The term ‘outpatient departments’ refers to any part of a hospital, excluding the emergency department that provides non-admitted patient care.
- under the Health Insurance Act 1973, a Medicare benefit cannot be paid for a professional service funded under an existing arrangement with the Australian Government or a state or territory government
- when you bill under Medicare for services you provide under rights of private practice at a public hospital outpatient, pathology or diagnostic imaging department, make sure you understand and meet the legislative requirements. These include:
- the patient must have chosen to be treated as a private patient
- the patient is eligible for a Medicare benefit
- the service is eligible and not already funded by other means
- that you have received a referral that is valid for the purposes of billing specialist Medicare Benefit Scheme (MBS) consultation items, and
- the correct MBS item number is billed for the service you provided
- the patient has been referred to a named medical specialist who is exercising a right of private practice, and
- the patient chooses to be treated as a private patient.
For more informationStay up to date with the Medical Benefits Schedule at MBS Online and manage your billing by:
- regularly checking details of all services billed to Medicare in your name or under your provider number
- referring to the substantiating services provided under rights of private practice at public hospital outpatient departments guideline. The guideline provides information about the documents you can use if you're asked to verify services rendered at public hospital outpatient departments as part of a Medicare Compliance audit
- referring to our case studies for practical examples of how to be compliant if billing under Medicare for services provided to private patients under rights of private practice at public hospital outpatient departments
- reviewing our information on billing Medicare in public hospitals to help you understand your legal obligations, and
- contacting us at firstname.lastname@example.org if you have any questions about Australian Government funding for public hospitals.