Proposed 2025 Bulk Billing Changes

Navigating changes to bulk billing can feel overwhelming, but Cubiko is here to help you understand the potential impact of the Proposed 2025 Bulk Billing Changes on your practice.

This feature is available to our Best Practice software integration customers.

This feature is also available on the multisite dashboard. 

This dashboard provides a specific calculation based on historical data to help you decide what to do in response to the changes. 

It is built to answer the question: if the practice continued to provide the same services to the same patients, how might your billings change under the new arrangements?

This dashboard is designed to give you hard numbers and clear projections based on your data, so you can make informed decisions about the future of your practice.


To navigate to this dashboard, head to the Industry Updates tab > Proposed 2025 Bulk Billing changes

This article breaks down everything you need to know about the new dashboard and the upcoming changes. You'll learn how these changes might impact your revenue, patient care, and workflow, and find guidance on using the dashboard to get personalised projections.

The sections included in this article are:


The upcoming changes to bulk billing incentives and the key details, assumptions and limitations

Upcoming changes

The Australian Government has proposed changes to bulk billing incentives, which are set to roll out on the 1st of November 2025. 

The announcement includes two key changes which will impact practice revenue:

  • Expanded patient eligibility for bulk billing incentives: Bulk billing incentives will be available to all Medicare-eligible patients, rather than just concession card holders or those 15 and under.
  • Practice incentive payment: An additional 12.5% practice incentive payment will be available to practices that bulk bill all GP Non-referred attendances.

These metrics compare current billings to two different scenarios for what may happen after Nov 1, depending on how the practice and practitioners choose to bill:

  • Increased incentive availability: What would happen if the practice took advantage of the new incentives available to all bulk billed services.
  • Universal bulk billing: What would happen if the practice already is, or adopts universal bulk billing and claims the 12.5% practice incentive payment.

Cubiko has built this snapshot of Practice data and the impact of the proposed changes to bulk billing based on the information and resources available. To provide a useful result, we have made several assumptions about how the bulk billing changes will be implemented. These assumptions are listed on the cabinet for your benefit, make sure they apply to the individual characteristics of your practice and business. Cubiko will update the information we provide as the situation evolves.

Navigate to the dashboard and select the "Modelling and Assumptions" tab for a comprehensive overview of the key details, assumptions, and limitations, including:

  • Pattern of services and services provided
  • Bulk billing incentives
  • Patient eligibility
  • Practice incentive payment


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Getting started and using the dashboard

To navigate the Proposed 2025 Bulk Billing Changes Dashboard, follow these steps for personalised insights into how the changes will affect your practice.

1. Modified Monash Model

Please select the appropriate Modified Monash Model region from the dropdown to ensure the correct calculations apply to your Practice.

2. Check and update your date range

The historical services and billings used for the calculations are reflective of the date range selected. 

3. Select Practitioner

By default, calculations include all Practitioners unless a specific Practitioner is selected. Use this filter to review data for individual Practitioners. You can also view detailed information for each Practitioner in the Practitioners tab.

4. Start on the Overview tab and review your data

The Overview tab gives you a high-level summary of how the upcoming changes may affect your practice's revenue.

These projections are based on your past services and assume that you’ll keep providing the same services but may change how you bill for them.


Overall effect

How do we calculate this?

Services are grouped based on:

  • Whether the service was a GP Non-referred attendance.
  • Whether the service was bulk billed or privately billed.
  • Whether a bulk billing incentive was claimed for the service.

This lets you see how the changes may impact different categories of services, as well as your overall revenue.

Key Metrics

  1. Billings - Your total historical billings based on services provided over the selected date range. This is the starting point for all calculations.
  2. Billings with increased incentive availability - Total billings if bulk billing incentives were applied to all eligible bulk billed services under the new rules.
  3. Billings if adopting universal bulk billing -Total billings if your practice fully bulk bills, including the 12.5% incentive payment and removing private gaps on relevant services.
  4. Current Service Mix - A breakdown of how your current services fit into key categories (e.g., bulk billed with/without incentives, privately billed). This helps you see how each group will be affected by the new rules.

What is the impact of the expanded incentive eligibility?

Even without changing billing patterns, practices will have access to additional incentives for more patients.

Key metrics:

  • Additional bulk billing incentives — Extra revenue available for bulk billed services that were previously ineligible for incentives.
  • Bulk billed services based on patient eligibility — A heatmap showing how many services were bulk billed, broken down by patient age and concession card.
  • Was an incentive charged for a bulk billing? — A chart showing what percentage of bulk billed services already have an incentive applied.

What is the impact if the practice adopts universal bulk billing?

If you fully bulk bill, including patients you currently charge gaps for, these changes will have a larger impact.

Key metrics:

  • Potential gap reduction: Revenue you would lose from no longer charging private gaps.
  • Potential bulk billing incentives: New incentive revenue available for services that were previously privately billed.
  • Practice incentive payment: Extra 12.5% revenue for every GP Non-referred attendance if fully bulk billed.
  • Bulk billings with an incentive: Value of current bulk billed services that would now attract an incentive.
  • Bulk billings without incentive: Value of current bulk billed services that would still not attract an incentive.
  • Mixed billings: Value of current mixed billing services if moved to bulk billing.
  • Other billings: Services that won't be impacted, such as custom items or non-GP services.

After reviewing the overall impact, visit the Practitioners tab to see how these changes would affect each individual Practitioner.

And the Services tab to explore specific services in detail.


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FAQ's and resources

Key Resources:

FAQ's

Q: What is the page looking at?
A: The announcement includes two key changes which will impact practice revenue:
  • Expanded patient eligibility for bulk billing incentives Bulk billing incentives will be available to all Medicare-eligible patients, rather than just concession card holders or those 15 and under. We look at services you already bulk bill, which do not currently attract an incentive due to the current patient eligibility status.
  • Practice incentive payment An additional 12.5% practice incentive payment will be available to practices that bulk bill all GP Non-referred attendances. 

Q: When are these changes meant to come into effect?
A: The announcement came from the current government, and was matched by the opposition. Both stated 1st November, but more details will likely be revealed as time goes on.
 
Q: What services are being included in the calculations?
A: We are including all non-referred attendances, we understand that these are the only services eligible to attract an incentive and to be calculated towards the ‘100%’ universal bulk billing, additional PIP payment.
 
Q: How is the 12.5% calculated? 
A:  Based on the information we have available, we are calculating the 12.5% loading payment on top of the rebate amount for all GP Non-referred attendances. Our understanding is that the practice will only be able to claim the 12.5% practice incentive payment if all of those GP Non-referred attendances are bulk billed.
 
Q: Do you include the incentives in the 12.5% PIP calculation?
A: We specifically don't apply the loading payment to bulk billing incentives, custom items, surgical procedures, and other non-GP NRA services.
 
Q: What are the calculations based on?
A: The calculations are based on the Practice’s historical billings, assuming that the service mix remains the same, you can change the period you are looking at in the date picker.
 
Q: How do I look at the incentives for my area?
A: Select the MM location from the filter before you begin using the page
 
Q: Are you looking at patients registered for MyMedicare to calculate the triple incentives?
A: No, not currently
 
Q: Are you looking at Medicare-eligible patients?
A: No, not currently.
 
Q: Can I calculate what portion of the PIP would come to the Practice if we decided to calculate a split?
A: Not currently, though the data is available to download by Practitioner, enabling you to make these calculations.