Medicare bulk billing incentives and direct-billing GP economics

The bulk billing incentive is a Commonwealth payment on top of the MBS rebate when a GP service is bulk billed, that is, when the rebate is accepted as full payment and the patient has no out-of-pocket cost. The MBS Online factsheet on the changes (last updated 1 September 2025) states that, subject to the passage of legislation, from 1 November 2025 bulk billing incentives can be claimed when any Medicare-eligible patient is bulk billed. In the factsheet's words, all Medicare-eligible patients will have the same access to "the tripled bulk billing incentives for the most common GP consultations".

The same factsheet describes a separate Bulk Billing Practice Incentive Program: "Those practices that join the Program and bulk bill all patients for all consultations will be eligible for a quarterly incentive of 12.5% of their MBS revenue." If a workplace has joined the program, ask whether, and how, that incentive is reflected in your service fee.

Which incentive item applies differs by Modified Monash area: the MBS Online GP tables list the applicable item for each area from MM 1 to MM 7. This guide gives you the method rather than dollar figures, so use the item descriptors on MBS Online for the amounts that apply on the date of service.

The incentive is not a rebate increase for privately billed services. A workplace that mix-bills (a private fee plus the Medicare rebate) does not collect the incentive on a service unless that patient is bulk billed.

Your own numbers depend on three things you can check before a placement:

• Your consult mix: how many short, standard and long consultations you bill, and which items they map to on MBS Online.
• Your bulk-billing share: the incentive applies only to services that are bulk billed, so a mixed-billing list collects it on fewer services.
• Location: the incentive item that applies differs by the Modified Monash area the workplace is in. The rural work and MMM guide shows the MMM 2023 category for a postcode; confirm the area MBS Online applies before relying on it.

Multiply each item count by its rebate plus any incentive that applies, using the MBS Online figures for the date of service, and you have a defensible gross for a shift. That is more reliable than any headline average.

Once you have a gross figure for a shift, the service fee decides what reaches you. Net to you is gross billings minus the service fee, which is a percentage of those billings. On a 45% fee you keep 55 cents of every billed dollar; on a 32% fee you keep 68 cents. An increase in bulk-billed income is real, but a service fee that rises at the same time can absorb much of it.

In Sessional, log the shift with the Percentage of billings pay basis, using the share you keep (for example 55% on a 45% service fee), and set the income source to direct patient billing. Enter the billing revenue once it is known and the shift total is calculated from it. The shift rate basis guide explains how each pay basis is calculated.

The Thomas and Naaz doctrine means a medical centre with contractor GPs can owe payroll tax on the GP's share of patient billings wherever the relevant-contract provisions apply. Several states have layered GP-specific relief on top, structured differently and mostly tied to bulk billing: Victoria, NSW, Queensland, South Australia, and the ACT. Where relevant-contract provisions apply and no GP-specific relief does, the exposure stays with the workplace. That is why the same change in bulk-billed income lands differently depending on where the workplace is:

• Workplaces still pricing in payroll tax (for example in the Northern Territory and Tasmania, which have no medical-centre specific relief, plus any workplace outside the relief conditions elsewhere, such as non-bulk-billed or specialist work): many workplaces have raised their service fees and given the payroll tax on the contractor's share as the reason. A higher fee absorbs much of any increase in billings, so compare the fee you are offered against what you were paying before.
• Victoria: the 1 July 2025 GP exemption applies to GP wages to the extent they relate to bulk-billed (fully funded) items, so the relief is proportional to the workplace's bulk-billing share. Where a workplace qualifies and its fee has held near the earlier level, more of any increase in bulk-billed income reaches you.
• NSW, QLD, SA, ACT: each added its own GP relief (a NSW rebate from 4 September 2024, a permanent QLD exemption from 1 December 2024, an SA bulk-billing exemption from 1 July 2024, and an ACT exemption from 1 July 2025), mostly conditional on bulk billing. Where a workplace genuinely bulk-bills and qualifies, the payroll-tax driver on the service fee is reduced and fees should reflect that; verify the workplace's position before assuming the higher fee is justified.
• Western Australia: RevenueWA says its payroll tax law is not harmonised with the other jurisdictions on contractors, so the relevant-contract reasoning behind higher fees elsewhere does not carry across directly. If a WA workplace cites payroll tax for a higher fee, ask how that position was assessed.

Each workplace you add in Sessional records its state, and the earnings dashboard filters by workplace, so you can see what each relationship actually paid you.

Agency GP rates do move, but not in step with what the host workplace bills. The reason is structural: the agency contracts a fixed day-rate with the host workplace, keeps its own margin, and pays the contractor GP. When the host workplace's bulk-billed income rises, the agency can negotiate a higher day-rate only on renewal, and then only if the host workplace is willing to share the increase.

Regional and rural agency rates vary with the workplace, roster and travel required; the rural work and MMM guide covers what to check before a rural placement. If your work is mostly agency-placed, expect any change to arrive as a slow rate-negotiation cycle rather than a windfall. Recording each agreed rate lets you see that cycle in the monthly breakdown, which shows your average rate and gross for each month.

Sessional shows what you record; it does not calculate rebates or model Medicare settings. Three parts of the app help you see how a change lands in your own numbers:

• Shift records: log direct-billing work with the percentage-of-billings pay basis and the direct patient billing income source, then enter the billing revenue once it is known. The shift total is the billing revenue multiplied by your agreed percentage.
• Earnings dashboard filters: choose the tax year, quarter, month or all time, or set a custom date range, and narrow by workplace or free-text search. The monthly breakdown lists shift count, average rate and gross for each month, and the earnings ledger lists every shift. To compare before and after a change, run the same workplace filter over two date ranges.
• Per-shift margin and CSV export: link expenses to shifts to see gross minus tagged costs for each shift, and export the shifts for a date range and workplace as a CSV for your tax agent.

See also the agency vs direct billing comparison for the end-to-end take-home frame, the earnings dashboard guide for every filter, and BAS preparation for how GST-free medical services are reported.

• Has the service fee changed since you joined, and why? If you joined the workplace on a 32% fee and the contract has since rolled to 45%, much of any increase in bulk-billed income has been absorbed by the workplace. Ask what the increase is pricing in.
• Which of your services does the workplace bulk bill, and does the contract say how incentive income is treated when the service fee is calculated?
• Is the service fee ex-GST or GST-inclusive? A 45% GST-inclusive fee is a different net to you than 45% ex-GST.
• If the workplace is in Victoria, has the service fee increased since 1 July 2025? If it has, the workplace may be charging more than its actual exemption position justifies.
• If the workplace is in NSW, QLD, or WA, does the contract state the payroll tax assumption used to derive the service fee? Clarity here makes future renegotiations easier.
• Is GST being applied correctly on the service fee line? Service fees charged by the workplace to the doctor attract GST; the doctor claims an input tax credit if GST-registered. The direct patient billing guide covers the arithmetic.