Law Compliance Report - current edition - Report - Page 4
simpli昀椀ed billing by assignment arrangements where
a service is provided as part of hospital treatment or
hospital-substitute treatment:
where the assignor, being a private health insurer, has
an agreement regarding fees for the service, the bene昀椀t
will be taken to be assigned to the insurer unless the
bene昀椀t is claimed by an approved billing agent;
where the assignor makes a request to the provider of
the service (the operator of the hospital for hospital
treatment, and the organisation or the professional
for hospital-substitute treatment) that the bene昀椀t
be assigned to their insurer or an approved billing
agent, then the bene昀椀t will be taken to be assigned in
accordance with the request;
where the service is related to another service,
but unplanned, such as for treatment provided for
complications, the bene昀椀t will be taken to be assigned
to the insurer or approved billing agent.
Assignor of Medicare bene昀椀t to be given noti昀椀cations
On 1 July 2026, section 127 of the Act will be replaced
with various offences to ensure assignors of Medicare
bene昀椀ts are given noti昀椀cations and are able to review
information relating to the assignment of their bene昀椀t. For
example, it will be an offence if a professional (mentioned
in section 20A(1)(b) of the Act) does not provide the
assignor with a copy of the terms of the agreement as
soon as practicable after requested by the assignor.
Similar offences apply to responsible providers, insurers or
approved billing agents. The civil penalty for the offences
in section 127 will be 5 penalty units (currently $1,650.00).
Record-keeping in relation to assignments
New section 127A of the Act (commencing on 1 July
2026) introduces new record keeping requirements
for relevant persons under the Act. A relevant person
includes an approved billing agent, or a professional
(mentioned in section 20A(1) of the Act). Moreover, if the
right to the payment of a Medicare bene昀椀t in respect of a
professional service is taken to have been assigned and
the professional service was rendered by, or on behalf
of, the professional while hospital treatment or hospitalsubstitute treatment was provided, then the following
persons are also relevant persons:
for hospital treatment authorised by the operator of a
hospital—the operator of the hospital;
for hospital-substitute treatment authorised by an
organisation—the organisation;
in the case of hospital-substitute treatment to which the
above dot point does not apply—the professional.
The civil penalty for breaching section 127A of the Act is
5 penalty units (currently $1,650.00).
In short, section 127A requires a relevant person to keep
all records speci昀椀ed by the Regulations which are relevant
to the assignment of the right to payment of a Medicare
bene昀椀t to the relevant person, any claim for a Medicare
bene昀椀t assigned to the relevant person, or any matter
speci昀椀ed in the Regulations. The records must be kept in
electronic form or another form approved by the Secretary.
Importantly, regulation 89A of the Regulations will require
professionals who enter into an agreement under section
20A(1) of the Act to assign a Medicare bene昀椀t in respect
of a professional service and who make a claim for the
Medicare bene昀椀t, in accordance with the agreement under
section 20B of the Act to keep a copy of the agreement.
Furthermore, regulation 89D requires the records to be
retained for certain periods. By way of example, records
or a copy of an arrangement mentioned in section 20AAA
of the Act must be retained for 7 years after the day the
arrangement ceases to be in force. Moreover, a copy of
the modi昀椀cation to such a request and the assignor’s
written approval of the modi昀椀cation must be retained for
7 years after the day the request was so modi昀椀ed.
Failure to retain the records for the required period is an
offence under new section 127A of the Act with a penalty
of 5 penalty units (currently $1,650.00).
What you should do
Health service organisations should circulate this article to relevant staff to ensure they are made aware of the new
assignment of Medicare bene昀椀t requirements which will commence on 1 July 2026. In particular, health service
organisations should ensure record-keeping processes are established to retain the relevant records for the required time
periods.
We understand that the Department of Health, Disability and Ageing are currently working to create digital solutions to
improve the Medicare payment processes and more information about these digital solutions will be made available by the
Department in due course, in preparation for 1 July 2026.
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August 2026 Edition | Law Compliance Report
