Bianca McCulloch: My name is Bianca McCulloch – I am the Director of Bulk Billing Clinic Design and Implementation from the Department of Health, Disability and Ageing. This presentation has been developed to provide information to GPs, practice managers and other practice staff on the upcoming changes to bulk billing incentives and the Bulk Billing Practice Incentive Program. So, thank you so much for joining us today.
I'd like to begin by acknowledging the traditional owners and custodians of the lands on which we are virtually meeting today. For me, that's the Wurundjeri, Woi Wurrung and Bunurong, Boon Wurrung people of the Kulin Nation. I wish to pay my respects to elders past, present and emerging, and I'd like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander Peoples here today.
Today I'm joined by colleagues from the Department of Health, Louise Riley, the Assistant Secretary of the MBS Policy and Review Branch, and Jacob Grooby, Director of the MBS Affordability Section, and from Services Australia, Rachel McCauley, Acting National Manager, Provider Branch.
Before we start, a couple of housekeeping matters. We've got a lot of attendees in our session today, so we don't have the option for turning on video or microphone today, but there will be a Q&A session at the end of the webinar, and we invite you to submit questions via the Q&A function in Teams.
Please switch the Q&A option from ‘start a discussion’ to ‘ask a question’ as shown in the image. You can upvote questions by clicking on the arrow that appears at the bottom of the question, and we'll attempt to respond to as many questions as possible. This session is being recorded though, and it'll be published on our website, so you can always come back to it later on.
So just a bit of a context about the measure. As part of the 25-26 budget, the government announced a $7.9 billion investment to increase the GP bulk billing rate. This included 5.5 billion to expand eligibility for bulk bill incentive items to all Medicare eligible Australians.
And 2.4 billion to create the Bulk Billing Practice Incentive Program, which we're calling the BBPIP for short, and ongoing funding to support these measures. Today we'll talk to you about the need to improve affordability and access to GP services, the government's expansion of eligibility for bulk billing incentive items and BBPIP, understanding how over 4800 practices will be better off financially if they switch to bulk billing, key features of the BBPIP, the implementation support that we'll have, how to join BBPIP and how it'll be managed, and then we'll have time for questions and answers.
I'd now like to hand over to Louise Riley, who'll talk you through the expansion of the bulk billing incentive items. Over to you, Louise.
Louise Riley: Thanks, Bianca. Hi everyone. I'm going to start off with some of the basics, most of which you know, and I'll move through pretty quickly. So, of course, bulk billing incentives are items that are additional payments that we provide when a provider bulk bills an eligible patient for an unreferred service.
So as you all know, at the moment, bulk billing incentives are only available for people who are under 16 years of age or people who have a Commonwealth concession card.
Currently, that's about 42% of the Australian population. So from 1 November, that eligibility will be expanded to every Medicare-eligible Australian, so there'll be no longer any need to be under 16 or a Commonwealth concession card holder to be eligible.
The incentives will be available for everyone. So a really important point, because I've had a few questions over the last little while that suggest some people might have misunderstood this, is that there are no other changes to the bulk billing incentive items. We're not changing which incentive applies to which item or anything like that.
It's literally expanding their eligibility. So over 15 million more Australians from 1 November are going to be eligible for incentives and 45.5 million bulk billed services will now attract a bulk billing incentive.
That's around an extra 1 billion per annum. That's if providers don't do anything differently to what they're doing now. So we know that while under 16's and Commonwealth concession card holders are those that are eligible, we also know that a lot of other people are bulk billed in your practices.
If you change nothing but continuing to bulk bill at your rates that you currently are, an extra billion dollars will start washing through the system.
And another important point, that expanded access to bulk billing incentives is based on the patient. It's got nothing to do with whether the practice participates in the bulk billing practice incentive program or not. So next slide, thanks.
So currently there are 20 bulk billing incentive items and of course the item and the benefit depend upon the service provided and the location, of course, based on Modified Monash classifications.
So as you all know, the triple BBIs at the moment apply to all face-to-face general attendance items, essentially a level B and up. So those that are 6 minutes or longer. They apply to all telehealth general attendance consultations which are a level B, essentially for a level B, and then there are longer phone and video that attract a triple BBI with, if the patient is registered with my Medicare and if they get that service from the practice at which they're registered.
Of course, the original or sometimes referred to as single bulk billing incentives, they apply to all other unreferred services, including your level A's, your chronic condition management plans, mental health items, health assessments, and other procedural items and things. I won't go through and read them. I'm sure you will all appreciate that the value of the bulk billing incentives depends upon the Modified Monash region of the practice and that ranges from of course 100% for MM1 and it goes all the way up to 190% for those practices that are very remote in Modified Monash Region 7. All right. I think that's it from me and I'm now handing back over to Bianca.
