The opposition criticised the government for its long response times for PBS and Medicare claims, but Services Australia insists this isn't the full picture.
The processing time for PBS patient refunds almost tripled between 2021-22 and 2023-24, but the government says that its funding injection in late 2023 is already turning the tide.
According to data obtained during Senate Estimates by the Opposition, between 2021-22 and 2023-24 the average processing time for PBS patient refunds increased from 40 days to 119 days, and processing of PBS safety net claims increased from 34 days to 98 days over the same period.
Processing of Medicare entitlement statements and Medicare eligibility and enrolment claims increased from 38 days to 82 days and 19 days to 49 days respectively over the period.
The 2023-24 financial year also saw 77% of all bulk-billing claims completed outside of the standard turnaround time, which is 2-3 working days according to the Services Australia website.
Opposition spokesperson for health Ssnator Anne Ruston said this painted a grim picture of Medicare’s health, despite Labor’s touting.
“The unaffordability of essential healthcare is continuing to get worse under this government, forcing Australians to delay seeing their GP or getting their scripts refilled because they just cannot afford it,” Senator Ruston said.
“Now more than ever before, it is critical that the government ensures Australians can have their Medicare and PBS claims paid on time, but instead they have sent the system backwards.”
Speaking to Rheumatology Republic, a spokesperson for Services Australia, which processes Medicare and PBS claims on behalf of the Department of Health and Aged Care, emphasised the importance of looking at the numbers in context.
“When comparing 2021-22 and 2023-24, it’s important to understand pressures on the agency were masked during covid when staffing was significantly bolstered on a temporary basis,” they said.
“As the agency returned to baseline funding, it became clear that our supply of staff wasn’t meeting demand.”
In late 2023, services Australia onboarded around 3000 new staff.
“With the increase of staffing, we now have more officers available to process claims, leading to a fall in processing times,” said the spokesperson.
To date, the 2024-25 financial year has seen a turnaround in the wake of the staffing injection.
According to Services Australia, 95% of all bulk-billing claims were processed in alignment with their broad set of KPIs.
The average turnaround time for PBS patient refunds fell from 119 days in 2023-24 to 47 days.
The PBS safety net claims processing time claims now sits at 21 days, down from 98 days in 2023-24.
The turnaround time for Medicare entitlement statements and Medicare eligibility and enrolments fell to 29 days and 8 days respectively, down from 82 days and 49 days in 2023-24.
Data from the end of last year showed a 60% improvement in claims processing compared to the first three months of 2024.
Then Minister for Government Services Bill Shorten said that he was pleased with the progress, but there was more work to be done.
“Getting on top of claims processing is vital to supporting Australians at their most vulnerable and through significant events in their life,” Minister Shorten said.
“When people know their payment is sorted, they can get on with their lives and don’t need to call to chase it.”
