How general practices bill for services
In general practice, there are three principal ways to bill patients for services:
- bulk billing – the medical professional accepts the Medicare benefit as full payment for the consultation and there are no out-of-pocket expenses for the patient. The patient agrees for Medicare to directly pay the rebate to the doctor for the service provided
- private billing – the patient is billed an out-of-pocket fee determined by the practice. If the patient is a Medicare card holder, they may be eligible to claim a rebate from Medicare. For those not eligible for Medicare may be billed privately.
- mixed billing – both bulk billing and private billing is used in the practice.
Many practices have formal policies about which patients should be bulk billed, such as concession card holders and young people.
Many general practitioners also selectively bulk bill some patients, such as people who may not be able to pay a fee.
You should consider these variations in billing policies, and models should be flexible enough to allow for variations.
Medicare item numbers
Most funding for general practice services comes through private patient fees and the billing of Medicare item numbers.
Billing occurs after each service is provided to a patient.
Most general practices are private businesses that rely on billing Medicare item numbers to be viable.
When co-designing service models, you must consider which Medicare items can be billed through the model.
Other Commonwealth funding
General practice can access additional funding through the Commonwealth that may be applicable to service models, including:
These incentive payments presently generate only around five per cent of revenue.
Reviewed 01 December 2021