Bianca McCulloch: Thanks, Louise. So in addition to the expanded bulk billing incentives that Louise has just taken us through, the Australian government is creating the Bulk Billing Practice Incentive Program (BBPIP) to support general practices across the country to bulk bill all Medicare-eligible patients.
And the BBPIP commences on 1 November 2025. Practices joining BBPIP will receive an additional 12.5 per cent loading payment on MBS benefits earned from the eligible GP NRA services and that'll be split between the GP and the practice.
Participating practices must bulk bill all eligible services for all eligible patients and the incentive payment will be made in addition to MBS benefits paid. All GPs at a participating clinic must bulk bill all eligible services for all eligible patients.
Participating practices will be expected to advertise as a fully bulk billing clinic on Healthdirect's National Health Services Directory and you'll be supported to do that with marketing materials that we'll provide to identify your participation in the program.
The BBPIP is voluntary. Practices can choose to opt in and opt out at any time. We've been consulting with the sector on options for how the incentive payment will be split and government's now considering the position on that one and we expect an announcement in the next couple of weeks.
A full list of the BBPIP eligible items is available on the department's website at the link there, and the eligible items are subject to change with usual MBS item changes over time, and any changes to those items will certainly be communicated to practices.
Services that don't fall within that category, those categories, so for example some procedural items, aren't subject to the bulk billing requirement.
To help implement the program, Minister Butler sent letters to 6682 practices on the twenty-seventh of March, with individual modelling on the financial impact of expanded bulk billing and BBPIP for each practice. So if you haven't received that letter, do check your Services Australia HPOS inbox, as the information should still be in there. We're also developing a calculator to assist GPs and practice managers estimate the financial impact of bulk billing changes. The calculator is expected to be available on the Health website in early September and we will certainly provide some comms and information around that being available. We'll also be inviting practices to express interest in BBPIP in early September, and that'll give you an opportunity to access signage to advertise that you're participating in the program, and also an update newsletter, as we get closer to 1 November.
We're also supporting implementation through a national communications campaign, and that'll include advertising that'll roll out in two phases. The first phase will be focused on providing information about BBPIP for providers and practices, and the second phase will be directed at patients early in the new year.
The communications campaign will be supplemented by information such as fact sheets, frequently asked questions and program guidelines that'll be available on our website, webinar events like these ones, and outreach and support through PHNs, through the Australian Association of Practice Management and NACCHO.
Services Australia will also provide instructional material outlining how to register in the system and the steps to take, and that will be published on their Health Professional Education site where there's lots of other information about My Medicare already existing and about participation in those programs. For more information and to stay in touch with BBPIP updates, we really recommend bookmarking our URL that's listed on our slide there, www.health.gov.au/BBPIP.
And we'll be sure to provide lots of updates and information through that channel as well.
I'll now hand over to Rachel McCauley, who is the Acting National Manager from Services Australia, who will discuss how you can register for BBPIP and how the payments will be made. Rachel.
Rachel Macaulay: Lovely. Thanks Bianca, and good morning everyone. Practices need to be registered in MyMedicare to participate in the BBPIP. Practices already registered in MyMedicare need to continue to meet the existing MyMedicare accreditation requirements to participate and this includes being accredited against the National General Practice Accreditation scheme within 12 months of registering or being under a current exemption.
Practices not already registered in MyMedicare will be exempt from the MyMedicare accreditation requirements if they wish to participate in the BBPIP and the exemption is to ensure patients are not unfairly disadvantaged in accessing bulk billed services if their practice cannot achieve the accreditation before BBPIP’s launch on the 1st of November 2025. So Aboriginal Control, I'm sorry, Aboriginal Community Controlled Health Organisations and Aboriginal Medical Services can participate in MyMedicare and BBPIP if they provide Medicare-funded services.
Practices can register for BBPIP via the Organisation Register from the 1st of November through HPOS and patients do not need to be registered in MyMedicare to take up the services.
In terms of payments, incentive payments will be made quarterly and in arrears, and payments will commence in January 2026 based on MBS billing from the 1st of November. BBPIP, as mentioned, is different to the Practice Incentive Program known as PIP.
Incentive payments under BBPIP will be made through the Organisation Register and the already established MyMedicare capability.
MBS bulk billing incentive benefits will continue to be paid directly to the GP.
Payments will be automated, and Services Australia will assess the practice's bulk billing at the end of the quarter and will provide payment based on MBS claiming information that we hold in our system. The payment system will include a forecasting function so practices can track their bulk-billing rate and potential incentive payment over a quarter, and this will be found within HPOS. The incentive payments will be made to the practice’s and provider’s MyMedicare nominated bank account and this can be updated in the Organisation Register or in the Health Professional Online Services or HPOS account under ‘my details’.
Thanks, Bianca.
Bianca McCulloch: Thank you, Rachel. We'll now hear from Jacob Grooby, who will talk about trends in bulk billing and affordability of GP services, and he'll provide some detail on the financial modelling and the impact for providers and practices of BBPIP.
