Bills Digest no. 91 2007–08
Health Insurance Amendment (90 Day Pay Doctor Cheque Scheme)
Bill 2008
This Digest replaces an earlier version dated 8 April 2008, including
some additional contextual material on the position of significant interest
groups.
WARNING:
This Digest was prepared for debate. It reflects the legislation as introduced
and does not canvass subsequent amendments. This Digest does not have
any official legal status. Other sources should be consulted to determine
the subsequent official status of the Bill.
CONTENTS
Passage history
Purpose
Background
Financial implications
Main provisions
Concluding comments
Contact officer & copyright details
Passage history
Health Insurance
Amendment (90 Day Pay Doctor Cheque Scheme) Bill 2008
Date introduced: 19
March 2008
House: House
of Representatives
Portfolio: Health
and Ageing
Commencement: Sections
1 to 3 on Royal Assent. Schedule 1 to commence on Proclamation, or 12
months after Royal Assent, whichever is the sooner. The Explanatory Memorandum
states that delayed commencement is to allow Medicare Australia time
to implement new internal administrative arrangements.
Links: The relevant
links to the Bill,
Explanatory
Memorandum and second
reading speech can be accessed via BillsNet, which is at http://www.aph.gov.au/bills/.
When Bills have been passed they can be found at ComLaw, which is at http://www.comlaw.gov.au/.
The purpose of the Health Insurance Amendment (90 Day
Pay Doctor Cheque Scheme) Bill 2008 is to amend the Health Insurance
Act 1973 (HIA) to allow medical specialists and consultants physicians
access to the 90 Day Pay Doctor Cheque Scheme, where the original Medicare
claim is submitted to Medicare Australia electronically.[1] The Bill does not propose any amendments to the
existing scheme for general practitioners.
The 90 Day Pay Doctor Cheque Scheme was introduced in 2001 to guarantee
general practitioners (GPs) payment of the Medicare schedule fee even
when accounts are not paid. If a doctor does not bulk bill (that is, does
not accept the Medicare schedule fee or ‘benefit’ as full payment for
the service) there are other methods by which Medicare benefits are paid
to the doctor. Patients can pay the doctor’s account then claim the benefit
back from Medicare Australia and be reimbursed either in cash, cheque
or electronic funds transfer to their bank account. Around 43 million
Medicare claims (or 17 per cent of all claims) are paid by one of these
methods.[2]
Alternatively, when an account is not paid the patient may be issued
with a doctor’s account and can request from Medicare Australia a ‘pay
doctor via claimant cheque’ for the benefit to be made out to the practitioner
(GP or specialist or other medical practitioner) who rendered the service.
This cheque is then sent to the patient who then forwards it to the medical
practitioner along with any outstanding balance owed.[3] Around 13 million claims (or 5 percent of Medicare
services) are paid in this manner.[4]
In rare cases where the patient fails to forward the cheque within 90
days (or the cheque is not banked or goes missing[5]), the cheque is cancelled and Medicare Australia pays the GP
direct (via cheque or electronic funds transfer) under the 90 Day Pay
Doctor Cheque Scheme, thus guaranteeing the doctor receives the schedule
fee for the service. Currently the 90 Day Pay Doctor Cheque Scheme is
only available to GPs.
At the time this Scheme was first proposed in 2001 it was observed that
the problem of non-payment of patient accounts (which can be costly for
medical practices to chase up) is not limited to GPs. It was noted that
other medical practitioners (such as dentists, optometrists or pathologists)
also face this problem, so it was argued that making the scheme available
more generally would be more beneficial.[6]
At the time however, this proposal was not taken up.
However, the current Bill now proposes to make the Scheme available to
a wider range of medical practitioners, specifically specialists and consultant
physicians (including pathologists), but only where the original Medicare
claim is submitted electronically to Medicare Australia. Other health
practitioners, such as allied health providers and dentists, will continue
to be excluded from the Scheme. Current arrangements for GPs which allow
GPs to access the 90 Day Pay Doctor Cheque Scheme where their original
Medicare claim was lodged electronically or by mail will remain unaffected.
The Minister for Health and Ageing, the Hon. Nicola Roxon, MP, has stated
that giving specialists and consultant physicians access to the 90 Day
Pay Doctor Cheque Scheme will provide an incentive for these practitioners
to use electronic claiming of Medicare benefits.[7] This is because the amendments propose that access
to the Scheme will be dependent on the original claim being submitted
electronically. Electronic claiming over the internet has been available
since 2002 when HIC Online (now known as Medicare Online) was introduced.
