The Australian healthcare landscape is constantly evolving, and recent changes to the Medicare Benefits Schedule (MBS) concerning bulk billing incentives are significant for General Practitioners. As of November 1st, 2023, we've seen an exciting development: increased Medicare bulk billing incentive payments, often referred to as "triple incentives," for specific patient groups and consultation types.
This article aims to demystify these changes and provide a clear, practical guide for GPs and GP trainees to understand and utilise these incentives effectively, ultimately enhancing patient access to care.
Let's revisit some fundamental concepts:
What is a Medicare Rebate?
The Medicare rebate is the amount the Australian government contributes towards the cost of eligible medical services. When a patient sees a doctor, Medicare typically covers a portion of the scheduled fee for that service. The patient is then responsible for the gap, if any, between the scheduled fee and the rebate.Bulk Billing vs. Private Billing: What's the Difference?
- Private Billing: In private billing, the GP sets their own fee for a consultation, which may be higher than the Medicare scheduled fee. The patient pays the GP's fee upfront and then claims the Medicare rebate back from Medicare. They are responsible for the "gap" – the difference between the GP's fee and the Medicare rebate.
- Bulk Billing: In bulk billing, the GP bills Medicare directly for the consultation and accepts the Medicare rebate as full payment for the service. The patient assigns their right to the Medicare benefit to the GP, meaning Medicare pays the benefit directly to the GP. Crucially, for the patient, there is no out-of-pocket cost.
What is a Bulk Billing Incentive?
The bulk billing incentive is an additional payment from Medicare to GPs on top of the standard patient rebate, specifically for bulk billing certain vulnerable patient groups. It's designed to encourage GPs to bulk bill these patients, ensuring they have access to affordable healthcare. It is not a rebate paid to the patient; it is an extra payment for the GP.Who is Eligible for the Standard Bulk Billing Incentive?
The standard bulk billing incentive applies when you bulk bill:- Children under 16 years of age.
- Patients with a Commonwealth Concession Card. This includes:
- Pensioner Concession Card
- Health Care Card
- Commonwealth Seniors Health Card
And Now, the Exciting News: "Triple Bulk Billing Incentives"
From November 1st, 2023, Medicare introduced significantly increased bulk billing incentive payments – "triple incentives" – for specific consultations bulk billed to the same eligible patient groups (children under 16 and Commonwealth concession card holders).Who is Eligible for the Triple Bulk Billing Incentive?
The triple incentive applies to specific types of consultations when bulk billed to eligible patients:- Face-to-face General Attendance Consultations:
- Longer than 6 minutes (Levels B, C, D, and E). This includes most standard consultations.
- In any location: Within consulting rooms, residential aged care facilities, and even out-of-rooms consultations.
- At any time: During business hours and after-hours consultations.
- Telehealth General Attendance Consultations (Video and Telephone):
- MBS Level B video and telephone consultations.
- Video and telephone consultations longer than 20 minutes (Levels C, D, and E video only) AND the patient is registered with the practice through MyMedicare.
Important Notes on Triple Incentives:
- Triple the Standard Incentive: These new payments are triple the amount of the existing standard bulk billing incentive payments.
- Focus on Longer Consultations: The increased incentive targets longer consultations (over 6 minutes face-to-face, over 20 minutes telehealth for higher levels) recognising the value of comprehensive care.
- MyMedicare and Telehealth: For longer telehealth consultations (Levels C-E), MyMedicare registration is a key requirement to access the triple incentive. This encourages patient enrolment in MyMedicare, aiming for stronger patient-practice relationships.
What about Standard Bulk Billing Incentives? They Still Exist!
It's crucial to understand that the standard bulk billing incentive payments continue to be available for doctors to co-claim when bulk billing eligible patients for:- MBS Level A (and equivalent) general attendance consultations.
- Level C, D, and E video and telephone general attendance consultations where the patient is not enrolled in MyMedicare.
- All other relevant MBS unreferred services, such as:
- Chronic disease management items
- Better Access mental health items
- Eating disorder items
- Health assessments
- Minor procedures
The Modified Monash Model (MMM) and Incentive Scaling
The value of both standard and triple bulk billing incentives is scaled based on the Modified Monash Model (MMM) location classification of your practice. This model categorises locations based on their remoteness, from Metropolitan (MMM1) to Very Remote (MMM7).- Higher MMM = Higher Incentive: Practices in more regional, rural, and remote communities receive a higher bulk billing incentive to reflect the increased costs and challenges of providing healthcare in these areas.