Thank you, Jacob
Jacob Grooby: Thanks, Bianca. It probably won't come as a surprise to anyone here that the bulk-billing rate for GP non-referred attendances has fallen over the last few years. For a long time, the bulk-billing rate was pretty stable, at around 80 to 85%, even enduring through the indexation freeze until the start of the pandemic where obviously it increased with the mandatory bulk billing for some COVID telehealth items. But in the two years post the pandemic, we saw about a 10-percentage-point decline to a low of 75.6% in October 2023, just before the bulk billing incentives were introduced, the triple bulk billing incentives I should say. Since then, the bulk-billing rate has stabilised and it started to rise slightly, but we still haven't recovered the previous levels.
During the decline, many general practices shifted from a fully bulk-billing model to a mixed-billing or private-billing model, and you see our definitions down at the bottom there. As you can see, since 2020, the number of practices that bulk billed all of their services is nearly halved from about 55% down to 29%.
At the same time, the proportion of practices that are bulk billing less than 50% of their services has tripled, albeit from a lower base. It's important to note that these mixed billing practices still bulk bill over 75% of their services. That'll become important later.
Again, it's no surprise that this has caused total patient out-of-pocket costs to increase. In fact, it has more than doubled over the last three years from 780 million in 2020-21 and for a fairly-flat trend before that, to nearly 1.7 billion in 23-24.
Last financial year's figures haven't been published yet, but I can say it hasn't gone down. In fact, it's grown again.
Next slide.
All of this has had a measurable impact on patient access to GP services. Every year, the Australian Bureau of Statistics publishes a fantastic report called the ‘Patient Experiences in Australia’ report. It's based on a very large, very detailed survey. One of the questions they ask every year is whether someone has delayed or did not see a GP over the last 12 months due to cost.
As you can see on the chart on the left, the proportion of people deferring GP care due to cost has hovered between 3.5 and 4% for quite some time, with the outlier kind of low point during COVID.
Over the last two surveys, that proportion has more than doubled from 3.5% to 8.8%, and it's working age Australians that are most affected. You can see from the chart on the right, less than 2% of older Australians are avoiding GP care due to cost. The number is as high as 15% of people aged 25 to 34.
And that proportion has more than tripled over the last two years. None of this is of course to place blame at anyone’s door, just providing a little context for the investment in bulk billing generally and for the focus on bulk billing clinics specifically.
Switching gears a little bit now, I'll talk about the modelling behind the BBPIP and how GP clinics will be financially better off joining the program. In a second, I'll jump into the modelling itself. But first I wanted to spend a moment talking about the data that supports the modelling. The department has access to very detailed data about every MBS claim. This includes information on the patient, such as their concessional status, and information about the service itself, such as whether it was bulk billed or privately billed, how much the patient was charged and how much the patient received in MBS benefits and their residual out-of-pocket costs. We also are able to attribute claims to GPs and general practices where that practice participates in the Practice Incentive Program or PIP. That's about 6,682 practices.
This allows us to build an income model for those 6,600 general practices in Australia. And that's what we've done. This particular example is a mixed billing practice in a metropolitan area that bulk bill just over 75% of its services. During the 2025 calendar year, this practice received $670,000 in MBS benefits for the services they bulk bill. It received an additional $260,000 in bulk billing incentives for services that were bulk billed to children under the age of 16 and to concession card holders, so eligible people [for MBS bulk billing incentive items].
In total, they received $275,000 from patient fees.
Patients who were charged a fee then received a total of $160,000 in MBS rebates, and that becomes important later. That's included there in a little call-out box.
The GPs of this practice earned revenue of about $1.2 million from GP non-referred services in 2025. Important to note, this doesn't include any revenue generated from non-GP NRA services such as procedural items as they won't be counted towards bulk billing requirements of the program.
Over the next few slides, we'll adjust the current revenue to consider the positive impacts of the expansion of bulk billing incentive eligibility for patients to form a baseline income for every practice. And that's what we do here in this slide.
So we simulate this revenue by finding the number of services that GPs at this clinic provided, bulk billed sorry, to non-concessional patients in the 2024 calendar year. And we multiply that by the average rebate, bulk billing incentive rebate, the GPs in that practice received in that calendar year, which takes into consideration the service mix and the remoteness of the clinic. So adding this $125,000, in this case $125,000 of additional bulk billing incentives would go to this practice, which would make their baseline revenue $1.33 million and this is the baseline that we now simulate whether joining the BBPIP and bulk billing every service would make this practice financially better off or worse off. So can you hit the next slide?
The first step here obviously is to remove all of the patient fees as all the services will now be bulk billed. Next slide please.
Next step is to redistribute the $160,000 of MBS rebates received by patients for privately billed services to the GP because these services will now be bulk billed and the benefits are flowed directly to the GP.
