Assignment of benefit in Medicare bulk billing 011-25092442

When a health professional chooses to bulk bill a patient, a completed assignment of benefit agreement must be received from the assignor. This signifies an agreement between the health professional and the patient, allowing a provider to accept the Medicare benefit as full payment for the service.

From 1 July 2026, the following changes apply to the assignment of benefit policy and process:

• Assignment of benefit can happen either before or after the service is provided to the patient. See pre-assignment and post-assignment
• An assignment can be made electronically or on paper. See assignment agreement options
• An approved assignment of benefit form is no longer required, but the agreement must specify particular information. See the Resources page. Health professionals must keep an electronic copy of the assignment of benefit agreement for 2 years from the date the claim is made. See record keeping requirements
• The patient 'unable to sign' indicator will no longer be available

A pre-assignment agreement is an agreement entered into before the service is provided.

Note: the item number may not be known before the service is provided. For this reason, the health professional must include a description of the service. The provider can choose the correct description from a list supplied by Department of Health, Disability and Ageing (DHDA).

A pre-assignment could:

• happen through the practice booking software
• be sent by text message with a link to an agreement form, or
• be in writing.

The agreement must include the required particulars, see the Resources page for this list.

A post-assignment agreement is an agreement entered into after the service is provided.

A post-assignment could:

• happen through the practice booking software
• be sent by text message with a link to an agreement form, or
• be in writing

The agreement must include the required particulars, see the Resources page for this list.

An assignment can be made electronically or on paper. Examples include:

Electronic assignment examples

• The assignment agreement particulars are emailed to the patient. The assignor responds agreeing to the assignment
• The assignment agreement particulars are part of the practice booking software, and when the patient books their appointment, they agree to the assignment
• The practice sends the patient a text message with a link to a form that includes the assignment agreement details. The assignor accepts the assignment through a check box on the agreement.

Note: for Medicare Easyclaim, patients assign their right to a Medicare benefit by pressing the OK or YES button on the EFTPOS terminal in the practice.

Paper-based assignment examples

• The practice creates its own paper form with the assignment agreement particulars. The assignor physically signs this form
• The health professional prints the HPOS Assignment of Benefit form when lodging a bulk bill Webclaim. The assignor physically signs this form
• The health professional prints the Medicare Online Assignment of Benefit form when lodging a bulk bill claim through practice management software

Health professionals can still use the standard Services Australia assignment of benefit forms, but this is not mandatory. If the standard form is used, the claim must be marked as pre assigned or post assigned.

If the claim was:

• pre-assigned, the health professional must tick the relevant response and attach the pre-assignment agreement with the standard form
• assigned after the service has been provided, the health professional must make sure that the assignor signs the standard form

A basic service description is required for pre-assignment agreements. It gives the assignor some context about the service(s) expected to be provided.

Each item in the general medical services table will be allocated to one of the basic service description categories. Categories are based on:

• service characteristics
• time-tiering, and
• compliance considerations

The Department of Health, Disability and Ageing (DHDA) manage the categories. DHDA will also publish the descriptions as a file on MBS Online, like it does for MBS updates. Software vendors must keep software up to date using these files.

To view the basic service descriptions, see the Resources page for a link to MBS Online.

Note: basic service descriptions are not required for pre-assignment in pathology or diagnostic imaging.

A statement of assignor’s agreement must be included in pre-assignment agreements for both pathology and diagnostic imaging services.

For pathology services

This is a statement that the agreement, is the assignor’s agreement to assign their right to the payment of Medicare benefit payment for a:

• pathologist determinable service, and
• service not described in the agreement

For diagnostic imaging services

This is a statement that the agreement, is the assignor’s agreement to assign their right to the Medicare benefit payment for:

• an approved service, and
• a service not described in the agreement, but is deemed:
  • necessary by the rendering professional or
  • more suitable for diagnosing the patient's condition

See the Resources page for examples of how this may be displayed on a pre-assignment agreement.

It is mandatory for the date the patient or assignor assigned the benefit to be clearly stated on the agreement. This includes the patient writing the date in the signature field on the relevant bulk bill form.

If the date the patient assigned the benefit is not included on the agreement, the claim must be returned with a letter.

Health professionals must keep a copy of the assignment of benefit agreement for 2 years from the date the claim is made.

Patients do not need to keep a copy of the assignment of benefit agreement. The health professional must provide a copy if requested.

The person who is required to sign an assignment of benefit agreement is the person who:

• incurred the medical expense for the service provided, and
• would in the absence of the assignment, be entitled to payment of the Medicare benefit

This is not always the same person as the patient.

