken for them to warm up their hand rheumatism and work out how to use their scanner and email. The best part is at the end when they only needed a script and so I put through a 91890 and get rewarded with $18.85.

Dr WC   3/10/2023 10:44:33 AM

If Medicare is concerned about bulk billing incentives being misused in telehealth contexts (as the timing seems to suggest) could they not make a policy where bulk billing incentives are unavailable in telehealth consults? That'd still be preferable than this current signed form.

As it is the policy is systematically disadvantageous to the most needy - e.g. elderly, culturally diverse, First Nations people...

Dr Philip David Joseph Soffer   3/10/2023 1:51:21 PM

In theory, bulk-billed telehealth consults will now only be available to patients who have a scanner and a printer (and ink and paper). Most practices will need a new admin employee whose sole function would be to send and receive completed DB4E or DB020 forms and to adjust the appointment book if and when there is no reply and the appointment timeslot has been wasted. I wonder how often all this paper-work will be audited. Has anyone had their clinical notes (containing the patient's verbal medicare benefit assignation audited ?

Dr Daniel Bergman   3/10/2023 1:51:50 PM

I think I will give the relevant person in the health department all the phone numbers of my borderline psychotic patients who need to be followed up be me because psychiatrists won’t take them, hospitals won’t take them.
The patients don’t want to be followed up. I well no longer call them and talk for 30 minutes to assess if they are a danger to themselves or others (they are being bulk billed-no increase in bulk billing incentives planned for future anyway).
Now they are going to have agree to formally that I bulk bill them for a condition they feel they don’t have. (Where the rebate is so low anyway).
I know “everyone “ is under funded (they make less profit than before or able to keep going until patients accept they need to pay).
But if a large portion of a go’s work is managing mental health, at present they/I make a decent loss from this part on the work.
I might as well donate money I don’t have, to the health department for every mental health patient I see.

Dr Elaine April Joy Owen   3/10/2023 4:27:19 PM

When will or has this come into effect?

Dr Frank William Trewartha   3/10/2023 5:08:04 PM

More bureaucratic red tape
Retirement looking attractive

Dr Gary Ronald Franks   3/10/2023 8:03:40 PM

It is hard to believe that these changes were not intentionally introduced just prior to the introduction of the 'carrot stick 'of the triple 10990 from 1st Nov. Its getting all too hard . I was helping patients by BB most Telehealth .This is about to change and so patients suffer again due to Government intervention .

Dr Sally Elizabeth McDonald   4/10/2023 8:37:52 AM

We have decided to privately bill , for most patients it will be rebate only, we have always privately billed more complex Telehealth.
Only had a problem with one patient being unable to do it yesterday, she’s terminally ill with brain Mets and I chose not to bill( swings and roundabouts) and I can cope with that.
No blowback at all from other patients

Dr Susan Mary Schlicht   4/10/2023 9:13:46 AM

Well, now apart from all the above, we have actually downloaded these forms - which look like the old Medicare vouchers patients used to sign. You can type in the patient details OK but once you close the form - you need a password to reopen it! I don't know if this is just a problem on our computer system or what - but at this stage the forms are unusable. I suppose we could print them out before closing them and scan back in and email to patient that way. This is just farcical.

Dr Maureen Anne Fitzsimon   4/10/2023 9:45:00 AM

As I now work part time, I often follow up results via telehealth on my days off. Can we have the patient sign a consent for Telehealth in anticipation of the Telehealth consult a few days later? How soon after the Telehealth consult does the form need to be signed? There are so many questions!! The RACGP needs to take this to the media. “Government makes it impossible for the frail, very sick, and elderley to access Telehealth”.

Dr Javier Armando Campuzano Ortiz   4/10/2023 1:26:14 PM

effective from yesterday myself and my practice have stopped bulk billing telehealth, I encourage all of you to do the same and explain to patients why so they can complain to the DoH

Dr Geoffrey James Bovell   5/10/2023 12:39:07 AM

Why? Needs to be explained .Telehealth has been very beneficial for everyone. Hopefully organizations that represent GPs can advise and achieve a better option soon.

Dr Martin Alistair Monroe   6/10/2023 8:44:12 AM

Much will be made in coming weeks of the Federal Government “saving bulk-billing” by increasing (some) incentives from 1st November. Then there’s this. GPs prevented from offering a popular, convenient service to patients by Services Australia under threat of criminal sanction. My practice stopped bulk billing telehealth yesterday. Unhappy patients will be directed to their MP. The RACGP need to be all over this in the media, being clear the blame lies with the Government and not, as it will inevitably be spun, “greedy GPs”.

Dr Ali Tanko Kidmas   7/10/2023 8:02:56 AM

Low lying fruit? Another reason younger doctors are least likely to consider becoming General Practitioners. It’s true that fraud is of concern. But government policies that waters down general practice creates room for fraud. Rather than increasing the overhead costs and administrative workload of a General Practice, how about banning those who advertise their Telehealth services with stickers on the floors of supermarkets or chemists or social media to provide “quick bulk billed services” to people / patients they don’t have any long-term ongoing relationships with? Time to consider learning a new trade for those younger? Or early retirement for some of us? 🥱

Dr Wee Kiat Soh   12/10/2023 11:50:23 AM

More Forms...More time we do not have!!
Elderley patients ( which we have a lot of ) don't have emails, scanners and fax machines, but I have an Idea....Carrier pigeons might work!!