Medicare Benefits Schedule - Note MN.13.12

Under the Health Insurance Act the Assignment of Benefit (direct‑billing) facility for professional services is available to all persons in Australia who are eligible for benefit under the Medicare program. This facility is NOT confined to pensioners or people in special need.

If a participating midwife direct-bills, the participating midwife undertakes to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient. Under these arrangements:‑

· The patient's Medicare card number must be quoted on all direct‑bill forms for that patient.

· The basic forms provided are loose leaf to enable the patient details to be imprinted from the Medicare card.

· The forms include information required by Regulations under Subsection 19(6) of the Health Insurance Act.

· The practitioner must include the particulars relating to the professional service out on the assignment form before the patient signs the form and ensure that the patient to receive a copy of the form as soon as practicable after the patient signs it.

· Where a patient is unable to sign the assignment form the signature of the patient's parent, guardian or other responsible person (other than the practitioner, practitioner's staff, hospital proprietor, hospital staff, residential aged care facility proprietor or residential aged care facility staff) is acceptable. The reason the patient is unable to sign should also be stated.

The administration of the direct‑billing arrangements under Medicare as well as the payment of Medicare benefits on patient claims is the responsibility of the Department of Human Services. Any enquiries in regard to these matters should therefore be directed to Medicare offices or enquiry points.

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