Next slide please. These newly bulk billed services also attract a bulk billing incentive as everyone is now eligible for one. In this case it's about, it is $105,000. This brings a new total revenue just under what it would have been with practice, with patient billing. Go to the next slide.
We then add the 12.5 per cent incentive payment, which is also coincidentally $105,000 and that puts this practice's total revenue at $1.4 million, which is greater than it would have been if they had remained a mixed billing clinic. Go to the next slide.
So here we see the three phases, for want of a better word. We've got the revenue, this practice’s revenue in 2024 calendar year as it was, at 1.2 million, $125,000 better off due to the BBI eligibility changes.
And then if they join the thing, they'd be a further $95,000 better off, if they join the BBPIP. That's $220,000 better off overall, and their patients would be about $115,000 better off by not having to pay out-of-pocket costs. So that's the model.
And back to you Bianca.
Bianca McCulloch: Thank you, Jacob. OK. That brings us to the end of the formal part of our presentation. So we will go to questions now.
And I can see in the chat that we've certainly got a few questions coming through and we're looking at the upvoted questions. So just a reminder, if you'd like to add a question as per the diagram on the screen here, switch from ‘start a discussion’ to ‘ask a question’ as shown in the image, and you can upvote questions that are already there by clicking the arrow that appears at the bottom of the question. So we might get started. The first question that's coming up here for me is, do all practitioners have to participate in the practice given they are individual contractors?
The answer to that one is that yes, all practitioners at a practice need to participate and need to bulk bill all eligible services for all eligible patients in a practice, and that revenue is the basis on which the 12.5 per cent incentive would then be calculated.
Certainly if you don't participate in the BBPIP, you can still continue to bulk bill items and you can bulk bill all items or as many items as you choose. But in order to participate in the BBPIP and get that extra incentive of 12.5 per cent split between the practice and provider all providers at the clinic need to bulk bill eligible patients, and you'll also need to advertise that you're a bulk billing only clinic.
OK. The next one is if the clinic chooses not to bulk bill all patients, will we still receive the bulk bill incentive for all patients that are bulk billed? So the answer to that is similar to previous: no. So the bulk bill incentive is available for practices that bulk bill all of their patients, so all providers bulk billing all patients. However, if you bulk bill patients but aren't participating in the program, you will still receive bulk billing incentives through the MBS items.
This one we might go to yourself, Louise. This one's for you around MBS items. Are RACF and home visit item numbers covered by BBPIP.
Louise Riley: So the flag fall for visiting RACF’s is included in the list of eligible services and of course you claim that with the relevant attendance item which is included. And just to sort of back Bianca up on something she just said, just to be clear. So if you bulk bill patients, they will all be eligible for the incentive, you don't have to participate in the program to be able to claim the incentive items.
What you won't get if you don't participate in the program is the quarterly 12.5 per cent. The word incentive gets used too many times in these conversations, so just to clarify.
Bianca McCulloch: Thank you, Louise. And while we've got you there, there's a second question about items. So can you confirm things like wound care and iron infusion, which don't have item numbers, can continue to be privately billed please?
Louise Riley: So if you are claiming an attendance item, that means that it counts. But if you are completely privately billing, then you know where an MBS item is not claimed, then that doesn't count. And just to be clear, all procedural items, so your excision and those sorts of items, they're not included in the list of eligible services for the Bulk Billing Practice Incentive Program.
Bianca McCulloch: Thank you. And one more for you, Louise. Are the measure [BBPIP] and the MBS items going to be CPI indexed? And the comment is, it has to keep up with practice costs.
Louise Riley: Yeah, so of course. And I appreciate people out there saying there was an MBS freeze, but certainly MBS items are indexed. They were indexed on 1 July and will be indexed on 1 July forevermore unless government makes a decision. But of course, as the items are indexed that increases the value of the item, which is then reflected if you're participating in the Bulk Billing Practice Incentive Program, that is then reflected in the 12.5 per cent that you get.
Bianca McCulloch: Thank you. The next question is how is the 12.5 per cent incentive going to be split? At this stage, government is considering the proportional split between the provider and the practice. We have been engaging with the sector and seeking feedback on the split and there's been a really wide range of views right across the sector. So we're just in the process of landing the position and considering what's the best way forward and expecting an announcement on that in a few weeks.
Moving down the list of questions, if we register for the BBPIP midway through a quarter, will we miss out on that first quarter? Registration is eligible from the date of your registration, and I can see Rachel is ready to answer this one, so I might throw to you, Rachel.
Rachel Macaulay: Thank you, Bianca. No, you won't miss out. A practice will have an opportunity to backdate the registration so they can participate in the program. Thank you.
Bianca McCulloch: Thank you. So those payments will be made quarterly in arrears. The first quarter, because it's just the two months, November and December, because the program only commences from 1 November, the first quarter will assess just November and December claiming.
