unless paragraph (b) applies—on the account, or on the receipt, for fees in respect of the service;

if regulations made for the purposes of this paragraph specify a manner—in that manner.

the professional service is or will be rendered to the assignor or to another eligible person; and

(b) the agreement is entered into with the person by whom, or on whose behalf, the professional service is or will be rendered (the professional); and

the agreement provides that:

the assignor assigns the assignor’s right to the payment of the medicare benefit to the professional at the time the agreement is entered into or when the medicare benefit becomes payable (whichever is the later); and

the professional accepts the assignment in full payment of the medical expenses that have been or will be incurred in respect of the professional service by the assignor; and

any requirements specified in the regulations are met.

the professional service is rendered to the assignor or another eligible person while hospital treatment or hospital-substitute treatment is provided to the assignor or that other eligible person; and

(b) the assignor has entered into a complying health insurance policy with a private health insurer (the insurer); and

under the policy, the assignor is covered (wholly or partly) for liability to pay fees and charges in respect of the professional service; and

a claim is made under section 20B for the medicare benefit that would, apart from this section, be payable to the assignor in respect of the professional service; and

subsection 20AAA(1), (3) or (5) applies to the assignor’s right to the payment of the medicare benefit in respect of the professional service.

requirements relating to the content of agreements to be entered into, or the manner and form in which the agreements are to be entered into; and

requirements relating to information that must be given and the manner and form in which the information must be given; and

requirements relating to the giving of notifications before or at the time agreements are entered into, or before or after information is given.

any of the following conditions is satisfied:

the insurer concerned has an arrangement with the professional for the provision of treatment to persons insured by the insurer;

in the case of hospital treatment authorised by the operator of a hospital (see subsection (7))—the insurer has an arrangement with the operator of the hospital for the provision of treatment to persons insured by the insurer, and the operator of the hospital has an arrangement with the professional under which treatment is provided to persons insured by the insurer;

in the case of hospital-substitute treatment authorised by an organization (see subsection (7))—the insurer has an arrangement with the organization for the provision of treatment to persons insured by the insurer, and the organization has an arrangement with the professional under which treatment is provided to persons insured by the insurer; and

the arrangement or arrangements (as the case may be) cover (wholly or partly) a liability of the insurer, the operator of the hospital or the organization to pay fees and charges in respect of the professional service; and

the right to payment of the medicare benefit has not been assigned under an agreement entered into under subsection 20A(1).

if the claim for the medicare benefit is made by an approved billing agent—the approved billing agent;

otherwise—the insurer.

(a) unless paragraph (b) applies—the medicare benefit is covered by a request made by the assignor for the purposes of this paragraph, in accordance with requirements specified in the regulations, to the following person (the responsible provider):

in the case of hospital treatment authorised by the operator of a hospital (see subsection (7))—the operator of the hospital;

in the case of hospital-substitute treatment authorised by an organization (see subsection (7))—the organization;

in the case of hospital-substitute treatment to which subparagraph (ii) does not apply—the professional; and

if a request mentioned in paragraph (a) has been modified, in accordance with requirements specified in the regulations, after the professional service is rendered, by the responsible provider or a person authorised by the responsible provider—the medicare benefit is covered by the request as modified; and

the request, or the request as modified (as the case may be), provides that the assignor’s right to the payment of the medicare benefit in respect of the professional service is to be assigned to the insurer concerned or an approved billing agent; and

any requirements specified in the regulations are met; and

the right to payment of the medicare benefit has not been assigned under an agreement entered into under subsection 20A(1), or because of the operation of subsection (1) or (5) of this section.

(a) another professional service (the related professional service) is rendered while the hospital treatment or hospital-substitute treatment is provided; and

the right to payment of the medicare benefit in respect of the related professional service is taken to be assigned to the insurer concerned or an approved billing agent because of the operation of subsection (1) or (3) of this section; and

the professional service:

is rendered for a complication that arises during the related professional service; or

is unplanned but is rendered during planned treatment of which the related professional service is part, and is, in the view of the professional, necessary and urgent; and

the right to payment of the medicare benefit has not been assigned under an agreement entered into under subsection 20A(1), or because of the operation of subsection (1) of this section.

the operator of the hospital, or the organization, is a body corporate or a body politic; and

the treatment is provided:

by a person who is authorised by the operator of the hospital, or the organization, to provide the treatment; or

under the management or control of such a person.

