Medicare Assignment of Benefit: What Changes on 1 July 2026

Key Takeaways

• The new Medicare assignment of benefit (AoB) process for all bulk-billed and simplified billing services commences on 1 July 2026, after a six-month delay from the original 9 January 2026 start date.
• The legal instrument is the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025, made by the Governor-General on 21 August 2025.
• The current requirement for a GP to co-sign each bulk-billed AoB form is removed. Patients can assign their benefit digitally via SMS or email, opening a PIN-protected web form on their device, or on an updated paper form.
• Patients can assign benefit before the consultation (pre-assignment, for example at booking) or after the consultation (post-assignment). Assignment no longer has to occur during the attendance itself.
• Practices must retain a copy of the completed and signed AoB agreement for 2 years for every consent request. This is the first time a specific retention period has been written into the regulations.
• Enduring assignment of benefit agreements (a single consent reapplied to future services) are flagged in the policy but the supporting regulations are still being developed and are not in force at commencement.
• Practices that intend to send AoB SMS messages should plan to register a branded sender ID with the ACMA SMS Sender ID Register, or messages will appear to patients as "unverified".

The new assignment of benefit process for all Medicare bulk-billed and simplified billing services commences on 1 July 2026. From that date, patients can consent digitally through an SMS or email link, the GP co-signature requirement is removed, consent can be collected before or after the consultation, and practices must retain the signed agreement for 2 years. The change was delayed from 9 January 2026 after the RACGP and software vendors said the original timeline was unworkable.

What is actually changing on 1 July 2026?

The current bulk billing consent process has not changed materially since the 1970s. A patient signs a paper DB4 or DB4E form during the attendance, the GP co-signs to verify the service was provided, and the practice submits the assignment to Medicare. The Australian National Audit Office raised this as a problem in its January 2023 report on Medicare integrity, and Parliament passed the enabling amendments in May 2024 under the omnibus health legislation amendment bill.

The Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025, made on 21 August 2025, set the operational rules. From 1 July 2026, the GP co-signature requirement is removed for bulk-billed services, electronic forms become a valid alternative to paper, and the timing rule changes so that consent can be collected outside the attendance itself. The legislative scope covers every bulk-billed Medicare service and every simplified billing service, which means almost every primary care interaction your practice has with Medicare is in scope.

What is an enduring assignment of benefit agreement and when does it start?

An enduring assignment of benefit agreement is a single patient consent that can be reapplied to future bulk-billed services, instead of the patient needing to consent at every visit. The Department of Health, Disability and Ageing has confirmed this is the long-term direction, but enduring agreements are not part of the 1 July 2026 commencement. The departmental improving the assignment of benefit process page notes that work is ongoing on regulations to support bulk-billed enduring assignment agreements.

What this means in practice: from 1 July 2026, every bulk-billed service still requires its own per-service AoB, but the per-service AoB can be collected digitally and outside the attendance. Enduring consent will arrive in a later regulatory tranche. Practices should configure their software and workflows around the per-service rules first, and treat enduring consent as a future enhancement rather than a launch-day feature. The Medical Republic's coverage of the delay is consistent with the department on this point.

How does pre-assignment differ from post-assignment of benefit?

Under the new rules, the assignment of benefit is "de-coupled" from the attendance. There are two valid workflows.

Pre-assignment happens before the service is provided, typically at booking. The patient receives an SMS or email link, opens the PIN-protected web form, and assigns the benefit for the upcoming service. When the consultation occurs, the assignment is already on file. This works well for booked telehealth, recall appointments, and any service where the patient identity and the planned item can be reliably determined in advance.

Post-assignment happens after the service is provided. The patient leaves the consult and receives the SMS or email link later, then signs the form on their phone. This is closer to the current paper workflow, just digitised. It works for walk-in attendances, services where the actual item is not known until the consultation concludes, and patients who prefer to read the form at home.

Both methods are valid and a practice can use both. The patient still has to actually assign the benefit for a Medicare claim to be valid, so post-assignment carries a small claim-timing risk if the patient does not act promptly. Pre-assignment moves the risk earlier but front-loads the booking workflow.

