Medicare compliance resources
A list of publications and other resources related to Medicare compliance.
AskMBS Advisory – Allied health services – Part B – Mental health treatment
29 March 2022GuidelineThis is the second of two complementary AskMBS advisories on allied health MBS items.
Part of a collection: AskMBS AdvisoriesAskMBS Advisory – Existing relationship clarification
18 March 2022GuidelineInformation and advice for general practitioners and other medical practitioners about the COVID-19 MBS telehealth ‘existing relationship’ requirement, including a clarification of exemptions.
Part of a collection: AskMBS AdvisoriesPublic Register – Data matching activities
7 February 2022ReportThis pubic register records data matching undertaken for Medicare compliance purposes. <cite>Part VIIIA of the National Health Act 1953</cite> requires the Chief Executive Medicare to maintain this register.
AskMBS Advisory – Allied health services – Part A Chronic disease management
7 February 2022GuidelineAskMBS answers questions from health professionals about the Medicare Benefits Schedule
Part of a collection: AskMBS AdvisoriesOnline compliance platform – Terms of use
2 February 2022Terms of referenceThis document outlines the terms of use for health providers when using the Department of Health Online Compliance Platform to respond to the Department’s request to conduct compliance activities.
Online compliance platform – Privacy notice
2 February 2022Terms of referenceThis document provides information on how Department of Health handles health providers’ personal information when provider use the Online Compliance Platform to respond to the Department’s request to conduct compliance activities.
Guideline for substantiating claims for diagnostic imaging and pathology services rendered to emergency department patients of public hospitals
17 January 2022GuidelineThis guideline outlines what you can do to substantiate diagnostic imaging and pathology services rendered to emergency department patients of public hospitals and claimed under Medicare.
Part of a collection: Health professional guidelinesGuideline for substantiating personal performance by a consultant physician/specialist in a public hospital
17 January 2022GuidelineThis guideline outlines what you can do to substantiate that you as a consultant physician or specialist personally performed a referred consultation service on a private patient in a public hospital claimed under the Medicare Benefits Schedule (MBS).
Part of a collection: Health professional guidelinesGuideline for substantiating services provided under rights of private practice at public hospital outpatient departments
17 January 2022GuidelineThis guideline outlines how you can substantiate services provided under rights of private practice at public hospital outpatient departments.
Part of a collection: Health professional guidelinesCDBS – Guide to the Child Dental Benefits Schedule
6 January 2022GuidelineThis guide is for dentists and explains the arrangements and requirements for the Child Dental Benefits Schedule (CDBS).
Hospital certification for MBS items for repetitive transcranial magnetic stimulation (rTMS)
4 January 2022Fact sheetA factsheet has been developed to assist practitioners in preparing Type C certification, for submission to private health insurers, where rTMS treatment is provided in hospital. It also provides guidance on what to include when correctly completing Type C certificates.
Chronic Disease Management Plan – allied health checklist
7 December 2021Fact sheetMedical practitioners can refer eligible patients with chronic diseases to allied health practitioners. Allied health practitioners can claim Medicare benefits for some services as explained in the Allied Health checklist.
Chronic disease individual allied health services MBS items 10950–10970
7 December 2021InfographicThis document details how eligible patients should be billed for MBS items 10950 to 10970, including referral requirements, resources and access.
AskMBS Advisory – Non-GP specialist and consultant physician services
28 September 2021GuidelineAdvice for health providers and other users of the Medicare Benefits Schedule on the interpretation and application of MBS items, explanatory notes and associated legislation, to assist them in billing Medicare correctly.
Part of a collection: AskMBS AdvisoriesBetter Access Initiative Checklist - Social Workers
27 September 2021GuidelineSocial workers can provide focussed psychological strategies (FPS) under the Better Access Initiative (BAI), where their clients can access up to 10 individual sessions per calendar year.
Health Provider Compliance Strategy 2021–22
16 September 2021ReportThe Health Provider Compliance Strategy aims to help health providers understand their responsibilities in relation to compliance. It outlines the Department's compliance priorities for the 2021-22 financial year and describes the tools and methods used to identify and treat non-compliance.
Preparing a written submission for the Practitioner Review Program – for practitioners
9 September 2021Fact sheetThis fact sheet provides advice on preparing a submission.
Practitioner reviews – a practitioner guide
9 September 2021Fact sheetThis short guide describes how the Practitioner Review Program (PRP) is applied to practitioners whose Medicare servicing data (inclusive of Medicare claims and PBS prescribing data) indicates possible inappropriate practice.
Practitioner review – a guide for those who employ or engage practitioners
9 September 2021Fact sheetUnder the Health Insurance Act 1973 (Health Insurance Act), a person (including a practitioner) engages in inappropriate practice if they knowingly, recklessly or negligently cause or permit a practitioner who they employ or otherwise engage to engage in inappropriate practice.
AskMBS Advisory #1 – General practice services
16 August 2021GuidelineAdvice for health providers and other users of the Medicare Benefits Schedule on the interpretation and application of MBS items, explanatory notes and associated legislation, to assist them in billing Medicare correctly.
Part of a collection: AskMBS AdvisoriesData Matching Notice
12 August 2021GuidelineThe purpose of the Notice is to provide transparency and public awareness in relation to data matching which is undertaken for a permitted purpose under the <cite>National Health Act 1953 (National Health Act)</cite>, as part of Medicare provider compliance.
Frequently asked questions about Medicare billing in public hospitals
11 August 2021Fact sheetThese FAQs answer commonly asked questions on public hospital funding for public patients, and appropriate Medicare billing for private patients in public hospitals.
Prescribed pattern of services (the 80/20 rule)
29 July 2021Fact sheetWhat general practitioners and other medical practitioners need to know about how the 80/20 rule and high volumes of rendered services.
Pharmaceutical Benefits Scheme Non-compliance Fraud flyer
22 July 2021BrochureInformation and advice for providers about Medicare compliance.
Pharmaceutical Services Federal Committee of Inquiry
21 July 2021BrochureThe Pharmaceutical Services Federal Committee of Inquiry (the Committee) was established by the Minister to address concerns that some instances of claiming contravened the National Health Act 1953.