Medicare Benefits Schedule explained: What changes are coming On July 1
Doctors are concerned patients could be thousands out of pocket following a sweeping number of changes to the Medicare rebate.
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Patients could be forced to pay thousands of dollars in out of pocket costs for some surgeries following sweeping changes to Medicare rebate payments.
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.
What are the changes to the Medicare rebate?
The Medicare Benefits Schedule is a list of medical services subsidised by the Australian government to help make health care more affordable.
If your GP or specialist charges more than the MBS fee, Medicare only pays the benefit set out in the schedule and you have to pay the rest out of pocket.
From July 1, a number of changes will be made to the list, mainly relating to general surgery, orthopaedic and cardiac services.
At this stage, there’s no specific information about how much the changes will cost patients. It could be anything from a few hundred dollars to more than $10,000.
According to Australian Medical Association president Dr Omar Khorshid, there are many different surgeries on the list and it’s too early for doctors to say what each procedure will cost under the amendments.
“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,” he says.
Why is the Medicare Benefit Schedule changing?
Since 2015, a clinician-led task force made up of doctors, patient advocates and academics has been gradually reviewing more than 5,700 items listed on the MBS to modernise it.
They refine the list with the intention of ensuring patients are accessing best clinical practice rather than outdated and potentially risky services.
In the past, changes have included removing spinal fusion after it was found to be an ineffective treatment for chronic lower back pain.
Why are changes to Medicare benefits an issue?
Dr Khorshid says the rebate changes have been made without providing enough notice or information to the healthcare sector.
As a result, the payment processes and schedules of surgeons are not yet updated which, when combined with the fact that public hospital wait times for elective surgery continue to blow out, means many Aussies could be left with soaring out-of-pocket costs
“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,” Dr Khorshid 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.”
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