Starting 1 July, patients will no longer be able to verbally consent to being bulk billed, when amendments to legislation regarding Assignment of Benefit (AoB) take effect.

From 1 July 2026, practitioners won’t have to use an approved form or sign the ‘assignment of benefit’ agreements, but they will need the patient’s signature (either electronic or physical) and must keep a copy for two years, the Department of Health, Disability and Ageing (DoHDA) explained in a new FAQ about the changes.

Existing forms (DB4e and DB020) will be discontinued and will no longer be compliant, but optional example templates will be published on Service Australia’s website.

What’s behind the changes?

While there has been a longstanding requirement for patients to assign their Medicare benefit to the provider in exchange for not incurring out-of-pocket costs, the government temporarily permitted patients to do this verbally for telehealth services during the COVID-19 pandemic.

However, the Australian National Audit Office identified legal risk when patients only provided verbal consent, and DoDHA has previously explained that “requiring evidence of a patient’s assignment of their benefit mitigates incorrect claims and fraud, such as fictitious claims and charging of co-payments for services that are also claimed as bulk billed.”

The government claims it’s “modernising” and “simplifying” the Medicare payment process, and that the changes will “increase transparency for patients and better ensure the integrity of Medicare.”

Simpler, or a compliance nightmare?

However, some worry that the changes will only increase the administrative burden and red tape for practices – and could potentially leave vulnerable patients at risk.

David Dahm, an accountant specialising in medical and allied health practice, suggests that most practices will use text messages with a web-form link that the patient fills out and sends back – but what if they don’t? He is concerned that some proportion of patients won’t reply, leaving practice managers to chase up unreturned consents – or “write the encounter off and convert it to a private invoice,” potentially confusing or angering patients who expected to be bulk billed.

Could patients who aren’t satisfied after their appointment withhold consent, and therefore payment?

The FAQ notes that patients can assign the benefit before or after receiving the service – as long as it’s before the Medicare claim is lodged. But it can get complicated.

For example, if a patient assigns the benefit before receiving the service (which DoHDA calls “episodic pre-service assignment”) but then ends up getting a different service, they’ll have to provide a new agreement afterwards (what DoHDA calls an “episodic post-service assignment”).

Likewise, if they see a different doctor than planned, they’ll either have to complete an updated pre-service assignment beforehand, or a post-service assignment with that doctor’s details.

Ultimately, if a patient doesn’t agree to assign their Medicare benefit, DoHDA says “they should be privately billed and provided with an invoice to enable them to claim their Medicare benefit from Services Australia.”

Will the changes leave vulnerable patients – and potentially GPs – at risk?

DoHDA’s FAQ states that if a patient is unable to sign, an assignor such as a  parent, partner, carer, relative, person with power of attorney or friend could sign – but if the patient or ‘assignor’ does not sign, a bulk billing claim should not be made, which could prove tricky if someone isn’t around to sign on their behalf.

The RACGP has raised the concern that some populations such as those in aged care or who are homeless may be particularly at risk– with its president Dr Michael Wright noting that the FAQs “provide some clarity, but that doesn’t really fix the problem.”

DoHDA says “the department is working to finalise regulations to support enduring AoB for patients who are registered in MyMedicare or receive services from an Aboriginal Community Controlled Health Organisation or Aboriginal Medical Service.”

These will only need to be signed once for ongoing and future services from a preferred practice, and will begin in 2027.