We'll also have a forecasting tool available in the Services Australia systems that'll allow you to check throughout the quarter how you're tracking against the requirement and to get an assessment or a sense of whether you'll meet the eligibility of the claiming requirement for that quarter and assessment of the incentive will be automatic based on your MBS billing and paid in arrears, as I said, at the end of the quarter. So the first payments are expected to come out in January 2026.
Okay. I've got a question now, if we are a group practice and two GPs want to participate, can they, and the other GPs don't have to? So this is similar to an earlier question, but just to reiterate that all GPs at a practice do need to participate in order for the practice to get the 12.5 per cent bulk billing PIP incentive, the additional incentive, but practices can bulk bill or not bulk bill separately in a practice. But if your practice does want to join the BBPIP and be eligible for the BBPIP, then all GPs at the practice will need to bulk bill.
I’m just going to refresh and see if we've got some other questions popping up.
Okay. There's a question here about accreditation, will there be an expectation that practices who are not accredited, but register for MyMedicare to participate in BBPIP, become accredited? And if so, in what timeframe? Of course, we always encourage, you know, the practices to work towards accreditation and maintain those standards of quality. But at this stage there's no requirement or expectation for practices who aren't accredited but do participate in the program to become accredited. We know that there are some limitations for some practices and that for some practice types accreditation is not easily obtained, and we know it's a long pathway to accreditation. So at this stage the waiver for accreditation requirements for BBPIP will remain and certainly if that were to change into the future, there would be a large communication campaign and engagement with the sector on that. It's important to note that the accreditation waiver for BBPIP doesn't apply to any other MyMedicare related programs.
So if you're just participating in MyMedicare, you still need to meet the MyMedicare accreditation requirements. And if you're participating in the other incentives that leverage MyMedicare, for example, the GPACI incentive, you will need to meet the MyMedicare accreditation requirements, so the exemption is just for BBPIP, and it'll be specific to BBPIP. That exemption will be available from 1 November. So for practices who are already registered in MyMedicare, you won't need to re-register in MyMedicare again, you'll just need to register for BBPIP from 1 November.
For practices who are not already registered in MyMedicare, you can either register now if you're able to meet the accreditation requirements, or from 1 November, you can register in MyMedicare and seek the waiver from the registration requirements and then register to participate in the BBPIP program.
We do have a statement here, a question about why don't they just put the money into Medicare rebate and that way everyone who accesses the services are benefiting regardless of the billing model, and I think we can say that certainly the intent of the legislation, of the program, is to encourage an uptake in the rate of bulk billing and to support practices to bulk bill at a greater rate. That focus on bulk billing certainly reduces out-of-pocket costs and makes healthcare more affordable for patients.
And so the focus of this measure is absolutely about increasing that rate of bulk billing.
There's a question about MyMedicare and practices with more than one site, and the questioner is saying, I understand at the moment patients can only register for one site and that's going to make things a bit tricky for practices with more than one site. Do we think this will be looked at, please? So that's true at the moment. MyMedicare, the kind of core principle of MyMedicare, is about continuity of care and establishing a relationship with our practice and providers to ensure that that practice knows your care, knows your medical background, and is able to provide that wrap-around support for you. So the principle is that a patient registers with a practice. The registration for MyMedicare is with a practice, not with a provider, so if you're registered at a practice, you can see any provider at that practice and that will be the same for BBPIP. If you're registered in BBPIP, you'll be able to access these services from any provider at a BBPIP registered practice.
We're certainly aware of some of the challenges where a provider works at multiple locations and a patient might choose to see their provider at those different locations, but they're registered at one practice and that's particularly the case for the MyMedicare-linked MBS items.
We are thinking about what models we could consider that might help us make that arrangement a little bit more flexible, but I would caution that that is probably a little while away, a sort of mid-term consideration at the moment, and we're in the process at the moment of exploring some of the policy solutions or policy options for how we might make that element of the program a little bit more flexible. So it's certainly something we're looking at, but it's a mid-term reform at this stage.
I might just refresh.
I might throw this one to you, Louise. I'm not familiar with this form myself, so, there's a question around will we still have to obtain consent via a DB04 form? Is that one you're able to answer?
Louise Riley: Yeah, sure. Thanks, Bianca. So as some of you, I hope most of you are aware, there's some changes coming through around assignment of benefit to hopefully make it easier. So at the moment, if you're using one of the DB forms, there are a number of them, you will still have to obtain consent.
However, legislation was passed last year and we're looking at lots of ways to make it easier to do that, including pre-assignment. So we know that some of the billing, the sorry, the appointment platforms that many of you use have already incorporated it into their software and from January next year you'll be able to do that, obtain someone's consent prior to service being provided as well. But in short, you will still need to obtain the patient - the patient still needs to assign their benefit to you if you bulk bill them.
But we're hoping it'll be a lot smoother and a lot simpler with the changes that are being worked on now. Thanks, Bianca.
