Bulk Billing vs Mixed Billing: What Australian Practices Need to Know in 2026

What Is Bulk Billing?

Bulk billing is a payment arrangement under Australia’s Medicare system where a healthcare provider bills Medicare directly for a consultation or eligible medical service, rather than charging the patient. The provider accepts the Medicare rebate as full payment, meaning the patient pays nothing out of pocket.

In practical terms, a bulk billed consultation follows this process:

• The patient attends their appointment
• The healthcare provider delivers the consultation or service
• The patient assigns the Medicare benefit to the provider
• The practice submits the Medicare claim electronically
• Medicare pays the rebate directly to the clinic

When a practice participates in BBPIP, they must bulk bill all eligible services for every eligible patient. In return, they receive an additional 12.5% incentive payment on every dollar of MBS benefit earned from eligible services, paid quarterly and split between the practice and the GP.

What Is Mixed Billing?

A mixed billing practice charges some patients an additional fee above the Medicare rebate. The patient pays the gap fee directly while Medicare contributes a rebate toward the consultation cost. The difference between the full consultation fee and the rebate is commonly referred to as the gap fee or out-of-pocket cost.

Mixed billing gives practices flexibility. A clinic may bulk bill concession card holders and children while charging a gap fee for standard adult consultations, or bulk bill certain appointment types while privately billing others.

How the 2025 Medicare Reforms Changed the Equation

For much of the past decade, bulk billing rates were in decline. Rising operating costs: staffing, software, insurance, accreditation, and rent, had outpaced Medicare rebate growth, making fully bulk billed healthcare increasingly difficult to sustain commercially.

The November 2025 reforms changed the financial calculus significantly. The BBPIP extended tripled bulk billing incentives to all Medicare-eligible patients, not just concession card holders and children. The result has been a substantial shift in practice behaviour across Australia.

According to Cleanbill’s 2026 Blue Report, 40.2% of Australian clinics now fully bulk bill a standard adult weekday consultation, up from just 20.7% in early 2025. Over 1,000 practices switched to full bulk billing on or around 1 November 2025.

Bulk Billing vs Mixed Billing: Key Differences for Practices

Choosing between the two models involves weighing financial sustainability, patient demographics, administrative complexity, and competitive positioning. Here is how the two models compare across the factors that matter most for practice owners and managers.

Revenue and financial sustainability

Full bulk billing under BBPIP now attracts a 12.5% loading on top of MBS benefits and standard bulk billing incentives, paid quarterly. For practices with high patient volumes, this can meaningfully improve the financial viability of a fully bulk billed model.

Mixed billing retains the ability to charge gap fees, which may be necessary for practices with complex, longer consultations, high operating costs, or patient demographics that support private fees. The trade-off is that mixed billing practices do not qualify for the BBPIP loading.

Patient access and community expectations

Bulk billing removes the financial barrier to care entirely, which improves access for all patients but particularly for those on low incomes, concession card holders, and families with children. With the Federal Government actively promoting bulk billing availability through health.gov.au and Healthdirect, patients increasingly expect their GP to offer bulk billed appointments.

Mixed billing practices may face growing pressure in price-sensitive demographics as more competitors move to fully bulk billed models, particularly in metropolitan areas where patient choice is high.

Administrative complexity

Full bulk billing under BBPIP introduces its own administrative requirements. Practices must register with MyMedicare, link all providers to the BBPIP-registered practice in the Organisation Register, and ensure all eligible services are bulk billed consistently to maintain eligibility. BBPIP payments are made quarterly in arrears, requiring practices to reconcile incentive payments against their MBS billing activity.

Mixed billing practices must manage two parallel payment workflows, Medicare claiming for bulk billed consultations alongside patient payment collection and reconciliation for privately billed services. Without integrated systems, this creates significant administrative overhead.

Competitive positioning

The rapid shift toward full bulk billing is reshaping the competitive landscape, particularly in metropolitan areas. Practices that have not yet reviewed their billing model risk losing patients to nearby clinics that have moved to BBPIP. At the same time, mixed billing remains viable, and in many cases preferable, for specialty-focused practices, procedural clinics, and those serving demographics where patients actively choose to pay for longer or more complex consultations.

Should Your Practice Switch to Full Bulk Billing?

There is no universal answer. The right billing model depends on your practice’s specific circumstances. Key questions to work through include:

• What is your current patient demographic and what proportion are concession card holders, families, or working adults who may pay gap fees?
• What are your practice’s operating costs per consultation, and does the BBPIP-adjusted MBS rebate cover them sustainably?
• How many of your local competitors have already moved to full bulk billing under BBPIP?
• What is your average consultation length and complexity? Longer and more complex consultations may not be adequately compensated under bulk billing rebates alone.
• Is your practice registered with MyMedicare, and are all providers linked appropriately in the Organisation Register?

Many practices that switched to full bulk billing on 1 November 2025 have described it as a six to twelve month trial. The medium-term picture is not yet fully settled, and the decision should be revisited as BBPIP payment data becomes available and the longer-term financial impact becomes clearer.

The Administrative Challenge Behind Both Models

Whether your practice operates under full bulk billing or a mixed model, the operational side of Medicare claiming is complex, and the 2025 reforms have added new layers of compliance and reconciliation work.

Billing workflows connect directly to appointments, clinical records, payment reconciliation, reporting, and Medicare compliance requirements. Without integrated systems, practices can quickly find themselves managing fragmented workflows across multiple platforms.

For mixed billing practices, managing the parallel workflows of Medicare claiming and private patient payments without a unified system increases the risk of:

• Billing errors and rejected Medicare claims
• Missed BBPIP eligibility due to inconsistent bulk billing
• Reconciliation issues between Medicare payments and practice revenue
• Administrative delays and front desk inefficiency

How Zedmed Supports Both Billing Models

Zedmed is purpose-built for Australian healthcare practices, and its integrated platform supports the billing, claiming, and operational workflows required for both full bulk billing and mixed billing models in 2026.

Integrated Medicare claiming workflows

Zedmed’s medical billing software supports Medicare claiming, bulk billing, private billing, DVA claiming, and health fund processing within a single workflow. Claims are submitted electronically directly from within the practice management system, reducing administrative overhead and improving billing accuracy across both models.

Appointment scheduling connected to billing

Zedmed’s medical booking software integrates appointments, billing, and patient records together, allowing clinics to streamline front desk operations while improving patient flow and reducing duplication across bulk billed and privately billed appointment types.

Payment processing and reconciliation

For mixed billing practices, Zedmed’s integrated Payment Gateway functionality helps practices process patient payments, manage gap fee collection, and reconcile revenue against Medicare payments, all within the same system used to submit Medicare claims.

Practice reporting and operational visibility

Through integrations including Cubiko practice analytics, practices can gain visibility over billing activity, appointment utilisation, revenue trends by billing type, and operational performance, the data needed to assess whether your current billing model is delivering the financial outcomes your practice requires.