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How Medicare and billing works for GPs in Australia

If you’re a doctor planning to work in Australia, you’ll need to know about Medicare.

Established in 1984, Medicare is Australia’s national healthcare system.

Medicare covers the following:

  • free and subsidised treatment by doctors and other healthcare professionals
  • free treatment in a public hospital as a public patient
  • some subsidised services as a private patient in either a public or private hospital

Medicare is available to all Australian and New Zealand citizens, anyone issued with a permanent visa and in some circumstances, people who have applied for a permanent visa.

Australia also has a reciprocal health agreement with 11 countries (including the UK and NZ but not the US).

This covers the cost of medically necessary healthcare when Australians visit these countries as well as when visitors from these countries are in Australia.

GPs in Australia bill patients using the Medicare system in one of three ways – bulk billing, mixed billing or private billing.

But to tap into the Medicare system, foreign doctors must first be registered.

Medicare Provider and PBS Prescriber Numbers

Once registered by AHPRA, you’ll need to apply for a Medicare provider number and a Pharmaceutical Benefits Scheme (PBS) prescriber number.

Medicare provider number – This unique number allows you to use Medicare to claim, bill, refer or request their services.

You cannot use Medicare without this number and you cannot use the number of another healthcare professional.

Anyone registered in more than one profession or location will need to apply for multiple Medicare provider numbers.

Don’t delay in applying for a number because Services Australia advises the process may take up to 37 calendar days from application.

PBS prescriber number – this number allows you to prescribe medication under the PBS. 

It is not location specific but you will need multiple numbers if you provide health services across multiple professions.

The PBS ensures all Australian have access to necessary medication at affordable prices.

Pensioners and some healthcare card holders receive free PBS-listed medication.

Billing schedules

Once you have a Medicare Provider Number, you can begin billing through your medical practice.

Typically practices will ‘bulk bill’, ‘mixed bill’ or ‘private bill’.

Bulk billing – this means a GP accepts the scheduled Medicare fee and bills Medicare directly for the service. It leaves no out-of-pocket payment required from the patient.

Some GPs bulk bill all their patients, some choose to bulk bill only a certain group such as pensioners or healthcare card holders while others do not bulk bill at all.

Mixed billing – this means when a GP chooses not to bulk bill and instead charges the patient a fee directly. 

This fee requires a payment over and above what the scheduled Medicare fee is for that service.

It is payable immediately after the consultation, leaving the patient to claim the Medicare rebate back as the subsidised portion of the service.

Doctors are free to charge whatever rate above the scheduled Medicare Benefits Schedule (MBS) that they choose.

Private billing – this is when no Medicare rebate is available and the patient pays for the consult in full.

This may be because the patient does not have a Medicare card or for appointments such as pre-employment medicals, aviation medicals and heavy goods licences.

Medicare Benefits Schedule (MBS)this schedule outlines the Australian government fees payable for a wide range of medical services, consultations, procedures and diagnostic services.

It is regularly reviewed and updated.

GPs can use the schedule as a guide when determining the fees they intend to charge.

Latest trends

The Australian government is actively incentivising doctors to continue bulk billing, tripling the incentive for healthcare card holders and children under 16 from 1 November 2023.

It comes off the back of recent data that indicates the practice fell from 88% to 78.1% of all GP non-referred attendances in 12 months to early 2023.

In addition, just 35% of adult consultations were bulk billed.

A deeper dive into Australian bulk billing trends for the 2022-23 financial year can be found here.

How Medicare is funded

Most Australians pay for Medicare by contributing a minimum 2% share of their taxable income.

In addition, anyone not paying for private health insurance may be charged a Medicare Levy Surcharge.

This surcharge is applied to any singles earning more than $93,000 or families earning more than $186,000.

The surcharge level begins at 1%, rising to 1.5% for the highest income bracket.

Contact Health Recruitment Australia today

There’s a lot to consider when you are planning to live and work overseas.

It’s not easy to fully comprehend the mechanics of a new country’s health system.

But Health Recruitment Australia can help make your transition so much easier.

HRA is a recruitment agency set up specifically to match overseas doctors of all ages with the right clinics in Australia.

We’ll set you up in a practice that is the perfect fit for you, in a city or region you’ll just love.

And that’s just the start of it.

We’ll answer all of your queries and questions and even fill out all that annoying paperwork for you as well.

There’s a significant GP shortage in Australia right now, opening up multiple opportunities for doctors just like you so take some positive action today!

Why not start with an informal, no-obligation discussion with the experienced team at Health Recruitment Australia? Contact us.

Enquire now, and we’ll be
in touch shortly!

 

Enquire now, and we’ll be
in touch shortly!