Why Doctors Need to Get Serious About MBS Education
When Australian doctors graduate from medical school, they’re equipped to diagnose, treat, and save lives — but not to bill. Despite working in a system where Medicare is the financial backbone of healthcare, most doctors receive little to no formal education on the Medicare Benefits Schedule (MBS) or the complex rules that govern medical billing. This knowledge gap isn’t just an administrative oversight — it’s a legal and financial risk with real consequences.
The Scope of the Problem
The MBS is not intuitive. It’s a vast, ever-evolving document filled with item numbers, explanatory notes, restrictions, and dependencies. Yet doctors are expected to bill correctly from day one. Most learn “on the job,” relying on hand-me-down advice from colleagues, office managers, or hospital finance teams. Unfortunately, this informal approach often results in mistakes, not out of dishonesty, but simply because the rules are not well understood.
Studies and audits by the Department of Health and the Professional Services Review (PSR) consistently show that incorrect billing is widespread across specialties, settings, and seniority levels. While some errors lead to underbilling, many expose doctors to significant risk, including:
- Medicare audits and repayments
- PSR investigations
- Legal costs and reputational damage
- Potential suspension from Medicare or restricitions on medical billing
Why the Risk Is Growing
The compliance environment is tightening. Medicare is under increasing pressure to ensure public money is used appropriately, particularly in the wake of media scrutiny and budget constraints. As a result, doctors are more likely than ever to be audited — and with the complexity of the system, it doesn’t take intentional wrongdoing to find yourself in trouble.
Even seemingly minor errors — such as billing an initial attendance instead of a subsequent, or failing to document time-based consultations accurately — can lead to repayments or more serious consequences.
What Needs to Change
- Formal MBS Education: Billing should be a standard part of medical training, not something learned by trial and error. Just as doctors are taught pharmacology and procedural technique, they should also be taught how to engage ethically and legally with Medicare.
- Clearer Guidance: The current MBS structure lacks practical, real-world examples and often leaves clinicians guessing. Government agencies and professional colleges need to offer more accessible, specialty-specific guidance.
- Proactive Learning: Until structural changes occur, doctors must take ownership of their billing education. This includes attending webinars, reading updates, asking questions, and keeping accurate documentation for every bill.
The Bottom Line
Incorrect billing is not just a paperwork problem — it’s a professional risk. As clinicians, we would never treat a patient without understanding the relevant guidelines. Yet many of us bill daily without knowing the rules. It’s time to treat billing knowledge as a clinical competency — because ignorance is not a defence, and the stakes are high.
