What Is Bulk Billing?
Bulk billing is a billing arrangement under Medicare where a healthcare provider agrees to accept the Medicare benefit as full payment for a service. The patient pays nothing out of pocket, and the provider claims directly from Medicare. This arrangement makes healthcare more accessible, particularly for patients with limited financial means.
Bulk billing is entirely voluntary — providers choose whether to bulk bill on a case-by-case basis or as a blanket policy for all or some patients.
How Bulk Billing Works
- The patient presents their Medicare card at the time of service
- The provider assigns the Medicare benefit to themselves by having the patient (or guardian) sign a bulk billing assignment form
- The provider submits the claim electronically through their practice management software or the HPOS (Health Professional Online Services) system
- Medicare pays the scheduled benefit directly to the provider — typically within 1–2 business days
The provider receives the MBS (Medicare Benefits Schedule) fee for the relevant item number, which may be less than the standard fee they would otherwise charge a private-paying patient.
Bulk Billing Incentives
The Australian Government provides bulk billing incentive payments to encourage providers to bulk bill vulnerable patient groups. These incentives are paid in addition to the standard MBS fee and apply when bulk billing:
- Children under 16 years of age
- Commonwealth concession card holders (including Pensioner Concession Card and Health Care Card holders)
- Patients in specific geographical areas (e.g., Modified Monash Model categories 3–7, covering regional, rural, and remote areas)
Incentive amounts vary by service type and location — providers should check the current MBS for applicable item numbers and incentive amounts.
Registering to Use Medicare as a Provider
To submit Medicare claims, healthcare providers must be registered with Services Australia. This involves:
- Applying for a Medicare provider number for each location where you practice
- Meeting the eligibility requirements for your profession (e.g., being registered with AHPRA for medical practitioners)
- Setting up access to HPOS (Health Professional Online Services) for electronic claiming
- Ensuring your practice uses an approved practice management system for online claiming
Allied health professionals, including physiotherapists, psychologists, and dietitians, must also meet specific requirements to provide Medicare-claimable services (e.g., receiving referrals under Chronic Disease Management or Mental Health Treatment Plans).
Compliance and Obligations
Healthcare providers participating in Medicare have a number of compliance obligations:
- Accurate item number selection: Claiming the correct MBS item number for each service rendered
- Maintaining clinical records: Keeping adequate records that support each Medicare claim
- Audit readiness: Services Australia conducts compliance reviews and audits — providers should be prepared to substantiate claims
- Reporting changes: Notifying Services Australia of changes to your practice location, hours, or employment status
Fraudulent or incorrect claiming can result in repayment demands, civil penalties, or referral to the Professional Services Review (PSR) scheme.
Telehealth and Medicare
Medicare-subsidised telehealth services (video and phone consultations) are now a permanent feature of the MBS following their expanded rollout. Providers offering telehealth services must meet specific requirements, including ensuring the patient has a pre-existing relationship with the practice in most cases. Bulk billing telehealth attracts the same incentives as in-person bulk billing for eligible patient groups.
Key Resources for Providers
- Medicare Benefits Schedule (MBS) Online — mbsonline.gov.au
- Health Professional Online Services (HPOS) — for electronic claiming and provider number management
- Services Australia Provider line — 132 150
- Professional Services Review (PSR) — for guidance on compliance