Bianca McCulloch: Thanks Louise. The next question is, is there support or process if there's an admin error and a practice has privately billed a patient in error? A provider can make retrospective changes to previously lodged claims and retrospective changes can result in an underpayment or an overpayment of a previously paid incentive payment which would be adjusted in the next quarter. We will have the ability to make adjustments per quarter to correct any errors in claiming and we also are currently considering system arrangements that allow for a small error margin. We know that there are some MBS items where it's sometimes difficult to claim a bulk billed item, for example a newborn baby who doesn't yet have their Medicare card, or patients who've lost their card, or patients who are getting a service under a reciprocal health care agreement. So we will have some instructions on how to claim those particular types of items. We're looking at ways to make sure that doesn't impact your ability to still receive the 12.5 per cent incentive if you're participating in BBPIP. So the intention is that all eligible services for all eligible patients are bulk billed, but of course we recognise that there are some instances where that is difficult or can't happen or where there are admin errors as you say.
And so we will have some instructions on what to do in those circumstances.
There's another question about can practices that are already fully bulk billing join the BBPIP? And the answer to that one is a resounding yes, absolutely. And in fact your practice will be better off under the program because you'll then have access to the additional 12.5 per cent BBPIP incentive. So absolutely practices who are already fully bulk billing can join, and we certainly encourage you to do so.
Next question is, are these questions written down as FAQs in the official website? Because I think these questions will be very beneficial for all staff doctors to read, learn and discuss. We absolutely do have this material published on our website and you can see on the screen there, there's information available on our website. You can also go onto the Health website and search for bulk billing. There's a range of material there, including some examples, and examples of how the modelling would apply to standard practices and different sorts of practices, the impact of the bulk billing measures for providers, practices and patients. And there's a range of frequently asked questions and answers in the material as well. So there's a bunch of different resources.
As we progress towards 1 November, we'll continue to add questions and answers to the FAQs and add additional material to our website. And if you sign up to our expression of interest page, our early information page we’ll continue to send updates and more information out through that channel.
And you will also see messages coming from Primary Health Networks, the Australian Association of Practice Management and NACCHO as well that'll have additional information like the content that we've covered today.
There's another question here about the MBS item numbers for you, Louise. How about procedure item numbers? So are they included or not included?
Louise Riley: Yeah. So procedural items aren't included, as I've just posted in one of the questions on the Q&A, the published ones. So as Bianca was just saying, there's lots of information on our website including a list of all the non-referred or the eligible services that will be included, they’re the services that you have to bulk bill to participate in the program and they're the services on which the 12.5 per cent will be calculated. But procedural services are not included in that list. Essentially, they are all of your general attendance items.
Bianca McCulloch: Yeah. Thank you.
Jacob, there's a question about the modelling here, which I might throw to you on. So the modelling relies, the question is, the modelling relies on the practice receiving 100% of the income and employing doctors. We know this is typically not the case. Will the modelling extend out to understand how practices who receive a service fee from their practitioners actually work? I believe the modelling needs to be extended at the doctor and then the practice level.
Jacob Grooby: Thanks, Bianca. And for the question, we have done that already. We've done it on a GP basis and on a practice basis, assuming there is a split of income and we've done it kind of with several iterations depending on what the split of the incentive payment will be.
And kind of underlying assumptions about what the current practice fee average is.
That will change, I guess, at the margins based on what incentive split is decided on or is announced. But most of the change when that happens will be to who the money flows to rather than whether individual clinics are better or worse off. There will be some at the fringes that will change.
But yeah, mostly it's just kind of the question of where the benefit flows rather than whether a clinic and GPs are better off or worse off. I hope that makes sense.
Bianca McCulloch: Thanks, Jacob.
The next question is, can we please have a copy of the incentive percentages based upon the MMM? And I think this one might, the information might be available to you in the calculator.
The calculator will take account of the MMM incentive when you enter the information about where your practice is, but I might throw to Louise to talk about the MMM percentages.
Louise Riley: Yeah, and it was on one of my slides and you'll find it on the department's website as well, but I assume you're asking, so if you're a practice that's located in a metropolitan region, that's a Modified Monash level one, then bulk billing incentives are 100%.
And then they range up to 190% of that MMM1 value if you're in a Modified Monash region 7. So I'll quickly run through. So Modified Monash 2 locations get 150%, 3 and 4 locations get 160%, Modified Monash 5 get 170%, 6 get 180% and 7 get 190%. So that's the value of the bulk billing incentive, the, you know, the incentive item that you claim when you bulk bill a patient.
Bianca McCulloch: Thanks, Louise. Just a couple more. I think we're close to time. So this one is about, if an error is made, another question about if the error is made. So, what if an error is made and one private billed item slips through for a quarter, does this completely obliterate the incentive for that quarter or is there a correction process? So there will be a correction process, and we will make allowance for those small administrative errors. So we'll provide more detail on how that will work in the coming weeks. So we're certainly conscious that we don't want just one item or one administrative error to exclude you from being able to claim the incentive item.
