Everything you need to know about requiring a Medicare provider number
If you are going to be treating private patients in Australia, read the expert advice from our Regulatory team about how to get a Medicare provider number.
To treat private patients in Australia, you need to have a Medicare provider number. A Medicare provider number allows your patients to claim Medicare benefits for the services you provide.
Eligibility to access Medicare benefits is determined by the Health Insurance Act 1973 (the Act), which is administered by the Department of Health and Ageing. In particular, section 19AB impose a number of restrictions on access to Medicare benefits and must be satisfied before access to Medicare benefits can be granted.
What is Section 19AB
Section 19AB of the Act restricts Overseas Trained Doctor (OTD) or Foreign Graduate of an Accredited Medical School (FGAMS) from accessing Medicare benefits arrangements for a period of generally 10 years from the date of their first Australian medical registration. These restrictions are referred to as the ‘the 10-year moratorium’.
Who is restricted under section 19AB?
Medical practitioners who were first registered in Australia after 1 January 1997 and who meet the definition of an OTD or FGAMS are restricted under section 19AB.
You are considered an Overseas Trained Doctor (OTD) if your primary medical qualification was not obtained from an accredited medical school located in Australia or New Zealand.
You are considered a Foreign Graduate of an Accredited Medical School (FGAMS) if you obtained your primary medical qualification from an accredited medical school in Australia or New Zealand, and were not a permanent resident or citizen of Australia or New Zealand at the time you are enrolled.
What does this mean?
If you obtained your qualifications outside Australia or New Zealand and are applying for initial registration in Australia, section 19AB requires you to work in a District of Workforce Shortage (DWS) for a period of up to 10 years from the date of your first medical registration.
What is a DWS?
A district of workforce shortage (DWS) is a geographical area in which the local population has less access to Medicare-subsidised medical services when compared to the national average. These areas are identified using the latest Medicare billing statistics and are updated on an annual basis to account for changes in the composition and geographic distribution of the Australian medical workforce, and the latest residential population estimates as provided by the Australian Bureau of Statistics (ABS).
DWS classifications for general practice are generally provided for geographic areas that are referred to as SA2 boundaries. For specialties other than general practice, SA3 boundaries are used as the relevant DWS Assessment Area.
What happens if the area loses DWS status by the time I obtain registration?
The Department will consider whether the local area was DWS when employment negotiations commenced, which means you would normally qualify for a section 19AB exemption if you can show the area was considered DWS at the time you signed your contract.
Can I be exempt from working in a DWS?
There are a number of considerations for section 19AB exemptions, which include:
After-hours Exemption: the after-hours period is considered DWS Australia-wide for all medical specialties. As such, you would generally be able to obtain a section 19AB exemption to access Medicare benefits during the after-hours period anywhere in Australia. The after-hours period is defined by the Department as:
6pm to 8am Monday to Friday; and
All day Saturday, Sunday and Public Holidays.
Locum Exemption: you may be eligible for a section 19AB exemption to access Medicare benefits in a non-DWS location for a maximum of 6 months. You would not be able to work at that particular location beyond the 6 months while you remain subject to section 19AB.
Replacement Provision: you may be able to replace a restricted medical practitioner who held a section 19AB exemption and ceased practising in the local area within the last 12 months.
Spousal Exemption: you may be granted access to Medicare benefits in a non-DWS area if your spouse is accessing Medicare benefits in the local area, or is a skilled migrant (other than a medical practitioner) who is employed in an occupation which is listed on the Short-term Skilled Occupation List (STSOL) or the Medium and Long-term Strategic Skills List (MLTSSL).
Academic Provision: if you have been offered an academic appointment with an Australian medical school, you may be eligible to access Medicare benefits at the university health clinic that is tied to the academic institution.
Class Exemption: the following specialties are covered by a class exemption and considered DWS Australia-wide: cardiothoracic surgery, dermatology, emergency medicine, endocrinology, geriatric medicine, gastroenterology, general medicine, haematology, intensive care medicine, nephrology, neurology, neurosurgery, orthopaedic surgery, paediatric medicine, paediatric surgery, plastic and reconstructive surgery, urology, and vascular surgery.
You may also be interested to know that if you obtain a full-time ongoing s19AB exemption to practise at a particular location, you would generally be able to access Medicare benefits at another location in the same local area (SA2 or SA3 depending on your specialty), on the basis that you are already contributing to the Medicare billing statistics within the area.
How can we help?
We're lucky to have a team of five Regulatory and Migration experts in-house at Wavelength, including two Registered Migration Agents to help our Doctors through the process of applying for Medicare provider numbers and so much more. All Doctors working with us to secure a new job gain access to their expertise, advice and assistance with Medicare and AHPRA applications, as well as immigration visas.