How Does Medicare Work, and What Does Bulk Billing Mean?

If you're an overseas-trained GP making the move to Australia, you're likely required to work in a Distribution Priority Area (DPA) for up to 10 years.

This is part of what's known as the 10-year moratorium, a policy that ensures communities in areas of workforce shortage, often regional or outer metro locations, have better access to doctors.

Whether you’ve found a job through our service or secured your own position and just need help applying for a Medicare provider number, one thing almost every GP tells us is: “Medicare is confusing!” And they’re right, it can be. But once you understand the basics, Medicare and billing will start to make more sense. This guide breaks it down in a way that’s clear, simple, and tailored to you as a GP new to the Australian system.

What Is Medicare?

Medicare is Australia's publicly funded health insurance scheme. It gives patients access to free or subsidised healthcare services including GP visits, specialist appointments, tests and imaging, and some hospital treatments.

As a GP, Medicare is how you get paid for seeing patients. Your patients use their Medicare card, and you use your Medicare provider number to bill the government for eligible services.

What Is a Medicare Provider Number?

Before you can bill Medicare or start working in a clinic, you need to apply for a Medicare provider number. This is linked to:

• Your identity as a GP
• The specific location where you’re working
• The fact that you’re working in a DPA area (as prescribed under the Health Insurance Act 1973)

You’ll often need to go through a few steps first like getting AHPRA registration, a visa, and possibly a 19AB/19AA exemption before applying for the provider number. This is something we help many doctors with.

What Does ‘Bulk Billing’ Mean?

Bulk billing is the most common billing method in general practice. It simply means:

• You don’t charge the patient
• You bill Medicare directly
• You accept the Medicare rebate as full payment for the consultation

Let’s say you see a patient for a standard consultation (item 23). The current rebate is around $41.40. If you bulk bill:

1. The patient gives you their Medicare card.
2. You submit the claim electronically to Medicare.
3. Medicare pays you the $41.40.

The patient pays nothing. You get paid automatically, often within a day or two.

What If You Don’t Bulk Bill?

Some clinics use a mixed billing model, where patients pay a gap fee above the Medicare rebate. For example:

• The clinic charges $80
• The patient gets $41.40 back from Medicare
• The difference ($38.60) is the 'gap' they pay out of pocket

As a new GP in a DPA area, most of the clinics you’ll work at are likely to be bulk billing or mixed billing. The exact model will depend on the clinic's policies and location.

Tips for Understanding Medicare and Billing

1. Learn the MBS: The Medicare Benefits Schedule (MBS) is the list of item numbers and rebates for every service you can bill. You’ll need to know common item numbers like 23, 36, and 721/723 for care plans.
2. Use the Software: Most practices use software like Best Practice or MedicalDirector that integrates billing into your workflow making it easier to select item numbers and submit claims.
3. Ask for Help: Billing is a skill, and it’s okay to ask your practice manager, supervisor, or billing support staff when you’re unsure.

Starting your GP career in Australia comes with a steep learning curve, but understanding how Medicare and bulk billing work is a major first step. With the right support and a bit of practice, you’ll soon be billing with confidence and focusing on what you do best: providing great care to your patients.

Need help applying for your Medicare provider number or finding a job in a DPA location? We specialise in supporting overseas-trained GPs with everything from paperwork to placement. Contact us today! We’re here to make the transition smooth and stress-free.