Here's a simplified illustration of how the incentive scales (approximate values based on MMM):
- MMM 1 (Metropolitan) - 100% (Base Value)
- MMM 2 (Regional Centre) - 150%
- MMM 3-4 (Large-Medium Rural Town) - 160%
- MMM 5 (Small Rural Town) - 170%
- MMM 6 (Remote Community) - 180%
- MMM 7 (Very Remote Community) - 190%
Example Scenario:
Let's consider a Level B (item 23) face-to-face consultation longer than 6 minutes, within usual hours, bulk billed to a child under 16 or a concession card holder:
- MMM 1 (Metro): Base incentive amount (item 75870 - $21.35 - Note: Actual amounts are subject to MBS updates and should be checked on MBS Online)
- MMM 2 (Regional Centre): 150% of Metro incentive (item 75871 - $32.50)
- MMM 5 (Small Rural Town): 170% of Metro incentive (item 75874 - $36.65)
- MMM 7 (Very Remote): 190% of Metro incentive (item 75876 - $41.10)
Remember these are examples; refer to the MBS Online for precise and up-to-date incentive amounts for each item and MMM location.
Why are these Increased Incentives Important?
The Australian government introduced these triple incentives to:- Support Vulnerable Australians: Help doctors continue to bulk bill Australians who are most affected by cost-of-living pressures.
- Improve Access for Younger and Concessional Patients: Ensure that children, pensioners, and other concession card holders have better access to affordable general practice services.
- Target Investment in Primary Care: Strengthen primary care by directing increased funding to practices that bulk bill vulnerable populations.
- Reduce Healthcare Disparities: Address healthcare access inequities, particularly in rural and remote areas, and for those with socioeconomic disadvantages.
Practical Implications:
- Enhanced Practice Viability: The triple incentives can significantly improve the financial viability of bulk billing practices, particularly those serving vulnerable populations and located in regional and remote areas.
- Improved Patient Access: By making bulk billing more sustainable, these incentives encourage GPs to offer bulk billing options to eligible patients, reducing financial barriers to care.
- Understanding the Nuances: It's crucial to understand the specific consultation types and patient criteria that qualify for the triple incentive to ensure accurate claiming.
- Utilising MBS Online: MBS Online is your essential resource! Familiarise yourself with the bulk billing incentive items, their associated MBS consultation items, and the specific amounts payable based on MMM location.
- MyMedicare Promotion: For practices utilising telehealth, actively promoting MyMedicare registration to eligible patients becomes even more important to maximise access to the highest incentives.
- Balancing Bulk Billing and Practice Sustainability: While incentives are helpful, it's also important to consider the overall costs of providing high-quality care and find a sustainable balance between bulk billing and practice viability. The "doctor's loss" graphs highlight that even with incentives, bulk billing might not fully cover the true cost of healthcare.
Key Takeaways for GPs:
- Triple bulk billing incentives are now in effect (since November 1st, 2023).
- They significantly increase payments for specific consultations bulk billed to children under 16 and concession card holders.
- Face-to-face consultations longer than 6 minutes (Levels B-E) are included.
- Telehealth incentives are enhanced, especially for MyMedicare registered patients.
- Standard bulk billing incentives continue for other consultation types.
- MMM location significantly impacts the incentive amount.
- MBS Online is your primary resource for detailed information and claiming rules.
Resources for Further Information:
- MBS Online: www.mbsonline.gov.au - The official source for MBS items, rules, and incentive details.
- Department of Health and Aged Care Website: www.health.gov.au - Search for "bulk billing incentive" for policy documents and fact sheets.
- Services Australia Website: www.servicesaustralia.gov.au - For information on Commonwealth concession cards and patient eligibility.
- Health Workforce Locator: www.health.gov.au/resources/apps-and-tools/health-workforce-locator/app - To determine your practice's MMM classification.
- Doctor's Loss Graphs: https://www.ama.com.au/tas/bulk-billing-incentive-facts
GPs play a vital role in ensuring that vulnerable Australians receive the healthcare they need, while also supporting the sustainability of their practices. Stay informed, utilise the available resources, and continue providing excellent care to your communities.