Understanding the New Medicare Bulk Billing & BBPIP Reforms

Understanding the New Medicare Bulk Billing & BBPIP Reforms

  • October 20, 2025

From 1 November 2025, major updates to Australia’s Bulk Billing and Bulk Billing Practice Incentive Program (BBPIP) will come into effect, marking one of the most significant shifts in Medicare funding in recent years.

These reforms aim to strengthen primary care, reward bulk-billing GPs, and improve access to healthcare for patients. For practice owners and managers, understanding how these changes will affect your billing processes, incentive payments, and patient communication is essential. Whether your practice operates as fully bulk billing, mixed billing, or private billing, preparation and clarity will be key to ensuring a smooth transition.

Key Changes worth noting

  • Enrolment timeframe: Practices don’t have to register for MyMedicare (BBPIP) before 1 November, enrolment can happen anytime.
  • Eligibility requirements: All doctors in the practice must bulk bill all Nationally Registered Agreement (NRA) services to qualify for the BBPIP.
  • Additional incentive: The BBPIP is an extra incentive, not a replacement for existing PIP, WIP, or bulk-billing incentives.
  • Expanded eligibility: The bulk billing incentive now applies to all Medicare-eligible patients, not just those under 16 or concession card holders.
  • Scope of services: Skin procedures are excluded, practices may still privately charge for consumables, though skin checks themselves are considered a consultation and must be bulk billed.
  • Simplified payments: The 12.5% BBPIP incentive is automatically calculated by the Department of Health and Aged Care (DOHA) on a quarterly basis.
  • Split payments: Incentives are paid 50/50 between the practice and the doctor. GPs must set up banking details in MyMedicare via PRODA.
  • Decision support tools: The DOHA online calculators and Cubiko’s integrated calculator can help practices forecast financial outcomes before deciding whether to switch billing models.
  • Flexibility: Practices can withdraw from the BBPIP at any time, though re-educating patients about billing changes can be challenging.

Key Message

Review your data, communicate openly with your team, and keep your patients informed.

Whether you decide to remain mixed billing or move to full bulk billing, make sure your GPs, nurses, and admin staff are aligned on the approach and prepared to answer patient questions confidently.

Recommended Resources

Here are some official links and tools to support your practice:

Final Thoughts

These reforms represent an opportunity for practices to reassess their billing models, improve transparency, and ensure sustainability under the new Medicare framework. By using available tools, reviewing the data, and engaging the team, clinics can make confident, informed decisions that support both business and patient care.

If your practice would like support interpreting the new Bulk Billing and BBPIP reforms, or you’re looking to attract experienced GPs to strengthen your team, DXC Medical can help.

Contact:
Amy Dent
Principal Consultant
0412 174 152
amy.dent@dxcmedical.com.au 

 

 

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