Medicare Benefits

The Australian Government pays Medicare benefits to assist consumers with the cost of medical, optometrical and, in some cases, dental surgical services, provided on a private basis.

In this section:

MBS Online

contains the Medicare Benefits Schedule (MBS), A listing of the Medicare services subsidised by the Australian government. The Schedule is part of the wider Medicare Benefits Scheme managed by the Department of Health and Ageing and administered by Medicare Australia. MBS Online contains the latest MBS information and is updated as changes to the MBS occur. This site provides:

search the MBS functionality to allow both items and explanatiory notes to be easily accessed;
downloadable PDF versions of the MBS;
an email subscription to allow users to be notified of changes to the MBS; and
a create publication functionality whereby a dynamic PDF can be created based on preferred items

Professional Services Review

The Professional Services Review (PSR)is a statutory authority established by the Parliament of the Commonwealth of Australia to examine health practitioners’ conduct to ascertain whether or not they have:

practised inappropriately in relation to services which attract Medicare rebates; or
prescribed inappropriately under the Pharmaceutical Benefits Scheme.

The PSR was established in July 1994 as an agency within the Health Portfolio. It is independent of the Commonwealth Department of Health and Ageing and Medicare Australia. The PSR examines suspected cases of inappropriate practice referred by Medicare Australia.

Exposure Draft of the Health Insurance Amendment (Professional Services Review) Bill 2010

The Health Insurance Amendment (Professional Services Review) Bill 2010 is intended to increase the efficiency and effectiveness of the Professional Services Review (PSR) Scheme.

Medicare Benefits Statistics

Statistics on the numbers and value of Medicare benefits paid are at Medicare Benefits Statistics.
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How changes to the Medicare Benefits Schedule are decided

The need for changes to the way services currently included the Schedule are subsidised are considered by the Medicare Benefits Consultative Committee. Proposals for new treatments to be included in the Schedule are considered by the Medical Services Advisory Committee.
Medicare Benefits Consultative Committee
The Medicare Benefits Consultative Committee provides a forum for discussion between the Department and the medical profession on existing items in the Medicare Benefits Schedule (other than items covering diagnostic imaging and pathology items)

It provides for the review of an item or group of items in terms of adequacy of descriptions of items and fees for items and the existing structure of the Schedule but not so as to involve a general review of the overall fees throughout the Schedule, having regard to appropriate medical practice. The considerations of the Committee lead to amendments to the Medicare Benefits Schedule.

Membership of the Committee comprises representatives of the Department of Health and Ageine, Medicare Australia, the Australian Medical Association and the relevant craft or craft groups whose members have an interest in the items which are under review.

A similar committee operates when items concerning optometrical or certain dental services (such as those relating to cleft lip and palate conditions) are being reviewed, except memebership includes respectively the Optometrists Association Australia or the Australian Dental Association and the relevant dental craft group(s).

There are separate consultative arrangements for the Diagnostic Imaging and Pathology Services tables.
Medical Services Advisory Committee
The Medical Services Advisory Committee advises the Minister for Health and Ageing on the strength of evidence on new medical technologies and procedures in terms of their safety, effectiveness and cost effectiveness, and under what circumstances funding by the Medicare benefits should be supported.
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Legislation covering Medicare benefits

Medicare benefits are provided for by the Health Insurance Act 1973 which should be read in conjunction with the National Health Act 1953. These Acts and the Regulations made under them are available at the Australian Government ComLaw web site

Medicare Australia

Medicare benefits claims and payments are processed by Medicare Australia, now part of the portfolio of the Minister for Human Services . Medicare Offices are part of Medicare Australia. Medicare Australia internet site provides information for health service providers about how to work with Medicare benefits arrangements.

Medicare Australia Online

Medicare Australia Online increases convenience to patients and doctors by enabling medical practices to electronically lodge Medicare claims on the patient’s behalf.

Patients who are treated at a practice that uses Medicare Australia Online technology do not have to line up at their Medicare office to claim the Medicare rebate. Patients who pay in full can have their claims lodged by the GP or specialist surgery, and the Medicare rebate can be deposited into their bank account after a few days. This uses 21st century technology to improve convenience for patients.

Doctors whose practice uses Medicare Australia Online also benefit by reduced paperwork, quicker processing times and the ability to check a patient’s Medicare eligibility online.

Incentives for medical practices to connect to Medicare Australia Online are available to all general practices and specialists (except pathology - this is currently under negotiation). The incentive payments are $750 for metropolitan practices and $1,000 for rural practices.

More information on the Medicare Australia web site