There's a question about multiple sites. So, will the BBPIP apply to services at all sites in the same way as other practice payments and PIPs? This one is a little different to some of those programs, so registration in BBPIP will be by practice site, not by organisation or by sort of overarching corporate structure. So it will be by individual site. So as per MyMedicare registration, when you register a practice at a site level, all providers at that site would need to be registered and bulk billing and delivering bulk billed services to all eligible patients. But another site that's connected to the same business, might not be registered and doesn't need to be registered. So, it is at the site level as opposed to the organisation or the corporate level.
There's a question for you, Louise. Do all patients get the bulk billing incentive even without concession cards?
Louise Riley: So, yes, and I think I can see a couple of questions here about that. So just to be really clear, yes, at the moment only patients who are under 16 or who are a Commonwealth concession card holder are eligible. So from 1 November, every patient, if they've got a Medicare card, they are eligible for a bulk billing incentive.
I can see there's a question, what does Medicare-eligible patients mean? It's essentially all Australian citizens and a few others. It's any person in Australia who can access Medicare. So the incentives will apply for everyone.
Bianca McCulloch: Thanks, Louise. There's a question saying, I think you said we can register from 1 November for BBPIP. Is this correct or can we get organised in advance? That's an excellent question. Thank you. You can certainly register for my Medicare if you meet the accreditation requirements now. So you can do all of that process right now and get yourself set up for that aspect of the program. Patients don't need to be registered, but practices and providers need to be registered in MyMedicare to participate. From 1 November, you'll then be able to link to the BBPIP program itself. So there will be an extra step for practices who are already registered in MyMedicare and for those who are joining to participate in the BBPIP program. And from there you'll then be able to go about your claiming, submit your services and the claiming system, the MyMedicare system, will automatically assess your bulk billing rate over the quarter and make a payment to your nominated bank account, at the end of the quarter. So for the first quarter, that'll be early 2026. In order to set yourself up in MyMedicare, there's some really excellent, thorough information on the Services Australia Health Professional Education website. There is how-to guides, there's VODs and instructional material that you can work your way through and that will help you through the steps of setting up your organisation in the organisation register and participating in MyMedicare.
And there'll also be additional material there to help you work through the steps of nominating or participating registering in BBPIP from 1 November.
Was there anything you wanted to add to that one, Rachel? Oh, you’ve got your-.
Rachel Macaulay: Sorry, took a while to come off mute there. No, you've answered that beautifully. Thank you, Bianca.
Bianca McCulloch: No worries. So certainly there are those administrative efficiencies for practices who are already registered in MyMedicare. That part of the process is done, and this is just one extra step to participate in the BBPIP program.
Just having a look at the next round of questions.
This is another query on MBS items for yourself, Louise.
If an item 23 bulk billing and a 30071 private billing are billed together, is that OK for BBPIP?
Louise Riley: Someone will have to tell me what 30… - what the other number is. Sorry, I am useless at item numbers, but I'm assuming. So, I don't know the answer to this one, Bianca. This is to do with, we might have to take it on notice if that's all right.
Bianca McCulloch: That's OK.
Jacob Grooby: Sorry Louise, 30071 is a skin excise, excision. Sorry skin biopsy. So in that case.
Louise Riley: Oh, OK. So the, yeah, so the procedural items aren't included. So, you don't have to bulk bill procedural items, but you do have to bulk bill the attendance item.
Bianca McCulloch: Thank you. And another one about the new general practice chronic condition management item. Will the list be updated to include those items?
Louise Riley: Yes.
Bianca McCulloch: Yeah, it will. Thank you.
Okay, the accreditation requirements. There's a question on, what are the accreditation requirements? If you're registered for MyMedicare, are there further accreditation requirements? So the accreditation requirements are that you need to be accredited against the National General Practice Accreditation Scheme or have a current exemption. If you're already registered in MyMedicare, they're the requirements for MyMedicare. And those requirements, if you're already registered, will flow into the BBPIP program. For practices who are not registered in MyMedicare, there's a waiver of those accreditation requirements and there'll be a new exemption that's specific to BBPIP that will be introduced from 1 November, and that exemption will be solely related to BBPIP.
I'm just going back through.
There's a question about the payroll tax implication. Payroll tax is a state and territory tax that's applied, so we would encourage practices to do your own, to do your due diligence about the implications of state and territory taxation arrangements for your practice, and to consider those, the implications for your practice when determining whether you would participate in BBPIP.
There's a question about, how can we be guaranteed that the BBPIP will continue given this is the thing that makes it financially viable in addition to indexation and PIP payments have been removed in the past. What we can say is that there is forward funding for the BBPIP program over the next period and Jacob, I might throw to you about the funding model and the proposal, and that certainly the government is committed to improving and increasing and supporting the rate of bulk billing for all Australians.