How long must practices keep signed assignment of benefit agreements?

The new regulations introduce an explicit 2-year retention period for every completed and signed AoB agreement. This is the first time a specific retention rule has been written into the legislation; the existing paper-based process has no equivalent rule, although general Medicare record-keeping practice has long pointed to multi-year retention.

For digital AoB agreements, the retained record is the patient-signed web form itself (PDF or equivalent), with the patient identifier, service description, date of consent, and audit trail. For paper agreements signed under the updated paper-based workflow, the retained record is the signed paper form. Both formats are equivalent and both must be retrievable within 2 years if Services Australia, the Professional Services Review, or a compliance audit asks for them.

The 2-year retention rule is the floor, not the ceiling. Practices that already retain Medicare claim evidence for six or seven years (in line with broader Medicare record-keeping norms and any BBPIP record obligations) should keep doing so. The new rule simply means that a practice cannot dispose of an AoB agreement inside the 2-year window without breaching the regulations.

What must your practice management software do before 1 July 2026?

The change is essentially a workflow and data-capture change inside your practice management system (PMS). Every major Australian PMS vendor (Best Practice, MedicalDirector, Genie, Zedmed, Helix and others) is publishing implementation roadmaps. The mechanics each vendor has to deliver include:

• An electronic AoB form generator that creates a PIN-protected web form from the appointment or claim record.
• A delivery channel for the form via SMS or email, integrated with the patient contact record.
• A way to capture the signed digital form back into the patient record alongside the claim.
• A 2-year retention vault for signed agreements with retrieval by patient, date or claim.
• An updated paper-based workflow for patients who cannot or will not use a digital form.
• Mapping of MBS items to whichever service category structure the vendor uses for AoB grouping; Best Practice, for example, has mapped approximately 4,600 MBS items into 16 Basic Service Description categories that need to be linked to appointment types.

Confirm with your vendor in writing what its go-live date is, what configuration your practice has to do, and what training will be provided. If your PMS is not on a credible roadmap by mid-June 2026, that is a meaningful operational risk and you should escalate it before the deadline.

Do you need to register with the ACMA SMS Sender ID Register?

If your practice plans to send AoB SMS messages from 1 July 2026, the answer is effectively yes. The Australian Communications and Media Authority (ACMA) administers the SMS Sender ID Register, which lets organisations register a branded sender ID (an "alpha tag", such as "YOURGP") so that messages display as verified on the patient's phone.

Registration is not technically mandatory for the AoB regulations themselves, but messages sent from unregistered sender IDs increasingly display as "unverified" on Australian phones and are at risk of being grouped with scam alerts. There is a real prospect that a patient will miss or ignore an unverified AoB SMS, which means the consent does not get captured and the claim does not get made. Practices that already use SMS for appointment reminders may need to assess whether their current sender ID is registered and whether the same sender ID will be used for AoB messages.

Talk to your PMS vendor about its sender ID arrangements, then register your practice's sender ID with ACMA in line with the SMS Sender ID Register guidance. Allow several weeks for the registration to complete and propagate.

What practices must do before 1 July 2026

The following operational checklist captures the minimum your practice needs to have in place. Treat 1 June 2026 as the practical internal deadline so there is a four-week buffer.

1. Confirm in writing with your PMS vendor that its AoB module is in production and what your go-live date is.
2. Update your patient contact data so that mobile number and email are present and verified for the patients you bulk bill regularly. Digital AoB does not work without a current mobile or email.
3. Decide your default workflow: pre-assignment at booking, post-assignment after the visit, or a mix by appointment type. Document the decision.
4. Update your bulk billing consent script that reception uses with patients, especially for the first few weeks while patients adjust.
5. Register your practice's SMS sender ID with the ACMA Sender ID Register.
6. Configure your PMS retention settings so signed AoB agreements are stored for at least 2 years and are retrievable by claim.
7. Train every staff member who interacts with patients on the new flow (reception, practice nurses, GPs, and any locums). The change touches every bulk-billed visit.
8. Update your privacy policy and patient information sheet to reflect that AoB consent may now be collected via SMS or email link.
9. Plan for paper as a permanent fallback. Patients who cannot or will not use a digital form must still be able to bulk bill via the updated paper workflow.
10. Set a calendar reminder for the first quarterly review (October 2026) to check exception rates, missed AoBs, and whether claims rejected for missing AoB have been resubmitted.

