verbal assignment of benefit arrangements for telehealth services

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UPDATE: AMA receives key assurances on telehealth red tape

The AMA has received assurances from Health Minister Mark Butler that his department will address concerns about the assignment of benefit for Medicare bulk billed claims.

UPDATE 4.30PM FRIDAY, 6 OCTOBER 2023 The following statement from Health Minister Mark Butler has been issued today (6/10/2023) following a meeting with the AMA Vice President about telehealth red tape.

"I have asked my department to provide options to address concerns about the assignment of benefit for Medicare bulk billed claims, including legislative amendments. My department has advised me that until these changes are made, there are no plans to pursue any broad punitive actions on this issue unless it relates to fraudulent claims against Medicare."

The following was published in AMA Rounds at 7AM Friday, 6 October.

The Health Insurance Act (1973) showed its age this week, after fresh advice was published by Services Australia in relation to verbal assignment of benefit arrangements for telehealth services. The Health Insurance Act provides the legal basis for the payment of Medicare rebates, including the assignment of benefits by a patient.

Throughout COVID-19, the Department of Health and Services Australia have taken a largely common sense approach to this, allowing verbal consent for telehealth consultations to be documented in a patient’s clinical notes. However, an Australian National Audit Office review earlier this year raised concerns that this practical approach did not meet the technical requirements of the Health Insurance Act.

While verbal consent is still permissible under the revised advice, it comes with extra red tape. To make matters more complex, Services Australia has published inconsistent advice on different parts of its website. The AMA has been advised by the Department of Health & Aged Care that the most current  and relevant advice can be found here.

In short, verbal assignment is still possible, but there is a requirement to explain to the patient how you’ll fill in the patient signature field in the approved form and confirm that the patient agrees. If the patient agrees, you need to type patient verbally agreed in the patient signature field. The completed form then needs to be sent by email or text to the patient.

A more detailed set of FAQs is available at MBS online .

While the AMA understands the reasons for the updated advice being issued, it is clear that it is a red tape nightmare that needs to be fixed. To this end our advocacy with the Minister for Health and Aged Care along with his Department has already secured progress in a number of areas including:

• The Department will move to quickly consult on required changes to the Health Insurance Act, with the Government committed to progressing legislative amendments to ensure that assignment of benefits rules are updated to reflect modern practice, while also protecting the integrity of Medicare.
• A commitment that no retrospective compliance activities will be completed by the Department.
• Recognition of the need for digital solutions to be able to record consent with minimal red tape as part of normal workflows.

The AMA will keep members informed about work in this area, recognising the potential for the current interpretation to impact on access to care for patients and add unnecessary complexity to the day to day work of doctors.

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Assignment of benefit

Signature requirements when a patient assigns their Medicare benefit to the servicing provider as full payment for health services.

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Responsible person, patient unable to sign - sensitive issue, patient unable to sign - deceased, email agreement, assignment of benefit and signature requirements for telehealth services.

If a patient is unable to sign an Assignment of benefit form (DB020) , you can get a signature from any of the following:

• the patient’s parent
• the patient’s guardian
• another responsible person.

In the absence of a parent, guardian or responsible person, leave the ‘patient signature’ section blank.

Where the signature space is either left blank or another person signs on the patient’s behalf, the assignment of benefit form must include the following:

• the notation ‘Patient unable to sign’
• in the ‘Practitioner’s Use’ section, the reason why the patient was unable to sign. For example, use ‘unconscious’, ‘injured hand’ or ‘verbal consent obtained’.

If you’re submitting a claim using Medicare Easyclaim , you can get consent for assignment of benefits from the patient or the patient’s parent, guardian or other responsible person using the EFTPOS terminal. Press the OK or YES button on the EFTPOS terminal.

‘Responsible person’ refers to an adult person accompanying the patient or in whose care the patient has been placed.

A responsible person can include someone who is any of the following:

• the parent or guardian
• holds power of attorney
• holds a guardianship order
• the next of kin.

