Medicare Benefits

The Australian Government pays Medicare benefits to assist consumers with the cost of medical, optometrical and, in some cases, dental surgical services, provided on a private basis.

MBS Online

contains the Medicare Benefits Schedule (MBS), A listing of the Medicare services subsidised by the Australian government. The Schedule is part of the wider Medicare Benefits Scheme managed by the Department of Health and Ageing and administered by Medicare Australia. MBS Online contains the latest MBS information and is updated as changes to the MBS occur. This site provides:

search the MBS functionality to allow both items and explanatiory notes to be easily accessed;
downloadable PDF versions of the MBS;
an email subscription to allow users to be notified of changes to the MBS; and
a create publication functionality whereby a dynamic PDF can be created based on preferred items.

Professional Services Review

The Professional Services Review (PSR) is a statutory authority established by the Parliament of the Commonwealth of Australia to examine health practitioners’ conduct to ascertain whether or not they have:

practised inappropriately in relation to services which attract Medicare rebates; or
prescribed inappropriately under the Pharmaceutical Benefits Scheme.

The PSR was established in July 1994 as an agency within the Health Portfolio. It is independent of the Commonwealth Department of Health and Ageing and The Department of Human Services. The PSR examines suspected cases of inappropriate practice referred to the agency by the Department of Human Services.

On 6 July 2011, the Senate Committee announced an Inquiry into the PSR Scheme ('the Inquiry'). The Inquiry reviewed the structure and composition of PSR, the processes for making PSR appointments, operating procedures used to guide PSR Committees in reviewing cases, procedures for investigating alleged breaches of the Health Insurance Act 1973, and avenues for practitioners under review to respond to alleged breaches and to lodge appeals.

The Senate Committee made seven recommendations for improving the PSR Scheme on 25 October 2011 that the government has agreed to implement. The full report of the Senate Committee and other documents can be found on the Australian Parliament House website.

The Health Insurance Amendment (Professional Services Review) Act 2012 received Royal Assent on 27 June 2012. The amendments in the Act do not alter the purpose of the PSR Scheme or the MPRC process. These amendments improve administration; clarify issues raised in recent court decisions and address evidentiary matters.

The Act can be accessed at the ComLaw webpage.

Medicare Benefits Statistics

Statistics on the numbers and value of Medicare benefits paid are at Medicare Benefits Statistics.
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Medical Services Advisory Committee
Proposed changes to the Medicare Benefits Schedule (MBS) are assessed by the Medical Services Advisory Committee (MSAC) before they are considered for public funding by the Australian Government.

MSAC is an independent scientific committee comprising individuals with expertise in clinical medicine, health economics and consumer matters. MSAC provides advice to the Minister for Health on the strength of the evidence relating to the safety, clinical effectiveness and cost-effectiveness of a medical service, and the circumstances under which public funding should be supported. This process ensures that public funding is provided to medical services that have been shown to be safe and clinically effective, and represent value for money for both patients and taxpayers in the Australian context.

Applications made to MSAC for consideration and for advice to government are based on currently available documented evidence. MSAC utilises consumer representation, as well as relevant clinical expertise in its assessment processes to ensure the views of potential patients are taken into consideration. More information can be found at the MSAC web page.
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Legislation covering Medicare benefits

Medicare benefits are provided for by the Health Insurance Act 1973 which should be read in conjunction with the National Health Act 1953. These Acts and the Regulations made under them are available at the Australian Government ComLaw web site

Medicare Claims and Payments

Medicare claims and payments are processed by the Department of Human Services through a range of electronic and manual options. Doctors are already experiencing the benefits of electronic claiming for bulk bill payments. These benefits include streamlined business processes, reduced paperwork and faster payments. More practices are offering to lodge patient claims electronically using Medicare Easyclaim and Medicare Online, saving their patients a trip to a Customer Service Centre.

Patients can also claim a limited range of items over the internet through online services, which provides payment into their nominated bank account generally the next business day.

Doctors can use an electronic system (ECLIPSE) for in-hospital patient claims and estimate out-of-pocket costs. This is a secure connection between:

practices
public and private hospitals
billing agents
private health funds
Department of Human Services
Department of Veterans’ Affairs.

Doctors experience faster payments, less paperwork, increased cash-flow and streamlined billing processes using electronic claiming.

More information can be found on the Department of Human Services website.

Medicare data and the eHealth record system

Medicare data, including MBS, PBS, Australian Organ Donor Register and Australian Childhood Immunisation Register data, was incorporated into the Australian Government’s personally controlled electronic health (eHealth) record system in August 2012. Healthcare organisations can now register to participate in the eHealth record system and start viewing patient records via the healthcare provider portal.

Visit eHealth for information on how healthcare organisations can register to participate in the eHealth record system.

MBS Reviews

In the 2011-12 Budget, the Australian Government committed, through the Comprehensive Management Framework for the MBS (CMFM), to continue the systematic review of Medicare Benefits Schedule (MBS) items to ensure that they reflect contemporary evidence, improve health outcomes for patients and represent value for money. For more information please visit the MBS Reviews Page.

Medicare Benefits page

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