The Medicare Benefits Schedule (MBS) remains one of the most important funding mechanisms in Australian healthcare, supporting access to a wide range of primary healthcare, specialist, diagnostic and other health services. It is also constantly changing. For health service providers, this means it is worth regularly reviewing whether they are making full and appropriate use of available MBS funding to support better access, better care and improved sustainability.

Many organisations approach MBS optimisation by asking a simple question: “Which item numbers are we missing?”

In our experience, that’s the wrong place to start.

The greatest opportunities rarely come from teaching clinicians to bill differently. They come from understanding how a practice or service operates, identifying patients who are missing out on planned care, and redesigning systems so that appropriate care is delivered consistently and claimed compliantly.

What Is MBS Optimisation?

MBS optimisation involves more than identifying opportunities to improve billing accuracy. It requires healthcare organisations to understand Medicare requirements, service delivery models, clinical workflows, and the broader financial factors that influence sustainability. A strategic approach can help organisations use available resources more effectively while maintaining a strong focus on patient care.

Looking beyond the billing report

At Larter, our work begins with understanding the service as a whole. Under appropriate confidentiality and data-sharing arrangements, we may analyse clinical software, appointment books, billing reports, practice management systems and population health tools such as POLAR and PenCAT. Where appropriate, we also undertake structured database searches to identify cohorts who may benefit from additional planned care.

This allows us to identify patients who may be overdue for chronic disease management, preventive health activities, health assessments, mental health follow-up, medication reviews or other evidence-based care. More importantly, it helps organisations understand why those opportunities are being missed.

Often the barriers are operational rather than financial. Recall systems may be inconsistent. Appointment books may not support planned care. Documentation may not align with claiming requirements. Nurses may not be working to their full scope, or administrative processes may prevent eligible patients from being identified.

Sustainable optimisation requires system change

True MBS optimisation is about creating systems that support better patient care while strengthening financial sustainability.

Across projects with community health services, Primary Health Networks, rural practices and collaborative care models, we’ve consistently found that sustainable improvement comes from combining:

• strong clinical governance
• effective recall and reminder systems
• disciplined appointment book management
• nurse-led chronic disease and preventive care
• reliable practice data and reporting
• compliant documentation and billing processes
• regular performance monitoring.

When these foundations are in place, organisations often improve both patient outcomes and financial performance without increasing unnecessary activity.

Lessons from the field

Our work has included supporting remote general practices in the Northern Territory, reviewing community health general practice sustainability across urban and rural Victoria, examining a public health service operating throughout Queensland, and analysing collaborative rural service models in Western NSW.

Although each project is different, the findings are remarkably consistent. Organisations achieve the best results when they move beyond isolated billing education and instead develop an integrated improvement strategy that connects clinical care, operational workflows, workforce design and financial sustainability.

Connecting MBS Optimisation With Healthcare Sustainability

Effective MBS processes can contribute to the financial sustainability of healthcare services when they are aligned with appropriate service planning and operational practices. Reviewing billing patterns, workflows, and service models can help organisations identify opportunities for improvement while supporting the ongoing delivery of high-quality healthcare.

In many cases, this means identifying practical “quick wins” while also developing a staged implementation roadmap over the following one to three years.

Using Data to Improve Healthcare Service Delivery

MBS data can provide valuable insights into how healthcare services are being delivered and where operational improvements may be possible. Combining billing data with stakeholder perspectives and service evaluation can help organisations make evidence-based decisions that strengthen efficiency, sustainability, and patient outcomes.

Conclusion

MBS optimisation is about more than improving billing it can support better decision-making, operational efficiency, and the long-term sustainability of healthcare services. By combining MBS data with strategic planning, stakeholder insights, and evaluation, healthcare organisations can identify practical opportunities to strengthen service delivery while maintaining a focus on patient outcomes.

Frequently Asked Questions