This does not include the:

• health professional who rendered the service
• health professional’s staff
• hospital proprietor or staff
• aged care home proprietor or staff.

If you assess the reason a patient is unable to sign is of a highly sensitive nature, write in the ‘Practitioner’s Use’ section either:

• ‘due to medical condition’
• ‘due to sensitive condition’.

Only do this if revealing the reason would:

• mean an unacceptable breach of patient confidentiality
• unduly embarrass or distress the recipient of the patient’s copy of the assignment of benefit form.

This should not be routine practice. You can’t use ‘extenuating circumstances’ as a reason for no patient signature.

You and the patient must have entered into a bulk bill agreement at the time of service. This must include having the patient sign the assignment of benefit form.

If the patient has not signed the form, a signature from a responsible person is acceptable.

A responsible person can be either:

• the executor of the will
• an appointed administrator.

You must not write ‘patient deceased’ as a reason for not getting a signature on the assignment of benefit form.

Follow the steps in the table below when a patient assigns their right to a Medicare benefit to you by email.

For privacy reasons, don’t include the Medicare card number and provider number in the email.

This process complies with section 10 of the Electronic Transactions Act 1999 . This Act outlines the steps to be taken for an electronic signature to be recognised.

It also meets the legal requirement of needing a patient signature to assign a Medicare benefit.

Example email

Dear Mr Jones (patient)

Details of the telehealth consultation to be claimed with Medicare:

Item number: 91822

Benefit amount: $78.05

Date and time of consultation: 01.07.2022 10:30 am

Patient name: Peter Jones

Health professional name: Jane Smith

If you (the patient) agree to the assignment of the Medicare benefit directly to the health professional (bulk bill), reply to this email including the following wording:

• ‘Yes, I agree to the assignment of the Medicare benefit directly to the health professional’
• your (the patient’s) name or the name of parent or guardian (where a child is the patient and unable to sign).

Regards Dr Jane Smith

Privacy note: Your personal information is protected by law, including the Privacy Act 1988, and is collected by Services Australia for the assessment and administration of payments and services. This information is required to process your application or claim. Your information may be used by the agency, or given to other parties where you have agreed to that, or where it is required or authorised by law (including for the purpose of research or conducting investigations). You can get more information about the way in which the agency will manage your personal information, including our privacy policy .

You need your patient’s agreement to bulk bill the items before we can pay you the Medicare benefit, or the agreement of a responsible person for the patient. For example, a responsible person could be a child’s parent.

You can obtain a patient’s agreement in writing or by email for telehealth services. You’ll need to complete an approved assignment of benefit form. You must give the patient a copy of the completed approved form.

Read more about how you can get a patient’s agreement for a telehealth service by email .

Verbal assignment of benefit for telehealth services

If you can’t get patient agreement in writing or by email for telehealth services, you can get verbal agreement from your patient during the telehealth consultation.

You must complete the form approved for the purposes of s 20A of the Health Insurance Act 1973 electronically. You can use these approved forms:

• Bulk bill voucher- electronically transmitted claims form (DB4E)
• Assignment of benefit Medicare bulk bill Webclaim (DB020) .

Explain to the patient how you’ll fill in the patient signature field in the approved form and confirm that the patient agrees. If the patient agrees, you need to type patient verbally agreed in the patient signature field. You must send the completed form electronically to your patient.

If the patient doesn’t agree to assign their benefits, you can send them a private bill for the service.

You should keep a copy of all correspondence, claims and forms for at least 2 years. This is for auditing purposes if you are subject to a compliance review.

Getting verbal agreement is a temporary measure.

These requirements are not applicable to patients accessing health care funded by the Department of Veterans’ Affairs (DVA).

This information was printed 15 December 2024 from https://www.servicesaustralia.gov.au/assignment-benefit-for-bulk-bill-claims . It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/site-notices when using this material.

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