requirements relating to the content of requests or modifications to be made, or the manner and form in which the requests or modifications are to be made; and

requirements relating to information that must be given and the manner and form in which the information must be given; and

requirements relating to the giving of notifications at the time or after modifications are made, or before or after information is given; and

in relation to the making or modifying of a request—the circumstances in which the request may be made or modified.

in accordance with any requirements set out in the regulations; and

in the manner and form (if any) approved, by notifiable instrument, by the Chief Executive Medicare; and

within the period of 2 years, or such further period as is allowed in accordance with subsection (3A), after the rendering of the service.

requirements that must be met before a claim can be made;

requirements relating to the content of a claim;

requirements relating to the giving of notifications before or at the time a claim is made.

the person is a professional mentioned in paragraph 20A(1)(b); and

(b) the professional and an eligible person (the assignor) enter into an agreement under subsection 20A(1); and

the assignor asks for a copy of the terms of the agreement; and

the professional does not give the assignor a copy of the terms of the agreement as soon as practicable after the assignor asks for it.

the person is a professional mentioned in paragraph 20A(1)(b); and

(b) the professional and an eligible person (the assignor) enter into an agreement under subsection 20A(1); and

under regulations made for the purposes of this paragraph, the professional is required to give a notification to the assignor relating to the agreement or to a right to payment of a medicare benefit assigned under the agreement; and

the professional contravenes those regulations; and

those regulations specify that this paragraph applies.

the person is an insurer or approved billing agent; and

(b) an eligible person (the assignor) is taken to have assigned a medicare benefit to the insurer or approved billing agent under subsection 20A(2); and

the medicare benefit is paid to the insurer or approved billing agent; and

the insurer or approved billing agent does not give the assignor a notification:

in accordance with any requirements specified in the regulations; and

within 6 months of the payment.

the person is a responsible provider mentioned in paragraph 20AAA(3)(a); and

(b) an eligible person (the assignor) makes a request for the purposes of paragraph 20AAA(3)(a) to the responsible provider; and

the assignor asks the responsible provider for a copy of the terms of the request; and

the responsible provider does not ensure that the assignor is given a copy of the terms of the request as soon as practicable after the assignor asks for it.

the person is a responsible provider mentioned in paragraph 20AAA(3)(b); and

(b) an eligible person (the assignor) makes a request for the purposes of paragraph 20AAA(3)(a) to the responsible provider; and

the responsible provider, or a person authorised by the responsible provider, modifies the request as mentioned in paragraph 20AAA(3)(b); and

the responsible provider does not ensure that the assignor is given a notification:

in accordance with any requirements specified in the regulations; and

as soon as practicable after modifying the request.

under regulations made for the purposes of paragraph 20A(6)(c), 20AAA(8)(c) or 20B(2)(c), the person is required to:

give a notification to an eligible person; or

ensure that a notification is given to an eligible person; and

the person contravenes those regulations; and

those regulations specify that this paragraph applies.

requirements relating to the content of the notification to be given; and

requirements relating to the manner and form in which the notification is to be given; and

in the case of regulations made for the purposes of paragraph (2)(c)—circumstances in which the notification must be given.

the assignment of the right to payment of a medicare benefit to the relevant person under section 20A;

any claim for a medicare benefit assigned to the relevant person made under section 20B;

any matter specified in the regulations.

the right to the payment of a medicare benefit in respect of a professional service is taken to have been assigned under subsection 20A(2); and

(b) the professional service was rendered by, or on behalf of, a person (the professional) while hospital treatment or hospital-substitute treatment was provided.

in the case of hospital treatment authorised by the operator of a hospital (see subsection 20AAA(7))—the operator of the hospital;

in the case of hospital-substitute treatment authorised by an organization (see subsection 20AAA(7))—the organization;

in the case of hospital-substitute treatment to which paragraph (b) does not apply—the professional;

the assignment of the right to payment of the medicare benefit;

any matter specified in the regulations.

an electronic form; or

another form approved by the Secretary.

if the record is an agreement entered into under subsection 20A(1) or an arrangement mentioned in paragraph 20AAA(1)(a)—2 years after the agreement or arrangement ceases to be in force;

2 years after the day on which the records were created;

if the regulations specify a day for records of a specified kind, and the records are of that kind—that day.

keep the records required by subsection (1) or (3); or

keep the records in the form required by or under subsection (4); or

retain the records for the period required by or under subsection (5).

(a) before the commencement of this Schedule, an eligible person made an offer under subsection 20A(2) of the Health Insurance Act 1973 to enter into an agreement under subsection 20A(1) with respect to the medicare benefit payable in respect of a pathology service; and

on the commencement of this Schedule, the pathology service had not yet been rendered.