'Responsible person' is an adult person accompanying the patient or in whose care the patient has been placed. A responsible person can include someone who:

• is the parent or guardian
• holds power of attorney
• holds a guardianship order
• is the next of kin

This does not include the:

• health professional who rendered the service
• health professional's staff
• hospital proprietor or staff, or
• residential aged care facility proprietor or staff

After 1 July 2026, the 'unable to sign' indicator will no longer be an option for submitted bulk bill claims.

Claims submitted with 'unable to sign' indicators on or after this date must be returned with a letter.

The health professional and patient must have entered into a bulk bill agreement at the time of service. The patient must sign the assignment of benefit form.

Where a signature is not obtained from a patient, a signature from a responsible person is acceptable. A responsible person can be:

• the executor of the will
• an appointed administrator

Note: 'patient deceased' is not a sufficient reason for a health professional not getting a signature on the assignment of benefit form. The patient, assignor or the responsible person must sign the form.

A patient's refusal to sign the assignment of benefit form:

• is different from a patient being unable to sign the form. Patients refusing to sign the form is between the patient and the health professional
• it means that the patient and the health professional cannot enter into an agreement for bulk billing

The Department of Health, Disability and Ageing (DHDA) had a temporary policy change for health professionals getting patient agreement for an assignment of benefit for face-to-face services.

This change applied from 13 March 2020 to 21 September 2023 and only applied to claims for services provided during this time.

Where a patient was seen face to face and the health professional chose to bulk bill, reasonable steps were required to get a signature agreement. For example:

• Written signature
• Medicare Easyclaim, patient selected either the OK or Yes button on the EFTPOS terminal
• Email agreement, or
• Signature of a responsible third party

If the patient refused to sign the form (did not want to touch the pen or paper), the health professional could get the agreement verbally. To do this the health professional was required to:

• identify on the form that the patient was unable to sign the assignment of benefit and include the reason. For example, COVID-19, risk of exposure to COVID-19, verbal agreement given
• note the verbal agreement of assignment of benefit in the patient's clinical notes

Pathology services

Assignment agreements on a referral for pathology tests issued up to 12 months before 1 July 2026, are accepted and valid until 1 July 2027.

Services provided before 1 July 2026 but claimed after 1 July 2026

A new assignment data set is required as evidence of the assignor's agreement.

A new assignment agreement is required:

• to support a manual claim, or
• for a resubmitted claim made from 1 July 2026, for services provided before 1 July 2026

The Department of Health, Disability and Ageing (DHDA) is progressing regulatory changes to support a 12-month transition period for the assignment of benefit changes.

During the transition period:

• DHDA permit verbal assignment of benefit for all bulk billed patients in all settings
• health professionals must keep records of these arrangements for 2 years
• the use of verbal assignment of benefit does not remove the requirement to maintain these records

Note: during the transition period, some health professionals may not have access to software that has been updated to support the new assignment changes. In these cases, they should use the pre-assignment template available on the DHDA website to record the assignment of benefit.

The Resources page contains a link to DHDA website 'Update to Assignment of Medicare Benefit requirements - Bulk billing' with templates.

Manual bulk bill claims

If a provider lodges a manual bulk bill claim when there is a verbal assignment, they must write 'assignor verbally agreed' in the assignor signature field.

Eligible patients may enter into an enduring assignment of benefit agreement for ongoing general practitioners (GP) bulk billed services. This includes:

• MyMedicare registered patients
• aged care residents
• patients getting services from an:
  • Aboriginal Community Controlled Health Organisation (ACCHO), or
  • Aboriginal Medical Service (AMS)

An enduring assignment of benefit agreement may be completed by:

• the patient, or
• a person acting on the patient's behalf where appropriate

The following arrangements apply:

• MyMedicare patients may complete one enduring agreement covering services provided by all general practitioners at their registered MyMedicare practice (where offered)
• ACCHO and AMS patients may complete an enduring agreement with the ACCHO or AMS. Patients may have enduring agreements with multiple ACCHOs or AMSs
• Residential aged care residents may have multiple enduring agreements with different practitioners

To establish an enduring agreement of benefit:

• Patients/person acting on the patient's behalf must complete an enduring agreements template
• Completed templates must be retained by health professionals for the duration of the agreement

The Resources page contains a link to the templates.

Manual bulk bill claims

If a provider:

• lodges a manual bulk bill claim when there is an enduring assignment, they must write enduring assignment provided in the assignor signature field
• writes this, it overrides the need for pre or post assignment on the DB (Direct Billing) form for staff to select and then process the claim

The Department of Health, Disability and Ageing (DHDA) are responsible for post-payment compliance.