Bulk billing vs private billing calculator
The Bulk Billing Practice Incentive Program pays a 12.5% loading on eligible MBS benefits, split between practice and GP. But bulk billing removes gap revenue, and in most states contractor GP payments create a payroll tax exposure that the relief provisions only partly offset. These move in opposite directions, and the net answer is different for every practice.
This tool models all three together and shows you where the decision actually flips — including the cliff edges, where crossing a threshold changes the outcome by far more than the slope suggests.
Practitioners
Nurses, reception, practice management.
WorkCover, insurance, cosmetic. Whether this affects BBPIP eligibility is an open question — see the assumptions below.
What this model includes
Revenue side
- BBPIP 12.5% loading, split 50/50 between practice and GP
- Standard bulk billing incentives by MMM classification
- Gap revenue foregone on services you stop privately billing
- Non-Medicare revenue held separate
Cost side
- Deemed wages from contractor GP arrangements
- State payroll tax on those deemed wages
- Medical relief: QLD exemption, VIC/SA/ACT bulk-billing exemptions, NSW rebate
- Employed staff wages, which are exposed in every state
Why the cliff edges matter
Two thresholds dominate this decision. BBPIP requires bulk billing every eligible service for every Medicare-eligible patient — there is no partial participation, so the loading arrives all at once at 100%. And the NSW GP rebate is a cliff test at 80% bulk-billed in metropolitan Sydney, or 70% elsewhere: at 79% you get nothing, at 80% you get all of it. A smooth average will mislead you. The breakpoints above mark exactly where those edges fall for your inputs.
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Reviewed by eHealth Systems Pty Ltd