Services provided under rights of private practice at public hospital outpatient departments

This information will help you understand your legal obligations when billing under Medicare for private patients at public hospitals.

Page last updated: 18 January 2017

The term ‘outpatient departments’ refers to any part of a hospital, excluding the emergency department that provides non-admitted patient care.

Eligibility

    • under the Health Insurance Act 1973, a Medicare benefit cannot be paid for a professional service funded under an existing arrangement with the Australian Government or a state or territory government
    • when you bill under Medicare for services you provide under rights of private practice at a public hospital outpatient, pathology or diagnostic imaging department, make sure you understand and meet the legislative requirements. These include:
      • the patient must have chosen to be treated as a private patient
      • the patient is eligible for a Medicare benefit
      • the service is eligible and not already funded by other means
      • that you have received a referral that is valid for the purposes of billing specialist Medicare Benefit Scheme (MBS) consultation items, and
      • the correct MBS item number is billed for the service you provided
Under the National Health Reform Agreement an eligible patient presenting at a public hospital outpatient department will be treated free of charge as a public patient unless:
    • the patient has been referred to a named medical specialist who is exercising a right of private practice, and
    • the patient chooses to be treated as a private patient.

For more information

Stay up to date with the Medical Benefits Schedule at MBS Online and manage your billing by:

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