But Jacob, I might ask you to talk to the forward modelling.
Jacob Grooby: Yeah. So just a general point, I suppose in that, these figures we've given you on a four-year basis, which is consistent with budget books. This is an ongoing measure. So funding is in the budget bottom line in perpetuity to remove the program would be an entire decision of government. It's not going to lapse.
Bianca McCulloch: Thank you, Jacob. And there's another one for you just on the modelling and structuring of the payment. Given most doctors are independent contractors to the practice and pay a service fee for the use of the practice and services, how can it be expected that individual contractors be made to register for the practice to receive the BBPIP payment?
Jacob Grooby: I'm not sure if this is a question of, whether, individual contractors, GPs working at a clinic can be expected to kind of join in with the rest of the clinic’s billing policy, in which case I think that's very common, especially in bulk billing clinics and we'd expect that to be OK; or whether it's a question about how can it be expected that individual contractors be made to register with a practice at all. In that case, I think that's, you know, a requirement of MyMedicare is that the practitioners at a MyMedicare clinic sign up to that clinic in MyMedicare. If you don't do that, if you want to be a solo practitioner, then I think you're eligible to become a practice, a MyMedicare practice, as a solo practitioner and you're certainly able to access the BBPIP if you bulk bill as a solo practitioner. I think that covers both of the bases there.
Bianca McCulloch: Thanks, Jacob.
There’s another question about how the 12.5 per cent is applied. So is the 12.5 per cent applied on the whole amount or the consult item only or the incentive amount only?
Jacob Grooby: Yeah, I'll take that one as well. So it's applied to the consult rebate, or the consult benefit only. It's not included in addition to the, it doesn't factor in the BBI amount I suppose. So if you get $42 for a level B, it'll be 12.5 per cent of $42 and then you'll get an additional BBI payment of I think it's $20.35 or $21.35, but the 12.5 per cent only counts on the $42, not the $62 or $63 if that makes sense. Hopefully it does.
Bianca McCulloch: Thanks, Jacob. There's a question about the marketing materials. So will the marketing material support allowing advertising as fully bulk billed eligible Medicare items with out-of-pocket costs for non-eligible items? So we will have both a two-phased communication campaign. So the first phase is in the lead up to 1 November and through to the end of the year focused on providers and practices, providing information about how to join and sessions like these where we'll talk through the requirements of the program.
And then the second phase will be consumer focused, so patients and consumers, and we're anticipating that will roll out in the early part of next year. So it will look at and inform our patients about bulk billing practices, how to find bulk billing practices, and we'll be requiring practices to register on the National Health Services Directory, which has an option for bulk billing only practices and we will certainly be clear that the bulk billing services are for eligible items for patients. So the campaign material will talk in detail about what services, practices and patients can expect to be bulk billed when they access a practice.
I think we're getting quite close to time.
I think.
There's a question about the calculator. Will the calculator that will be provided enable us to add our gap fee in to see if the BBPIP will work for us? Jacob, are you able to talk to the calculator?
Jacob Grooby: Yes, certainly. So calculator as it's designed at the moment and it's still in its design phase, but it's getting pretty close, does have the functionality for you to add your own patient fees for categories of items, so for a level A, B, also categories of items, including short, standard, long, extended, prolonged consults and for care plans. So yeah, you'll have the ability to add your own information, your own bulk billing rates as well, and your own, kind of guess at how many services you do and how many concessional patients you see. It's quite an elaborate calculator.
We are going to help hopefully by providing some preset values based on your remoteness and your billing archetype, but you'll see that as it gets rolled out and we'll have some pretty lengthy explanation material as well to help.
Bianca McCulloch: Thanks, Jacob. And I think this will be the last question. How do we lodge interest in this program to access the tool to input our data? Is there an e-mail? So there will be what we're calling an expression of interest form available on our website. We're anticipating that will be in early September.
And the calculator we are expecting will be available around that time as well. So you'll be able to access it directly from our website, but we'll certainly be doing as much sort of outreach and communication and advice through PHN’s, through the Australian Association of Practice Management, through our existing sector communication newsletters and so on, and also through NACCHOs to let you know that those two tools will be available. So the calculator and also the expression of interest.
The expression of interest will then allow us to provide you with regular updates as we get closer to 1 November and also distribute early marketing material for those practices who are keen to participate and that will include signage for your practice as well as information to support you to talk to your patients about the change.
That brings us to the end of the session today. Thank you so much for your participation. Thanks for joining us. I hope that's provided you with some good information. We'll have a look at the questions we didn't get to and cover off any that are not covered already in our frequently asked questions in our resources on the website. I do encourage you to jump onto the Department of Health website and search for bulk billing. You'll see a bunch of information there and we'll continue to add to that over the coming weeks. Thank you so much and we appreciate your time today. Thank you.
Louise Riley: Thanks everyone.