This practice aims to provide excellent specialist medical care. In order to provide this service an appropriate fee must be charged to cover running costs. The cost of providing medical care (including overheads, secretarial support, office space, stationery, and so on) continues to increase with inflation. However the Medicare rebate has not changed significantly for a few years. In fact Medicare will only pay up to 85% of the fee it sets. It is not indexed to inflation or average weekly earnings. It is set by the government, as an amount that the government is willing to pay to help subsidise medical care for Australians. It does not reflect the actual cost or value of the service. Indeed the AMA has published a list of fees, which have increased in line with inflation, and are held to be fair remuneration for the service provided. These fees are substantially higher than the Medicare rebate. I do not intend to charge fees at AMA levels, but the fees will be higher than the Medicare rebate, so a “gap” payment will be required from the patient. The table below indicates the approximate fees, and the Medicare rebate for outpatient consultations. Note the Medicare rebate was frozen from 2012 – 2019.
Fee Examples
| ITEM | Description | AMA Fee | Your Medicare Rebate | MY FEE |
| 132 | Initial consultation- Management Plan | $650.00 | $249.40 | $490.00 |
| 110 | Initial consultation | $400.00 | $142.65 | $370.00 |
| 116 | Review consultation | $195.00 | $71.40 | $140.00 |
| 30084 | Bone marrow trephine | $175.00 | $54.80 | $140.00 |
| 13757 | Venesection | $185.00 | $67.95 | $68.00 |
| 13950 | Chemotherapy | $275.00 | $100.60 | $150.00 |
Note: Fees for in-patient services will be different. Private Health Funds will pay towards the costs. These services are indicated by an * after the item number on the account. For most private health funds the account for in-patient services is sent directly to the fund for payment, and generally no patient payment is required (Gap Cover).
Most specialists, and many GPs, cannot sustain their quality services by accepting the government fee alone. We are happy to discuss the fees charged at any time. This letter explains the reasoning behind the “gap”.
Finally payment of accounts is required on the day of the consultation. EFTPOS and credit card facilities are available. Administrative costs incurred in recovering excessively overdue payments will be passed on, and added to the account. Discounted fees will also revert to full AMA rates.
Payment methods:
- Cash
- EFTPOS
- Credit Card: Visa or Mastercard
Medicare Online is now available – after payment we can send the claim to Medicare for the rebate to be deposited to your account directly.
MEDICARE
Medicare is the Federal government organisation that administers rebates for eligible medical services.
Medicare rebates are set by government. All Australians have a Medicare Number and Card.
Medical accounts from GPs, Specialists, private Hospital admissions, Pathology and Radiology can be presented to Medicare for payment of a rebate. The rebate will pay towards the cost of the service.
The eligible services are Medical Services provided by private GPs and Specialists as well as private in-patient hospital admissions.
PRIVATE HEALTH FUND
Health Funds are allowed by legislation to cover in-patient hospital admissions (including day-case procedures) and not out-patient Medical services.
Health Funds pay the difference between the Medicare rebate and the Schedule Fee (or a higher amount if the doctor participates in Simplified Billing and Gap Cover arrangements with the health Fund.
Health Funds will also pay towards drugs, physiotherapy, pathology and radiology for private in-patients.
STATE GOVERNMENT PUBLIC HOSPITALS
The State Governments are responsible for providing, and funding, State Public Hospitals. Public patients in these hospitals are not eligible for Federal Medicare rebates, nor Health Fund payments (unless they are private patients in a public hospital).
Accounts will be handled as follows:
- Out-patient clinic visits: The Account is paid to the doctor at the consultation. The receipt is then presented to Medicare for the rebate, which will then be deposited by Medicare to the patient’s bank account.
- Accounts for Private Hospital in-patient admissions may be sent directly to the patient’s Health Fund by the doctor. In this scheme ( Simplified Billing and “gap cover”) the Health Fund will pay the total account to the doctor. The Health Fund then receives the Medicare rebate portion from Medicare. This simplifies the process of separate dealings with Medicare, Health Fund and Doctor for the patient.
- Some Health Funds do not participate in the Simplified Billing or Gap Cover schemes. The account for Private Hospital in-patient admissions will then be sent to the patient to pay, then claim medicare and health fund rebates.