Mind the gap, Medical Billing, The Private Practice magazine


It’s a fact that some doctors misunderstand the constraints of bulk billing. To set the record straight, Margaret Faux explains the Medicare rules, using out-of-hospital services as an example.

When it comes to billing outpatients, with the exception of worker’s compensation, third party and Veterans claims, there are only two options: bulk billing or patient claims.

According to the law, if you are bulk billing, the patient assigns their right to 85% of the scheduled fee to the doctor, and the doctor agrees that they will not charge any more than this amount for that service. Case closed.

However, some doctors have been unwittingly charging a further amount direct to the patient to cover the shortfall between the Medicare payment and their usual fees. In these incidents the doctors bulk bill the service then present their patient with a separate invoice, sometimes labelled ‘non-claimable item’ or ‘balance’, for the supposed remaining cost on that service.

As most doctors know, if you bulk bill there is no balance owing. By offering bulk billing to your patient, you have waived the right to any further payment for the service other than that provided by Medicare.

Losing Patience

Doctors who choose to bulk bill will do so for a range of reasons, including:

  • A consideration for the financial circumstances of their patients;
  • The administrative ease of streamlining their accounts (with the resulting savings to the practice);
  • The quick payment of funds;

These benefits are compensation for the reduced income that results from bulk billing.

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