Medicare and Digital Signing of DB4 Benefit Assignment Forms

The executive summary is that GP2U now offers Australia's only Medicare approved digital signing of DB4 form process. With a couple of mouse clicks a patient can now legally assign their Medicare benefits to a remotely located specialist. The background to this ground breaking eHealth development is presented below.

The Australian Medicare system came into existence with the proclamation of the Health Insurance Act (1973). Medicare was designed, not to pay doctors, but to provide patients with a benefit that they could apply to their doctors' bills. Bulk billing (where Medicare does pay doctors directly) hinges on section 20A of the Act.

What section 20A says is that a patient can assign their Medicare benefit to their treating doctor by signing the approved form, where the approved form is the form approved in writing by the minister. The approved form is called a DB4 form.

With the advent of Telehealth a problem arises. How does a Specialist obtain the signature of a patient who is not in the same physical location? The initial Medicare advice to doctors was that a patient's verbal consent over a video conference link would be accepted as satisfactory for the purposes of Section 20A and the assignment of patient Medicare benefits. Earlier this year that advice was revoked and replaced with advice that doctors could either get a physical signature using paper DB4 forms and regular mail, or use an email process.

At GP2U our core focus is on making Telehealth easy. Sending physical DB4 forms by ordinary mail, or using a complicated email process, that, like verbal assignment of benefits process that preceded it appears non compliant with the requirements of section 20A, seemed to be making Telehealth harder - so we started thinking.....

We already have a Medicare approved DB4 form, so why don't we just apply a digital signature to that?

The Electronic Transactions Act (1999) sets out the requirements for a digital signature. The GP2U process for a digital signature follows the industry standard MD5/RSA algorithm as specified by the World Wide Web Consortium (W3C). W3C is the peak organisation largely responsible for Internet standards. The detailed W3C technical specification for a digital signature is found here.

We submitted our solution to Medicare on 6th February 2012 and after a rigorous overview process Medicare have provided written confirmation accepting our digital signing of DB4 form process is compliant with the requirements of the HIA.

" In relation to the digitally signed DB4 it appears, based on the information you have provided, that your model would
meet the requirements of the Health Insurance Act 1975 (the HIA) for the assignment of Medicare benefits"

You can read the full text of the Medicare approval letter here.