Medicare provider number for overseas trained doctors and foreign graduates
Information for health professionals who got their medical qualification outside Australia or New Zealand, or who were not citizens at the time of enrolment.
Overseas trained doctor
You are an overseas trained doctor (OTD) if you are a health professional who got your primary medical qualification from a medical school outside Australia or New Zealand.
You are a foreign graduate of an accredited medical school (FGAMS) if you:
- got your primary medical qualification from an accredited medical school in Australia or New Zealand, and
- were not a permanent resident or citizen of either Australia or New Zealand at the time of enrolment
Section 19AB restrictions and exemptions
Section 19AB restrictions of the Health Insurance Act 1973 apply to OTDs and FGAMS who:
- obtained their first medical registration on or after 1 January 1997, or
- became a permanent Australian resident or citizen on or after 1 January 1997
Section 19AB establishes a 10 year moratorium or restriction on Medicare provider numbers. OTDs and FGAMS are generally required to practise in a district of workforce shortage (DWS). This is to qualify for a provider number while you are subject to the moratorium under Section 19AB.
You will still need a section 19AB exemption in order to access Medicare benefits. This is if you do not have Australian permanent residency or citizenship by the end of the 10 year moratorium.
Once you have become an Australian permanent resident or citizen, you must have satisfied the Section 19AA requirements before you can claim Medicare benefits.
If you are an OTDs or FGAMS you will require a section 19AB exemption before you can be granted a Medicare provider number and billing privileges for your employment. You will be assessed for a section 19AB exemption as part of the Medicare provider number application process if you meet the definition of OTD or FGAMS. There is no separate application form for an exemption. You need to submit a completed Application for an initial Medicare provider number for a medical practitioner form (HW019) to us.
When an OTD or FGAMS makes a Medicare provider number application, we will:
- add the health professional’s name to one of the existing class exemptions under section 19AB – the class exemption fact sheet available on the DoctorConnect website identifies each type of employment engagement that is covered by a class exemption, or
- apply on behalf of the health professional for an individual exemption to Department of Health (Health), in cases where the type of employment has not already been class exempted
If Health needs to assess your application against the 19AB requirements, they have a statutory timeframe of 28 days to finalise their assessment and, if approved, grant an exemption. If Health grants you a section 19AB exemption, it is sent back to us so that we can then issue you with a Medicare provider number.
Doctors who are an OTD or FGAMS must wait until they have been granted an exemption before they attempt to provide services that would normally attract a Medicare benefit.
District of workforce shortage
Section 19AB serves a workforce distribution function and provides that OTDs and FGAMS must practise in a district of workforce shortage (DWS) to qualify for:
- an exemption, and
- a provider number
This restriction applies for a minimum period of 10 years and is called the 10 year moratorium.
Under section 19AB, a health professional must be one of the following to qualify for a provider number:
- a permanent or temporary resident with a valid section 19AB exemption, working in accordance with that exemption
- a permanent resident who has completed their 10 year moratorium, or
- an OTD or a FGAMS who was first registered before 1 January 1997
A DWS is a geographical area in which the local population has less access to Medicare subsidised medical services when compared to the national average. These areas are identified using the latest Medicare billing statistics.
Statistics are updated annually to account for changes in the composition and geographic distribution of the Australian medical workforce. They also take into account the latest residential population estimates as provided by the Australian Bureau of Statistics (ABS).
DWS was introduced in October 2001, and continues to be used to identify areas of Australia experiencing the most serious needs for medical services. This is demonstrated by a comparative shortage of doctors who are billing Medicare.
More information on DWS can be found on the DoctorConnect website.
Track and scale
Track and scale is a non-cash incentive offering OTDs and FGAMS opportunities to reduce their 10 year moratorium restriction period.
Your eligibility for scaling is assessed each month. You are eligible if:
- your moratorium period has begun
- you hold a Section 19AB exemption for your location
- your total Medicare billing claims value is equal to or above the $5,000 monthly threshold, and
- you have worked in an eligible Australian Standard Geographical Classification—Remoteness Area (ASGC-RA) 2–5 category
The ASGC-RA is a geographic classification system developed by the ABS to allow measureable comparisons between 'city' and 'country' Australia.
You can find more information about the ASGC-RA on the DoctorConnect website.
You do not need to apply for scaling discounts. You will automatically receive scaling discounts if you meet monthly eligibility criteria.
Scaling bonuses are greater for doctors who practise in more remote areas.
You can check the ASGC-RA classification of your medical practice using the locator map on the DoctorConnect website.
Schedule fee threshold
You must meet a schedule fee threshold of $5,000 each month in an eligible regional or remote practice.
The scaling discount is then applied based on the ASGC-RA with the highest claiming activity, using all of your eligible locations with a current Section 19AB exemption for that month.
Claiming activity is based on date of service and schedule fee totals for eligible services. The result determines whether you have met the value of schedule fee threshold for the month.
Scaling calculations occur on the last day of each month and include the previous 3 months. For example, on 30 June 2011, the scaling calculation will include and calculate all of June, May, April and March. This ensures any eligible claims are identified if submitted after the monthly scaling has been completed.