If your practice is also working through MyMedicare registration obligations or preparing for the 80/20 rule and PSR scrutiny, bundle the AoB workflow change into the same Medicare compliance refresh; the people, processes and records overlap heavily.

Frequently Asked Questions

When do the new Medicare assignment of benefit rules start?

The new assignment of benefit process for all Medicare bulk-billed and simplified billing services commences on 1 July 2026. The commencement date was originally 9 January 2026 but was delayed by the Department of Health, Disability and Ageing in late 2025 after the RACGP and software vendors said the original timeline left practices and PMS providers without enough lead time to implement the changes safely. The 1 July 2026 date is set in the Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025, made on 21 August 2025.

What is an enduring assignment of benefit and how is it different from per-visit consent?

An enduring assignment of benefit is a single patient consent that can be reapplied to future bulk-billed services, so a patient does not need to sign a fresh AoB at every visit. This is the long-term policy direction but it is not part of the 1 July 2026 commencement. The Department of Health has confirmed that work is ongoing on the regulations needed to support enduring agreements. From 1 July 2026, every bulk-billed service still requires its own per-service AoB; the change is that the per-service AoB can now be collected digitally and outside the attendance.

How long must practices retain signed assignment of benefit agreements?

Practices must retain a copy of every completed and signed assignment of benefit agreement for at least 2 years. This is the first time a specific retention period has been written into the assignment of benefit regulations. The 2-year period applies to both digital agreements (the patient-signed web form) and paper agreements signed under the updated paper-based workflow. Practices that already retain Medicare claim evidence for longer should continue doing so; the 2-year rule is the regulatory minimum, not a ceiling.

Can patients still sign a paper assignment of benefit form?

Yes. An updated paper-based workflow will continue to be available alongside the digital options. The department has confirmed paper is a permanent fallback rather than a transitional measure, recognising that some patients cannot or will not use SMS or web forms. Practices should plan to keep a small stock of the updated paper form and to brief reception staff on when to offer it. The paper form will follow the new rules (no GP co-signature required, 2-year retention) but will not require the patient to have a mobile phone or email address.

What must practices do with their practice management software before 1 July 2026?

Confirm in writing with your PMS vendor that its AoB module will be production-ready by 1 July 2026 and ask for the configuration your practice has to do. Most vendors are publishing implementation guides and configuration steps. Update your patient contact records (mobile and email) for the patients you bulk bill regularly, because the digital workflow depends on accurate contact details. Register your practice's SMS sender ID with the ACMA Sender ID Register so AoB messages appear as verified. Confirm the retention settings store signed agreements for at least 2 years. Train reception, nursing and GP staff on the new workflow well before 1 July.

Are simplified billing services in scope, or only bulk billing?

Both. The Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025 cover the assignment of benefit process for all Medicare bulk-billed services and all simplified billing services. Simplified billing covers in-hospital medical services where the doctor's account is sent to the patient's private health insurer and Medicare for combined processing. The mechanics of the digital form and the 2-year retention rule apply equally; specific scope and timing detail for simplified billing follow the same regulations.

What happens if a patient does not complete the digital assignment of benefit?

A bulk-billed Medicare claim is only valid if the patient has assigned the benefit. If a patient does not complete the digital AoB (for example, ignores the SMS link, or the link expires), the practice cannot make a valid bulk-billed claim for that service. Practical options are to follow up the patient through reception, to offer the updated paper form, or to discuss alternative billing arrangements. Practices using post-assignment should monitor unsigned AoB volumes weekly and chase patients quickly, because every uncompleted AoB is an uncollected Medicare benefit.