Pathology Compliance

Page last updated: 15 August 2018

Background

As part of the Department of Health’s focus on continual improvements with Medicare compliance, the Department has identified a number of concerns relating to MBS pathology claims and will conduct a range of compliance activities related to these during 2018.

The Department has written to providers whose claiming raises concerns, including providers whose pattern of claiming was substantially different to their peers.

What are the Department’s concerns?

The identified concerns include:

Why have you been sent this letter?

You have been asked to review your claiming of pathology items to ensure that the MBS item descriptor being claimed accurately reflects the services rendered, and that the services rendered are clinically appropriate.

For any claims that do not meet the criteria, you should fill out the Voluntary Acknowledgement of incorrect payment form.

How to contact us

If your matter relates to a specific compliance activity, you can contact the Voluntary Compliance Team by email or post.