Medicare rebate changes could leave thousands out of pocket

Australia’s top doctors are concerned a large number of changes to the Medicare rebate next month could leave thousands of patients out of pocket.

From July 1 this year, more than 900 Medicare Benefits Schedule (MBS) items for rebates for private surgery are set to change as part of the MBS Review of all 5,700 Medicare rebates. The latest changes will affect rebates for orthopaedic surgery, general surgery and heart surgery.

The Australian Medical Association (AMA) said on Sunday it is concerned that the healthcare sector — including health funds, hospitals, doctors and patients — were not given enough time to be ready for the July 1 changes.

“Less than one month out from the implementation of these changes, and we still do not have all the information we need to assess and change over our schedules and payment processes to reflect the changes,” AMA President, Dr Omar Khorshid, said.

“We had enough problems in November 2018 when the first tranche of MBS Review changes resulted in private health insurers, through no fault of their own, not having their schedules updated in time.

“That meant that no-gap arrangements were not possible or were significantly delayed leading to uncertainty for doctor and patient alike. Patients were left out of pocket, spinal surgeries were delayed, and doctors couldn’t provide patients with informed financial consent about potential gap fees.”

Khorshid said those changes involved replacing 70 spinal surgery items with 60 new items. However this time, the healthcare sector is expecting changes to 594 orthopaedic surgery items, 150 general surgery items and 188 cardiac surgery items.

“After the spinal surgery debacle, the AMA and the private health sector told the Department of Health that six months’ lead time is needed ahead of MBS changes,” he said. “More than two years later, we are facing the same problems, but with more than ten-fold the volume and complexity.”

Khorshid went on to say because the healthcare sector hasn’t been given enough time to process the new changes, it’s hard to tell how much certain procedures will cost going forward.

“This will put significant financial and operational risk on health insurers and private hospitals, and leaves doctors and patients scrambling and confused about what and how to bill against Medicare and private health insurance policies come 1 July,” he said. “We simply don’t know what the rebates from funds will be, as they haven’t had the time to prepare and release them in advance – including for surgeries already booked for next month.”