10 Dec Bulk billing or mixed billing? Five strategy checks before you change your GP clinic fees
For many GP practices, the question of bulk billing vs mixed billing has become more complex, not less.
On paper, the expanded bulk billing incentives and the new Bulk Billing Practice Incentive Program (BBPIP) from 01/11/2025 make full bulk billing look attractive – particularly for clinics under financial pressure or facing competitive bulk billing offers nearby.
However, in a recent advisory engagement with a Melbourne GP clinic, a deeper item‑level analysis told a different story. Once we modelled the numbers, incentives, eligibility rules and operational impacts, a more nuanced conclusion emerged:
In many metropolitan settings, a selective mixed billing strategy can outperform full bulk billing on both revenue and sustainability, while still protecting access for priority cohorts.
Before you change your clinic’s fees, work through these five strategy checks.
1. Understand BBPIP eligibility and the “all‑or‑nothing” rule
From 1 November 2025, bulk billing incentives are expanded and BBPIP introduces an extra 12.5% incentive on eligible services, split between the GP and the practice. This is a significant policy shift, but it comes with a critical condition:
- To participate in BBPIP, a practice must bulk bill all eligible MBS services across all GPs.
- In practice, this is an all‑or‑nothing operational commitment. You cannot selectively bulk bill some eligible patients and privately bill others if you want to stay in BBPIP.
For many clinics, this is the first strategic fork in the road:
- If you join BBPIP, you commit to full bulk billing for all eligible services, and your billing flexibility narrows.
- If you do not join BBPIP, mixed billing remains permitted and common. Many practices continue to bulk bill priority cohorts (e.g., concession card holders, children, vulnerable groups) while privately billing others, depending on their local market, cost structure, and positioning.
Before you model anything else, be clear on whether BBPIP participation is even feasible for your practice, workforce, and patient base.
2. Model item‑by‑item economics, not averages
High‑level averages can be misleading. To make an informed decision, you need to look at item‑by‑item economics.
Two key comparisons:
- Gap‑sensitive standard consults (e.g. short/standard MBS items) where patients are more price‑aware and gaps are a major revenue driver.
- Incentive‑rich items that are more likely to be bulk billed, where the marginal 12.5% BBPIP incentive can meaningfully lift revenue.
In some metropolitan catchments, the foregone patient gaps on standard consults can outweigh the additional incentive income from BBPIP. In others, particularly where private‑pay capacity is lower, the incentives can close the gap.
A simple way to frame this is to build a revenue bridge for each scenario:
- Start with the current revenue by item.
- Subtract the foregone gap if you move those items to bulk billing.
- Add the incentives captured under BBPIP (or other bulk billing incentives).
- Compare the expected revenue under: Full bulk billing with BBPIP, Targeted mixed billing (bulk billing priority cohorts, private billing others)
This item‑level bridge often reveals that a targeted mixed billing model can deliver stronger financial outcomes while maintaining access for key patient groups.
3. Factor in patient mix, location and local market
The right GP billing model is never decided in isolation from your patient mix and location.
A few practical considerations:
- Location and MMM classification: Incentive values scale with the Modified Monash Model (MMM). Regional and rural practices may see a stronger case for full bulk billing because the incentive uplift is more material relative to local fee expectations.
- Private‑pay capacity: Metropolitan clinics with a higher proportion of privately insured or higher‑income patients often have more room to sustain mixed billing without significant patient loss.
- Expanded eligibility: Changes to eligibility rules can shift volumes towards bulk-billed cohorts, which may improve the case for bulk billing in some areas, but not all.
Sector updates and market behaviour suggest that:
- Many practices are still weighing the trade‑offs, rather than rushing to full bulk billing.
- Only a subset of clinics – often those in specific geographies or with particular patient demographics – are moving immediately to full bulk billing under BBPIP.
Your decision should be grounded in your own data and local market signals, not just national headlines.
4. Protect access and be transparent on fees
Whether you choose bulk billing, mixed billing, or a hybrid approach, two principles remain non‑negotiable: access and transparency.
A robust GP billing strategy will usually:
- Maintain bulk billing for priority cohorts (e.g. concession card holders, children, vulnerable or disadvantaged patients), even in a mixed billing environment.
- Please clearly let me know who is bulk-billed, who pays the gap, and what those gaps are.
Patients are more accepting of fees when:
- The rules are simple and predictable.
- Gaps are modest and targeted, rather than broad‑based and constantly changing.
- The practice explains why changes are being made (e.g. to maintain quality, retain GPs, support longer consults, invest in nursing and chronic disease management).
If you do adjust fees:
- Focus on non‑eligible adult standard consults first.
- Make modest, targeted changes, then monitor the impact on:
- Patient volumes, DNA (did not attend) rates, GP satisfaction and retention, overall revenue and margin
A monthly review of realised volumes, incentives and gaps will help you avoid over‑correcting.
5. Operationalise your decision and audit it regularly
Once you have chosen your billing policy – including whether you will participate in BBPIP – the work is only half done. The next step is to operationalise and audit the model.
Key implementation steps include:
- Align GP contracts and agreements with the chosen billing model, including how incentives are shared and how gaps are handled.
- Update reception scripts and patient communications so front‑of‑house staff can confidently explain your fees and bulk billing rules.
- Ensure your practice management software (PMS) is configured correctly
- Accurate tagging of eligible patients and items
- Correct application of bulk billing incentives
- Clear separation of bulk billed vs privately billed services
- Strengthen claim assurance and compliance processes to minimise leakage and rejections.
We recommend a 12‑week review cadence after any significant change:
- Check that eligibility tagging is accurate.
- Confirm that realised incentives are tracking close to your model.
- Identify any unexpected shifts in patient behaviour or GP billing patterns.
- Adjust your strategy where needed, based on real data rather than assumptions.
Conclusion: Evidence‑based, patient‑centred, not just incentive‑led
For some GP clinics – particularly in regional or lower-socio-economic areas – full bulk billing under BBPIP may be the righte answer.
For many metropolitan practices, however, our advisory work suggests that staying on a well‑designed mixed billing model, while bulk billing priority cohorts, often delivers:
- Stronger financial sustainability
- Better GP retention and recruitment
- Maintained or improved access for vulnerable patients
The best GP billing strategy is:
- Evidence‑based – grounded in item‑level modelling, not averages.
- Patient‑centred – protecting access and transparency.
- Operationally feasible – able to be implemented and audited in the real world.
If you’d like a neutral, item‑level billing model or a simple “impact bridge” template to compare full bulk billing vs mixed billing for your own practice, Aspire Partners can help. We work exclusively with medical practices across Australia to align billing strategy, financial performance and patient access.
Written by Praba Ganeshan, CPA
Reachable for further discussion at (03) 9853 3007 or email praba@aspirepartners.com.au
If this post was interesting to you and you’d like to hear more, please get in touch with us on admin@aspirepartners.com.au and we’ll add you to the mailing list.