The Government is now operating in accordance with the Caretaker Conventions pending the outcome of the 2022 federal election.

Who must comply with Medicare obligations

All health professionals in Australia must meet certain requirements to be able to bill their patients under Medicare.

Not all health professionals bill patients through government programs. Those who do need to comply with our legislation so we can ensure everyone is using the system fairly.

Healthcare providers billing patients under Medicare

If you are an allied health professional seeking to provide a service in Australia, you must be registered. You can register with the Australian Health Practitioner Regulation Agency (AHPRA) or your relevant registration authority. You will also need to have a Medicare provider number if you wish to claim Medicare benefits for your patients.

Medical doctor eligibility

Eligibility to use Medicare benefits is determined by your ability to satisfy 19AA and 19AB of the Health Insurance Act 1973 and related regulations.

Pharmacists claiming under the Pharmaceutical Benefits Scheme

If you are a pharmacist, or PBS approved supplier and are providing or claiming Pharmaceutical Benefits Scheme (PBS) payments, you must comply with both PBS and Medicare compliance laws. This is regardless of where you are providing your service (either to a depot or an approved location).

Organisations receiving Practice Incentive Program payments

If you are an organisation or peak body that receives Practice Incentive Program (PIP) payments, you must comply with PIP and Medicare compliance laws.

Dentists providing services through the Child Dental Benefits Scheme (CDBS)

If you are a dentist who receives payment through the Child Dental Benefits Scheme. When providing a service, you must comply with our compliance laws to continue receiving your payments.

Last updated: 
30 September 2021

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