What an AoB is
An assignment of benefit is a patient’s agreement to have their Medicare benefit paid to someone else. In bulk billing, that is the doctor who provides the service. Medicare pays the doctor directly, the doctor accepts the Medicare benefit as the full fee, and the patient pays nothing. For in-hospital services, the Medicare benefit is 75 percent of the MBS fee.
The AoB agreement is the record of that arrangement, and it is the legal basis for a bulk-billed claim.
When you need one
You need a valid AoB before you submit any bulk-billed Medicare claim. This applies in every setting: rooms, telehealth, aged care and hospital, including private inpatients. You don’t need one when the patient is privately billed and pays the account themselves. The new requirements also don’t apply to DVA-funded services.
Privately insured inpatients involve a separate assignment. When a claim goes through ECLIPSE, the patient assigns their Medicare benefit to their health fund (or an approved billing agent), so the fund can pay the Medicare and fund benefits together. This is called simplified billing. Many hospitals include this assignment in their admission paperwork, so check with each hospital where you work. If a hospital’s paperwork doesn’t include it, give your patients a written explanation of how their account will be processed. It should state that the Medicare component is collected and paid on their behalf.
What the agreement records
For a bulk-billed service other than pathology or diagnostic imaging, the agreement must record seven things:
| Before the service | After the service | |
|---|---|---|
| Patient name | ✓ | ✓ |
| Date of assignment | ✓ | ✓ |
| Assignment type | Pre-service | Post-service |
| Whether the patient is the assignor (yes or no) | ✓ | ✓ |
| Doctor’s name, and practice address or provider number | ✓ | ✓ |
| Date of service | ✓ | ✓ |
| The service | Basic service description | MBS item number(s) |
The patient, or someone authorised to act for them, signs the agreement on paper or electronically. An electronic signature can be a signature on a screen, a typed name or an “I accept” box. A YES reply to a text can also work if you can show who replied and what they were sent. It has to identify who agreed and show what they agreed to. The doctor doesn’t sign.
There is no longer a required government form. Any paper or electronic agreement is valid if it records all seven elements and the patient or assignor signs it.
Patients aged 14 or older can generally sign for themselves. A parent, guardian, carer or person with power of attorney can sign for a patient who can’t. The treating doctor and their staff should not sign as the assignor.
Before or after the service
Pre-service. The patient signs before the service. The exact item number usually isn’t known yet, so the agreement uses a basic service description instead. These descriptions are published by the Department on MBS Online, and each one groups related MBS items under a plain-language label. The agreement stays valid as long as the service delivered falls within that description. One pre-service agreement can also cover a series of planned services by the same doctor, up to six months ahead, as long as the agreement sets out the dates and services.
Post-service. The patient signs after the service and before the claim is submitted. The agreement lists the MBS items actually provided, so nothing needs to be predicted.
Both methods are valid, and a practice can use either one for any patient. A signed agreement can’t be edited. If the service falls outside a pre-service description, or a different doctor provides it, a new agreement is needed before the claim is submitted.
Verbal assignment until 30 June 2027
A transitional arrangement allows verbal assignment for bulk-billed services until 30 June 2027. The patient, or their assignor, agrees verbally instead of signing. You should record that they agreed verbally, keep that record with the agreement, and give the patient or assignor a copy if they ask. The agreement still needs the same seven elements as a signed one.
Keeping the record
You must keep each agreement for two years from the date of the claim and give the patient or assignor a copy if they ask. You don’t send agreements to Services Australia, except to support a manual claim, or if Services Australia asks.
How to implement this in your practice
- Choose pre-service or post-service for each kind of work. Pre-service suits planned work where the dates and services are known, such as a booked list or a series of visits up to six months ahead. Post-service suits work where the items aren’t known until afterwards. You can use both, and choose for each patient.
- Set up your agreement. Paper or electronic, it needs the seven elements and the patient’s or assignor’s signature. Show the patient the completed agreement before they sign. Bulk-billed diagnostic imaging and pathology use different elements, so check those separately.
- One agreement for each doctor. Every doctor who bulk bills the patient, such as the surgeon, the assistant and the anaesthetist, needs their own agreement.
- Keep service descriptions current. The basic service descriptions are updated with each MBS update, on 1 January, 1 March, 1 July and 1 November. Check your forms and software after each one.
- Brief your staff. They can collect agreements but must not sign as the assignor. A signed agreement can’t be changed, so if the service or the doctor changes, take a new agreement before the claim goes in.
- Record verbal agreements properly until 30 June 2027. Note that the patient agreed verbally, with the same seven elements, and keep it with the claim records. Have signed or electronic agreements running before the transition ends.
- Check each hospital’s admission paperwork. For privately insured inpatients claimed through ECLIPSE, confirm the hospital takes the simplified billing assignment.
- Store every agreement for two years. Keep them where you can produce one for the patient, a manual claim or a Services Australia request. The doctor stays responsible, even when a billing service keeps the records.
- Lodge bulk-billed claims within a year. Assigned bulk-billed benefits must be claimed within one year of the service.