Claiming Medicare in public hospitals when exercising rights of private practice

Information to help you understand your legal obligations when billing under Medicare for services in public hospitals.

Page last updated: 23 December 2016

This applies to services provided under rights of private practice to both:

    • admitted, and
    • non-admitted patients, other than at an emergency department.

Eligibility

    • under the Health Insurance Act 1973, we cannot pay a Medicare benefit 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 to a private patient in a public hospital, make sure you understand and meet all requirements. These include that:
      • an admitted patient has elected to be treated privately
      • a non-admitted patient has chosen to be treated as a private patient
      • the patient is eligible for a Medicare benefit
      • you have received a referral that is valid for the purposes of billing MBS consultation items
      • you bill the correct MBS item number for the service you provided
      • a formal agreement exists that allows you to exercise a right of private practice at the public hospital
      • you have a right of private practice agreement, and
      • you are exercising your right of private practice when the service is rendered
Note: 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. This is 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:
    • regularly checking details of all services billed to Medicare in your name or under your provider number
    • referring to our case studies for practical examples of when to bill under Medicare for services provided to private patients in public hospitals
    • reviewing our information on billing Medicare in public hospitals to help you understand your legal obligations
    • contacting us at hospital.financing@health.gov.au if you have any questions about Australian Government funding for public hospitals.

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