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Significant assignment of benefit reform on the way
The RACGP has welcomed legislation to overhaul and streamline the process for bulk billed Medicare services, which is currently ‘stuck in the 1970s’.
The plan comes after the Australian National Audit Office identified governance, compliance, and integrity risks within the expansion of telehealth.
A new-look, contemporary, and better-integrated process for the assignment of benefit for bulk-billed Medicare services is on the way, with draft laws to be debated in Federal Parliament.
The legislation, which was tabled this week, comes after a sustained advocacy effort from GPs to overhaul the outdated process, which the RACGP described as onerous and ‘fundamentally flawed’.
Under the existing laws, the process is largely paper based, and includes requirements such as a patient needing to physically sign to consent for bulk-billing benefits to be paid directly to the health provider.
‘The patients want changes because they don’t want to be carrying around useless pieces of trash, whether it be digital or paper,’ RACGP Expert Committee – Funding and Health System Reform member Dr Emil Djakic told newsGP.
‘Providers want this because they don’t want to be storing reams of paper in their offices demonstrating that this arrangement was in place.
‘And the payer, being the insurer, want this as well because they want nice, easy systems that allow them to move money appropriately but with the right amount of certainty that the action was valid.’
In response to these concerns, the proposed new laws would allow for:
- enabling pre- or post-assignment of benefit, rather than it needing to occur during the attendance
- allowing enduring pre-assignment agreement in some cases, so the patient does not need to assign their benefit at every bulk-billed consultation
- removing the current approved assignment of benefit forms
- removing the requirement for providers to co-sign the assignment of benefit agreement
- removing the need to give patients a copy of the signed agreement if they do not request it
- introducing a notification requirement so patients are alerted when a claim is submitted on their behalf
- requiring providers to retain relevant documentation for two years, with records allowed to be electronic.
Dr Djakic welcomed the plan, saying the current systems are ‘stuck in the 1970s and this change is actually playing catch up’.
‘What happened, because of legislation which is dated to the 1970s where paper was the thing and paper records, there was a lot of legacy language built into the legislation,’ he said.
‘What we’re doing here is changing the law and updating it to become more contemporary with electronic transactions.
‘It’s all designed to make sure that Medicare works more easily in this current digital world with the right levels of accountability.’
The reforms come after the
Australian National Audit Office identified governance, compliance, and integrity risks within the expansion of Medicare telehealth services last year.
In response, the Commonwealth called for the process to be modernised, with the proposed amendments addressing these identified risks by using technology to ‘reduce administrative burden, better engage patients, and improve payment integrity’.
Federal Assistant Health and Aged Care Minister Ged Kearney said the changes will make ‘critically needed improvements’ designed to make it easier for GPs and health professionals to bulk bill patients.
‘This will modernise the assignment of benefits process, bring it into the 21st century and help to further safeguard Medicare from fraud,’
she told Federal Parliament.
‘GPs have long complained of an overly complex and onerous paperwork process that is inefficient and holds back productivity.
‘This upgrade has been sorely needed for many years now.’
The RACGP has especially welcomed the proposal’s emphasis on workflow and system integration, as well as the shift to an automated process where possible.
However, the college has also stressed the importance of educating providers and patients when the new process is introduced to address current literacy gaps.
And while Dr Djakic said the ‘devil is in the detail’, the legislation represents an opportunity to see reform happen appropriately.
‘There was a huge amount of work that happened on behalf of members because the members howled about this – this was probably the loudest howl members had for anything in the last five years,’ he said.
‘It was really something they said, “college, please take action”, and they were very upfront.’
The amendments are set to be debated later this year and will take effect 18 months after they are approved, allowing time for consultation on the changes and updates to practice IT systems.
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