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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