However, take-up of Medicare Online for patient accounts has been slow,
with 7455 medical practices registered to use online claiming in 2006–07,
and just 6632 actually transmitting claims (the bulk of which are bulk
billing claims).[8] Medicare
Australia has recently introduced Medicare Easyclaim, an EFTPOS-based
system that will allow patients and practices to lodge claims electronically
and receive payments via electronic funds transfer direct from Medicare
Australia. The benefit of online claiming is that patients can lodge their
claims immediately after the consultation, removing the need to attend
a Medicare office or submit a claim via mail. In order to encourage medical
practitioners to migrate to the new system (which requires additional
software, an EFTPOS machine, and the incurring of some EFTPOS charges)
support packages are being offered to GPs, medical specialists, consultant
physicians, pathologists, radiologists and software vendors.[9]
The support package being offered by Medicare Australia to encourage
these medical practitioners to move to Medicare Easyclaim includes providing
specialists and consultant physicians access to the 90 Day Pay Doctor
Cheque Scheme, currently only available to GPs.[10]
However, as noted previously, other medical professionals, such as allied
health providers and dentists, may experience similar problems with unpaid
accounts. It is not clear why in extending the Scheme to medical specialists
and consultant physicians these other groups, who would clearly benefit,
are not included.
The peak medical organisation the Australian Medical Association (AMA)
originally expressed support for the introduction of the new Medicare
Easyclaim system.[11]
This followed the successful resolution of negotiations with the former
Coalition government in September 2007, which resulted in the government
announcing a support package to assist medical practices migrate to the
new system.[12]
However, recently the AMA has expressed concern over the electronic claims
system, suggesting that it, along with the Easyclaim system, is ‘needlessly
complex’—they suggest a ‘single low cost system for the payment of all
Medicare rebates’.[13]
The implementation of the Bill is costed at $4.5 million over four years.
According to the Explanatory Memorandum the costs include the cost
to Medicare Australia to introduce the necessary system changes and manage
the program.[14]
When the original 90 Day Pay Doctor Cheque Scheme was introduced in 2001,
there were no significant financial costs.[15] The proposed expansion of the scheme to include
medical specialists and consultant physicians might therefore be expected
to incur minimal additional administrative costs (as many of the necessary
systems must already be established to manage the existing scheme). The
Portfolio Additional Estimates Statement (PAES) for the Human Services
Portfolio 2007-08 show that most of the costs associated with the expanded
scheme are for the incentive packages being offered to medical practitioners
to move to Medicare Easyclaim.[16]
Item 1 proposes to amend subsections 20(3) and (4) of the HIA
by inserting the terms ‘specialist or consultant physician’ after ‘general
practitioner’ wherever the latter term occurs. The proposed amendments
will allow specialists and medical practitioners access to the 90 Day
Pay Doctor Cheque Scheme, and also allow for any ‘pay doctor via claimant
cheques’ issued in favour of the medical specialist or physician to be
cancelled, eliminating the potential for ‘double dipping’ by a claimant
(patient).
Item 2 proposes a new subsection 20(6). This subsection
would make access to the 90 Day Pay Doctor Cheque Scheme by specialists
or consultant physicians dependent on the original claim for the Medicare
benefit being submitted electronically as prescribed in the regulations.
This proposed amendment will not affect the current arrangements for GPs,
which remain unchanged.
Item 3 proposes that the amendments will apply in relation to
professional services rendered on or after the day on which the Schedule
commences.
Concluding
comments
The proposed amendments will provide specialists and consultant physicians
access to the 90 Day Pay Doctor Cheque Scheme. This which will benefit
these medical practitioners as unpaid accounts will now be guaranteed
after 90 days, provided they utilise electronic claiming. The Bill does
not propose extending this benefit to other health professionals such
as dentists and other allied health practitioners, although this would
clearly be of benefit to these health groups and their patients. Arrangements
for GPs will remain unchanged.
The proposed amendments will also encourage medical specialists and consultant
physicians to migrate to electronic claiming for patient accounts (particularly
using the new Medicare Easyclaim system), by making access to the 90 Day
Pay Doctor Cheque Scheme dependent on the original claim being submitted
electronically to Medicare Australia.
The cost of the implementation of the proposed Scheme appears to be mainly
associated with the incentive packages being offered to medical practitioners
to migrate to electronic claiming.
Amanda Biggs
15 May 2008
Bills Digest Service
Parliamentary Library
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