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If you provide documents that verify only some of the services under review or don't respond to our requests, we can send you a formal notice to provide substantiating documents.
To issue a notice, we must have:
- a reasonable concern that a payment of a MBS or dental benefit for a service may be more than the amount that should have been paid
- sought advice from a medical or dental practitioner employed by us
- consulted with a relevant professional body about the types of documents that can help substantiate a MBS or CDBS service
- an explanation of the reasonable concern
- details of the MBS or CDBS services that need to be substantiated
- the type of information that can help substantiate those services, and
- if original, copies or extracts of documents are required
A Notice to Produce documents cannot be issued to a patient or their parent or legal guardian.
A reasonable concernA reasonable concern is where we believe that a MBS or dental benefit paid for services exceeds what should have been paid. It doesn’t relate to the clinical relevance of the service provided.
For example, if a MBS benefit is only payable for a service when a specific test is undertaken, we will ask the person to produce documents that demonstrate that the test was performed.
Complying with a Notice to ProduceWhen you submit documents, only provide information you think will help us determine whether or not the services you have claimed should have been paid.
You are not expected to produce documents that contain clinical information about your patients unless it is needed to substantiate a claim. Clinical details that aren’t needed for this purpose can be censored. If clinical records are needed to substantiate services you can elect to submit the information to one of our medical or dental practitioners.
To help you determine the type of documents that may substantiate a service we, in consultation with relevant professional bodies, have developed a set of Health Professionals Guidelines.
You may choose to voluntarily acknowledge an incorrect payment by completing the Voluntary Acknowledgement of incorrect payments form.
In the case of a MBS audit, administrative penalty amounts may be reduced if you choose to voluntarily acknowledge an incorrect payment before the date specified in the notice.
If you voluntarily acknowledge an incorrect payment, we will contact you to confirm how much you owe.
Do not send money with the form.