Update re: New Medicare Rules

Dear Alevia members,

There have been some new Medicare rules introduced which may affect some of our Alevia patients. We have provided a summary of changes here to assist you.

Medicare bulk billing assignment

In the past when you visited a doctor and you were bulk billed, you would either sign a piece of paper or press a button on a terminal to consent to be bulk billed. There has been a period of time during COVID when verbal consent was sufficient (as telehealth did not permit signing of forms) and now there is a return to the requirement for patient consent to be recorded in your record, whether you are having a face to face or telehealth consult.

Given that we are a private billing clinic this will not affect the majority of patients unless there is a consult that the Doctor has agreed to bulk bill.

What does it mean for you?

Patient journey

If your consult is bulk billed, you will receive a secure SMS from Alevia Medical Weight Loss’s mobile number, to seek your consent. Please note, if you do not consent to be bulk billed, then you will be privately billed instead, and attract and out of pocket fee.

You will need to enter your Date-Of-Birth as recorded with Alevia to access the information relating to your bulk-billed consult. The format required is displayed within the message i.e. ddmmyyyy

Once your DOB has been verified, a digital version of the consent to bulk bill form (DB04(e)) is displayed with an instruction to review the data.

You will be provided with the option to either Accept or Decline the Benefit Assignment.

If Accepted, you will get the option to download a .pdf copy of the document for your records.

If Declined, you will be presented with additional information on how to discuss or handle the dispute with Alevia and you will be privately billed instead.

You can also download a .pdf copy of the document following a Decline.

The .pdf document is password protected with the your Date-Of-Birth as an additional security measure.

Frequently asked questions

What is Bulk Billing?

Bulk billing (or direct billing) is where a medical practitioner, with the patient’s agreement, accepts the patient’s Medicare benefit as full payment for a service. When a practitioner bulk bills a patient, the practitioner can receive the Medicare benefit for the service directly from Services Australia, using the online claiming facility.

For bulk billing to occur there must be an agreement under which the patient assigns their right to a Medicare benefit to the practitioner who must accept it as ‘full payment of the medical expenses incurred in respect of the professional service’ provided.

A patient is required to sign a Medicare assignment of benefit form for a bulkbilled professional service, unless using an online system such as Medicare Easyclaim or any other system that allows the patient to digitally sign an electronic assignment. The patient must be offered a digital or paper copy of the assignment of benefit form to retain.

The assignment of Medicare Benefits is NOT a new process. It has been mandated from the inception of Medicare, many years ago.

The Department has allowed clinics to obtain verbal agreement for the assignment of their Medicare Benefit for Telehealth as an interim measure during COVID. However, this period is now complete.

The assignment of Medicare Benefits applies to ALL Bulk Billed consults, both in-clinic and Telehealth. The assignment of Medicare Benefits does NOT apply to private billing.

Is consent required for each individual consult? i.e. If I have a TeleHealth Phone / Video call today and again next week, do I need to sign consent each time.

Yes. A patient’s consent to assignment of their Medicare benefit as payment for bulk billed services must be obtained after each occasion of service.

Must the consent form include the actual MBS items linked to that consult and description of what is being consented for?

Yes. For an assignment of benefit in accordance with section 20A of the Health Insurance Act 1973, there must be an agreement under which the patient (or person responsible for the medical expenses such as a parent of a patient) assigns his or her right to payment to the practitioner who must accept it as full payment for the professional service provided. The agreement must be in accordance with the approved (DB4) form. A patient is required to sign a Medicare assignment of benefit form for a bulk-billed service unless using an online system such as Medicare Easyclaim or some other system that allows the patient to digitally sign an electronic assignment. This applies to services rendered in the practice and in residential aged care facilities. If a practice uses an online system, a patient can assign their right to a Medicare benefit to the provider by pressing the OK or YES button and the patient must be provided with a digital or paper copy of the assignment of benefit to retain. For telehealth services, providers should make efforts to obtain a patient’s signature in whichever way is appropriate to their needs. Options include the provider posting the completed assignment of benefit form to the patient for them to sign and return, or obtaining the patient’s agreement by email. With regard to obtaining consent via SMS, any form used would have to include the same information required by form DB4. You should contact Services Australia to seek their approval of any proposed form and associated consent procedures.

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